About A Few Threads
A monthly newsletter for healthcare leaders navigating change, one honest idea at a time.
Some months it's a pattern I've been noticing. Some months it's a question I can't quite let go of. Occasionally, it's a practical resource I've created. Always, it's something worth sitting with.
Issue 1 · July 2026
The Question That Changed My Thinking
What if resilience isn't the only issue?
This month: alignment, and how sustained pressure changes the leader we become.
Have you ever reached the end of a week feeling like you accomplished a great deal, but somehow drifted a little further from yourself?
Sometimes the drift is almost impossible to see while it's happening. You hear yourself say yes to something you don't have the capacity for. You answer emails late into the evening even though you promised yourself you wouldn't. You finish another week feeling productive, but somehow less like yourself than you did on Monday.
For much of my career, the question I returned to most was: How can I become more resilient. Over time, a different question surfaced: what if resilience isn't the only issue? What if alignment matters too? I began noticing it in others, and eventually in myself: talented, committed people working incredibly hard and still feeling depleted, not from a lack of resilience, but from losing touch with what actually sustains them.
Underneath that was a harder question: why do we drift from alignment in the first place? Often, it's because we're living according to scripts we never consciously chose: what success looks like such as what makes us valuable, what a "good leader" is supposed to be. These scripts often served us well, once. They may have helped us build real careers and real relationships. But there comes a point when something feels off, when we're chasing goals that no longer feel like our own, and the drift is gradual enough that we don't always notice it happening. The problem isn't failure. It's that we're still living by a script that no longer fits.
Pressure doesn't remove your strengths.
Pressure adds a second layer. It doesn't just keep an old script running. Under sustained pressure, the strengths that once made you effective can begin to show up differently:
The same drive that made you dependable starts looking like an inability to say no.
The same calm that made you a steady presence becomes emotional distance.
Nothing was lost. It drifted.
When a leader drifts from themselves, it rarely stays private:
You hear it in the tone of a meeting.
You see it in how fast decisions get made, or don't.
You feel it in the way people start holding back instead of pushing forward.
Alignment isn't only personal. It shapes the room around you.
Noticing is the beginning of choice.
A script is not a fact. It's a story, and stories can be edited, rewritten, sometimes let go of entirely. It's difficult to change a script that we don't realize we're following. The moment we notice it, we create the possibility of choosing differently. So, once you notice, what do you do? There isn't one right way back to alignment:
Some leaders return to a set of reflection questions on a regular basis: what matters most right now, what am I tolerating, where do I feel most like myself.
Others talk it through with a coach or a trusted colleague as clarity often comes more quickly in conversation than it does in solitude.
Others prefer something more visual, exploring what they're moving toward instead of trying to define it in words. With clients, I sometimes use what I call an Action Board to map out what they're moving toward rather than simply naming it. There's something clarifying about seeing it in front of you instead of just carrying it in your head.
There's no single right pathway. What matters is that it becomes something you actually return to, often enough that misalignment gets caught early. Pressure doesn't just exhaust us. It slowly pulls us away from ourselves.
I believe coaching isn't about helping leaders become someone different. It's about creating space for them to reconnect with who they already are beneath the pressure, so they can grow with greater clarity, intention, and sustainability.
What I've been building
Over the past few months, I've been creating practical resources and tools around many of these ideas, not to provide answers, but to help leaders reflect more deeply, see their situation more clearly, and take meaningful action.
What Is Your Energy Costing You?: A two-week tracking practice for noticing what's draining your energy, and what's genuinely restoring it. It pairs naturally with everything above. Download it at michelletruppe.com/resources
Before Burnout: Burnout doesn't look the same across the org chart, and naming it early often makes the difference between recovering easily and running on empty for too long. Read the piece that started this conversation (LinkedIn link). It resonated with more healthcare leaders than I expected, and prompted some real conversations I didn't anticipate having.
One question I'm leaving you with this month
If you're honest, is the way you're leading right now closer to a script you inherited, or a choice you're actually making?
Issue 2 · August 2026
The September Push: What's Really Needed
Do we prepare the conditions for this work as much as we prepare for the work itself?
This month: the four conditions that sustain leadership, and how scarcity narrows them under pressure.
Leading up to September, we spend enormous energy preparing the work ahead.
Projects begin, service changes launch, people return from holidays. Some Septembers begin with tremendous energy and excitement for the year ahead. Some begin with very real constraints and strain, on leaders, teams, organizations, and those they serve.
After twenty-four years in healthcare, I'm still in this rhythm. I’m no longer a director, but I’m walking alongside leaders as a coach as they move through it again this year.
