Know Where You Stand
When I run, I pay attention to three things: the terrain, the weather, and me - what's happening in my own body and mind.
Some days all three align. The trail is clear. The temperature is comfortable. I feel strong. Those runs are easy, easy.
Many days, at least one is challenging. This winter it’s the ice and the wind. Three years ago I was often tired when I started. What matters these days is knowing where I stand and reading all three landscapes (the terrain, the weather, and me) honestly and adjusting accordingly.
I've been running for nearly thirty years, and this simple framework has become intuitive. It also applies directly to how I lead both myself and others in my career.
The Three Landscapes
The terrain is the external landscape you're navigating. When I run, it's the surface under my feet: pavement or trail, dry or muddy, flat or steep.
At work, it's your business reality: reimbursement rates, regulatory requirements, staffing constraints, capital limitations. This landscape exists whether you acknowledge it or not.
The weather is the cultural and relational climate. On a run, it's the conditions around me: temperature, wind, precipitation, visibility.
In your organization, it's the team's current state: Are people energized or depleted? Is there trust or suspicion? Do colleagues speak up or stay quiet? Is there space for honest conversation?
The internal landscape is you: your physical state, your mindset, your capacity right now.
On a run: Am I strong or dragging? Present or distracted? Too cold or overheating?
At work: Am I curious or defensive? Prepared or unsettled? Operating from security or from fear?
Why Healthcare Leaders Face More Complex Landscapes
Healthcare leadership requires navigating particularly challenging terrain and weather.
You're balancing clinical excellence and business discipline. Community accountability and financial pressure. These tensions don't resolve. They require constant calibration.
And your team brings fundamentally different training and perspectives:
Clinicians are focused on patient care, trained to prioritize individual outcomes over system efficiency.
Academic physicians are scientifically oriented, focused on evidence, research, and advancing knowledge.
Financial leaders are managing resource risk and regulatory compliance, trained to see constraints and protect sustainability.
Operational leaders are optimizing workflows, managing staff, keeping the daily work functioning.
As an executive, you navigate terrain and weather that's more complicated than any single function leader faces. If you lean too far toward clinical priorities, you risk financial instability. Focus only on margins, and you lose mission alignment. Please one stakeholder group, and you may upset another or miss performance in a critical dimension.
This requires reading more signals, carrying more gear, adapting more frequently than a simple morning jog.
What Happens When You Misread the Weather
I learned this at a six-hospital academic and rural health system where I was helping align system-wide priorities.
The task: Get nearly two dozen system leaders to agree on priorities for the annual plan.
We convened an alignment workshop with a clear agenda. We'd review the strategic objectives, discuss possible initiatives, and vote on priorities. The terrain was mapped.
But as we worked through the agenda, the weather became clear: people were not ready to vote. There wasn't enough shared understanding of the potential breadth of work. Different hospitals had different needs. Leaders had different priorities.
The other workshop leaders and I pivoted in real time.
Instead of pushing through to a vote, we facilitated a frank conversation about what tensions people were feeling related to the work. What work people actually wanted to work on but wasn’t even listed on the priority list. We listened to the competing perspectives. We surfaced the misalignments.
Then we regrouped. We convened a second virtual workshop the following week. This time we came prepared a narrowed down list, a framework with clear definitions. The discussion at the first workshop got us to a short list. That combined with a framework and a simple voting process created the structure and clarity people needed. "This is exactly the clarity we needed," one leader said.
With this in place, the vote on what to prioritize was straightforward. We reached alignment on a focused list of annual goals.
This was alignment in practice and in outcomes. People were aligned on what we were doing, the process reinforced that alignment, and the outcome created system-wide strategic focus.
We succeeded because we adapted to the weather. We named what was actually happening in the room ("we're not ready to decide yet") and adjusted our approach accordingly.
When You Miss the Terrain Entirely
The VC backed healthtech startup I was Chief of Staff at has closed. There's no revenue, no customers, no employees.
We failed to read the landscape well enough to deliver on our promise.
The terrain signals were there. We just didn't respond to them in time.
Internal metrics clearly showed the business wasn't on track to meet revenue and platform user targets. The sales process was taking far too long. Pilot agreements weren't converting to contracts on the necessary timeline. Patient volume numbers were equally slow. We weren't getting users on the platform at the rate we needed.
The terrain was clearly becoming more difficult for us.
