The Quiet Cost of Misalignment

We’re trained to look for the obvious expenses. The ones that show up in a P&L or throw off a benchmark. A few clicks into QuickBooks and you’ll find them—marketing overages, team inefficiencies, rent that doesn’t make sense anymore.

Those are easy to spot. But the biggest leaks I see inside clinical businesses aren’t line items. They’re misalignments.

They show up quietly—through culture drift, leadership fatigue, or the kind of turnover that leaves you wondering if the issue is really just hiring.

Sometimes worse than turnover is when people stay... but shouldn’t. That subtle, sticky resistance to change or clarity? It almost always points to misalignment at the top.

A founder I work with shared something that’s stuck with me. When I asked when she truly started identifying as the CEO of her company, she paused and admitted— “Only after things nearly fell apart.”

For years, she was holding the reins but still operating under an older identity. One rooted in keeping peace, being needed, and working harder instead of leading differently.

It wasn’t sustainable. The business began to reflect that misalignment. Staff resisted change. Boundaries blurred. And burnout crept in—not just for her, but across the team.

The shift came when she realized that she’d been undermining her own authority by clinging to an outdated version of herself.

When she stepped fully into a CEO identity—not in title, but in posture—things started to move.

She made hard calls. Had uncomfortable conversations. Grieved some of the fallout. But from that place, she rebuilt with intention.

New therapists began reaching out. New revenue lines opened. And she came back to the core services she actually wanted to scale.

The people who resonated with her clarity stayed. Those who didn’t, left.

That used to scare her. Now it feels like relief.

I once heard the phrase, “All people bring us joy—some by coming, and some by going.” Early in my career, it felt harsh. Now it just feels honest.

Misalignment in leadership doesn’t always feel dramatic. It’s more like a slow drift. A car pulling slightly to one side. An instrument just barely out of tune.

You can drive like that for a while. You can even get used to it. But eventually, it wears you out.

And it doesn’t fix itself.

So if something feels off—if you’re doing all the things but something underneath still feels disconnected—don’t ignore it.

You don’t need to overhaul everything overnight. But you do need to start telling the truth.

Where are you out of alignment? What’s one courageous step you’ve been avoiding?

Because the business should work for you—not run dependent on you.