September brings the questions it always brings: readiness for launching a new pilot or service enhancement, recruitment, team changes, training needs, anticipating roadblocks, a new mandate rolling out. These are necessary and important, yet an additional question has become clear:
Do we prepare the conditions for this work as much as we prepare the work itself?
The literature on sustainable leadership points to several conditions that help leaders sustain themselves over time. Four that stood were peer connection, coaching, personal practices, and organizational conditions. What stood out to me was that they don’t really work well in isolation.
Peer support matters, but it cannot fully compensate for an organizational culture that makes sustainability impossible. Coaching creates space to think, but it doesn't replace rest and recovery. The strength comes from how these conditions reinforce one another.
September will still ask us to adapt, pivot, learn quickly, and respond to what we cannot predict. Those demands aren't going away. I'm simply wondering whether this is something else worth bringing into the mix.
And then there’s complexity. It’s not going away.
Under sustained pressure, complexity can begin to feel like scarcity: not enough time, not enough people, not enough money, not enough capacity. And when everything starts to feel scarce, the conditions that sustain us can be the first things we stop protecting.
As a healthcare leader, you’ve been adapting to extraordinary pressure for years. Budget constraints, staffing shortages, growing complexity, and the lasting effects of the pandemic have shaped how many leaders approach their work. Over time, it can become easy to operate as though there simply isn't enough.
It shows up in the planning itself. When pressure is high and resources are tight, leaders can become understandably protective. Collaboration feels harder to engage in. Coaching feels difficult to justify. Time for reflection is often the first thing to disappear. The very conditions that help leadership stay sustainable begin to narrow.
It shows up just as clearly in what leaders are willing to protect for themselves. The feeling of time scarcity convinces a leader that rest or time off is the one thing there's no room for. This ends up looking like working over the weekend, a long string of late nights, worn as proof of commitment rather than named and acknowledged as a very real cost.
It doesn’t stay personal either. It begins to shape the team around them. We know that sustainable leadership is shaped by what we model around realistic workload, rest, difficulty, and asking for help. When those things are protected, something changes for them and for those around them. Scarcity can make those practices feel surprisingly difficult to defend, even when we know they matter.
Like many other forms of drift, scarcity becomes visible only when we step back and notice what it has changed. There's no single way back. For some, it starts with noticing how scarcity is shaping what feel possible. For others, it begins with an honest conversation with a peer or coach about what has become your new normal. That's why September isn't only a time to prepare and plan the work. It's also a time to consider which of the four conditions are supporting you well and which ones have become the hardest to stay connected to.
What I've been building
I’ve been creating practical resources to help leaders these ideas beyond the newsletter.
You Were Never Meant to Carry This Alone: A framework exploring four conditions: peer connection, coaching, personal practices, and organizational conditions and how they work together to support sustainable leadership. Download it at michelletruppe.com/resources.
What if Alignment Matters Too: A reflection on resilience, alignment, and the questions that help leaders notice what is no longer working, and what may need to change. Read the piece here on LinkedIn.
One question I'm leaving you with this month
September is coming. The pace will increase. Some things can't be controlled. The conditions we create often can.
What condition am I missing?
Issue 3 · September 2026
The Connections We Build: What Distance Can Teach Us
What actually sustains connection across distance and time in our work and our lives?
This month: connection, the everyday moments that build it, and what proximity can and can't do.
My mom wrote letters to four girls in search of a pen pal. One finally wrote back and shared, “I’m allowed to talk about boys.” A friendship was born. It was 1956, and my mom was 12.
They wrote for years on aerograms, thin post-war paper that folded into its own envelope. The space to write on was very small, so they had to write tiny to fit the life of a teenager onto one page. At least once a month, often more, they wrote each other about everything … the big things like boyfriends, marriages, children, launching businesses, divorces (well, my mom’s), illnesses and loss. All the milestones and significant events were shared, of course, but most of the time across seven decades was about the everydayness of life, the ordinary moments that make up our days. They were there for each other across an ocean, for decades before “virtual” was a word any of us used or even imagined. My mom didn’t start using email until 2015, and after that, the handwritten letters became rare.
In 1986, nearly thirty years into their friendship, they met in person for the first and only time, when my mom's pen pal visited Canada. The local paper thought it was remarkable enough to even write about. I've tried to get my mom to travel to see her friend once more. It hasn't happened yet.
What sustained their relationship wasn't living close to each other. It was ordinary life, alongside important life events for seventy years and sharing it with each other month after month. In leadership, we often assume connection happens because we share a hallway or a schedule. What actually sustains connection, especially across distance, is doing the small things again and again. While my mom and her friend didn’t have proximity, they had the kind of consistency that’s hard to imagine.