But we also didn't truly understand the terrain we were navigating. We weren't certain about reimbursement codes and how to capture revenue effectively. We were unclear how changes to payment models would impact clinician usage. To succeed in value-based care, one type of client was going to need to add staffing resources, which just wasn't feasible post-COVID.
The terrain was getting really, really difficult, and we didn't have the right competencies or tactics to navigate it.
We tried to change tactics. We tried to pivot the business model. But in the end, it didn't work.
The lesson: Watch the terrain closely at the beginning, and if you're struggling on it, fix yourself before you venture further into the wilderness. Just because you have more money or different people on the team doesn't mean you can overcome the terrain. It might just be too hard. You might need to turn around, or find a completely different way to cross it, or cross it at another time.
It's hard to stop and turn around when you've gone so far, put in so much effort. But sometimes that's the smartest and safest decision.
Patients missed out on technology that could have helped them. Investors lost capital. Teams got laid off. The consequences of misreading the landscape were real.
Sometimes You Need to Pull Yourself from the Race
I don't often drop out of races or quit jobs, but I have done both.
I dropped out of a major Colorado 100-mile mountain race at mile 50 because my head wasn't in the game. I was doing well physically. I had plenty of time before the cutoffs. I could have rested at the aid station. But my mind wasn't up for the challenge. I didn't have the mental focus that day.
I pulled myself from the race.
Three months later, I won my age group at the Midstate Massive 100-mile race across Massachusetts, running and hiking through a hurricane. At the 50-mile halfway aid station, I changed clothes. Every single piece. The only tiny element of clothing that wasn't completely soaking wet was my underwear.
I crushed it that day. I managed the terrain, the weather, and myself.
The difference in my performance was not due just to physical capability. Rather, it was honest self-leadership and honest assessment of my will. In Colorado, I recognized my internal landscape wasn't right for the challenge ahead. Three months later in my home state of Massachusetts, I was in tune with all three landscapes and adapted accordingly.
How This Framework Helps You Lead
I use this framework with clients to help them see both the business and human reality—self and others. It helps them manage themselves and others better, which creates better engagement and leads to better results. For you, this translates to better conversations, better idea flow, more trust, better care, lower risk.
If you're struggling with cultural problems you can't quite diagnose, this framework gives you language to ask "What's the weather in the room?" It helps you understand your team better and helps them feel seen.
The metaphor reduces emotional risk and creates more psychological safety for people to speak up. Instead of "Why is everyone so resistant?" you can ask "What's the weather like for you right now?" They can say "Well, it's starting to get really cold out. We need to stop and put our jackets on."
People can answer that question honestly without feeling defensive.
In practice, this becomes both a simple framework you use to manage situations and a powerful analogue you use to create alignment with your team or stakeholders. It helps tell a story, which is easier for people to remember and easier for people to participate in.
The Practice
Before an important conversation, I assess:
The terrain: What are the facts? What constraints are real? What's actually at stake?
The weather: What's the team's current state? Is there trust in this relationship? What's the emotional temperature?
Myself: What am I bringing to this? Am I centered or scattered? What do I need to do differently to show up well?
Sometimes I realize I need to wait. The weather isn't right for a difficult conversation, or I'm not in the right state to lead it well.
Sometimes I see I've been focused entirely on terrain (strategy, analysis, the "right answer") while ignoring weather (how people are actually experiencing this moment).
Sometimes I notice I'm operating from fear rather than possibility, and I need to reset before proceeding.
Right now, I'm advising a client on the risk of doing important culture work now versus waiting until after they get through an operational crunch. Nursing leadership recently departed. Patient volumes are high. And the culture work isn't budgeted and margins are very tight.
He and the board need to decide: invest the time and resources in culture work now, or wait until the terrain (budget) improves, knowing the weather (culture) might deteriorate further.
There is no right answer. Just an honest assessment of all three landscapes and the judgment call about which risks are worth taking.
The Stakes
In healthcare, the stakes of misreading landscapes aren't abstract.
When executives push strategic changes without reading team capacity accurately, clinicians burn out and leave. When boards demand growth without understanding market reality, organizations overextend and compromise care. When leaders operate from fear instead of clarity, they make defensive choices that compound problems rather than solve them.
An Invitation
Think about the hardest leadership decision you're facing right now.
What is your landscape? Which elements are you reading clearly? Which ones are throwing you off or causing problems?
How can you get help to better manage yourself and your people amidst that?
This framework has helped me become a better leader—of myself and others. It gets richer when we learn from each other's experience.
I'd welcome the conversation. Onwards!
