Welcome to The Transforming—the always-happening, always-unfolding state of change in your job, and the continuing result of market forces far beyond our control.

Partly because of how those forces have changed healthcare and partly because of an outdated approach to working in the world those forces have created—how we work is mismatched with reality.

This mismatch creates frictions you've perhaps felt: frustration, depletion, disorientation, confusion, a sense of disconnect …

Plus—

—this mismatched approach is the cause of too-slow change, too-siloed work, too-much bureaucracy, and too-much or too-little of whatever else is getting in the way.

But it's not just us individuals.

Instead of a football game, and its well-understood paradigm and agreed-upon certainty (known opponent, game planning strategy, timeboxing, best practice playbooks), the organizations we work for, built for an operating environment of predictability, are figuring out, as we speak, how to operate in the wilderness, too. But they're responding to these forces with the only way they know how: with football field thinking.

Yet we're working in an environment where the terrain shifts beneath our feet, where the path forward isn't marked, and where success looks different depending on where you stand. Our organizations' well-intentioned but unfit responses translate into realities that wear on us.

And this creates real challenges for us in the wild. An overnight shift in strategy. More bureaucracy. Transformation on multiple fronts. Another edict from up top. Compressed timelines. More frequent reporting. Just get-it-done directives. Meetings, lots of meetings. Stressed co-workers. And, maybe more than ever—am I going to have a job tomorrow? Next week? A year from now?

The result? A growing sense of disconnection between what we know needs to happen and what we're being asked to do. We experience change fatigue as we sprint from one initiative to the next without time to integrate. We feel the weight of impossible expectations—innovate, but follow the process; be efficient, but document everything; collaborate, but stay in your lane.

There's a difference between the natural challenges of healthcare work and the fundamental mismatch we're experiencing now. It's not just that work is hard—it's that the approaches we're using to navigate this complexity are increasingly at odds with the reality we face. When our organizations respond to wilderness conditions with football field thinking, the friction isn't just an inconvenience—it becomes structural, systemic, and increasingly difficult to overcome through individual effort alone.

Even if work feels okay right now—good leadership, meaningful work, a role that fits—The Transforming still touches your work life in ways you might not always notice. The stability you've established costs more to maintain than it once did. The ground keeps shifting underneath it. What worked for you may not exist for the people coming up behind you. Planning, for next week, next year, and especially for your career is more difficult when the horizon is always shifting.

While our organizations figure it out, we're left to get the work done in an environment of uncertainty, complexity, and yes, constant change. We don't know what's going to happen next. No one does. We can't. That's what working in the wilderness is like.

You respond to the situation in front of you.

That's the move. Because work in the wilderness isn't impossible, it's just different from working on a football field, and what it requires most of all, is recognizing our reality.