I've been thinking about their friendship in the context of leadership. We often talk about proximity as though it is the cornerstone of connection at work. What if proximity is one condition that makes connection easier, not “the thing” that creates it? And what happens when proximity simply isn't an option?
The Everydayness of Connection
We tend to connect when something big happens such as a difficult conversation, a crisis, a team win, a moment when someone needs support. Yet we know that relationships aren't built in those moments alone. They are built through the accumulation of smaller ones, like the quick check-ins, the follow-up after a hard day, or even the few minutes before a meeting starts. These moments matter, a lot.
Brené Brown’s research on connection and leadership offers one helpful lens. Her work, along with broader research on workplace relationships, suggests that connection is strengthened when people feel seen, heard, understood and valued. Research on workplace relationships and informal interaction points in a similar direction. Some of the interactions that matter most to our experience at work aren't the formal ones that we schedule. They happen in the everyday parts of our work and life. My mom and her friend were doing exactly that over and over again: sharing what mattered, remembering the details of each other's lives, and making space for one another across the distance.
I think we give too much credit to the big moments and often underestimate the everyday ones. Connection actually comes from what is ordinary and repeated, the stuff that happens in-between.
Proximity creates opportunities for connecting. It doesn't guarantee connection.
Being physically near people makes some things possible without much effort. You can bump into someone in the hallway, notice that they seem distracted, and then end up having an unplanned conversation. It presents an opportunity to share an experience without scheduling it. Over time we build familiarity with each other by crossing paths regularly.
The research doesn't suggest that proximity is irrelevant. We know that proximity and connection aren't the same thing. A person can sit three desks away from someone for five years and barely know them. Someone else, working across the country, can become a person they deeply trust.
In 2024, I heard Robert Waldinger speak at a Leadership and Happiness Symposium about what researchers have learned from the Harvard Study of Adult Development, now in its ninth decade. On his closing slide, he left the audience with three points that are worth paying attention to: human connection is a major source of health and happiness. Technology has the power to either isolate us or connect us. Lives at home and work can be structured to combat isolation.
And this matters in healthcare leadership because proximity isn't always something we can choose. People work different shifts, teams work across multiple sites, leaders may have staff they rarely see in person and some relationships happen almost entirely through a screen, a phone call, a message, or a brief encounter between competing demands. So, if proximity isn't always available and isn't sufficient even when it is, what else helps create connection?
Creating Connection When Proximity Isn't Possible
In Tomorrowmind, psychologists Gabriella Rosen Kellerman and Martin Seligman describe three conditions that support connection: time affluence, synchronicity, and individuation. Time affluence isn't about having more time. It's the experience that, in the time you do have, there is enough space to actually be with another person. Synchronicity is sharing something in real time, for example a debrief after a difficult case, or solving a problem side by side. And individuation is being known as a person rather than that just the role you are in at work. A leader may not be able to speak with every staff member face-to-face each day, but they can remember what someone told them last week and ask about it when they next connect. It might sound like this: The last time we talked, you were worried about the restructuring. How is that sitting with you now? These seemingly small things can make a big difference.
And that brings me right back to my mom.
1956 → 2026
This summer, my mom sent her friend an actual letter, with a newspaper clipping, through the mail. Her friend emailed back, laughing, to say she hadn't received a letter in the mail in years. Seventy years later, they're still finding ways to connect. The medium has changed for them, yet the distance never did.
We have more ways to connect than my mom and her friend ever did. We have Zoom, phones, email, messaging, shared documents, virtual meetings and countless ways to reach someone who isn't in the room. Yet the tools themselves don't create connection.
What matters is what we do with them.
· Do we make room for the ordinary stuff?
· Do we share the big and small experiences, rather than only information?
· Do we remember what matters to people and then come back to it?
· Where am I relying on proximity to create connection, rather than creating it intentionally?
My mom and her friend have been showing up for each other for seventy years, in whatever form was available at the time. Maybe that's the common thread … the willingness to keep showing up, in whatever form available, for the people we've decided that matter.
What I’ve Been Building:
Over the past few months, I've been thinking a lot about what helps healthcare leaders lead sustainably, not only through the big challenges, but through the everyday realities of leading people under sustained pressure. Much of that work comes back to noticing what is easy to miss when things are busy: our energy, our patterns, our relationships, and the way pressure shapes how we show up.
I've been building practical resources around these ideas, so leaders can reflect more deeply and see their situations more clearly. You can explore them at michelletruppe.com/resources.
I've also been developing a workshop that brings these ideas to a more interactive space. More on that soon.
One Question I am Leaving You With This Month:
Where are you waiting for proximity to do what only you can do: build connection and deepen relationships?