The Performance Paradigm: Three Shifts for Healthcare

Alexa Miller, from our close partner Arena Labs, shares a round-up of healthcare insights from last year, gathered from a diverse group of performance experts closely associated with Liminal Collective. Arena Labs is a pioneer of high performance in modern healthcare.

Jan 4, 2021

ur thanks to Alexa Miller, Arena Labs and their many contributors for this article, originally published here.

Performance science is the study of human thriving. What does it mean to apply that idea of thriving to the minds, bodies, and teams of those in society most committed to the care and thriving of patients? It’s a particularly important part of the piece of what a much better future looks like.

Through my work with Arena Labs this year, it has been a privilege to study the science of performance, as well as the tools and stories of thriving and success as lived by athletes, performance artists, and civic leaders. And what a year to do it. Ten months into the pandemic, our healthcare workforce is truly all of the things: Deeply exhausted: questioning the reality of longevity, and shaken in trust–all while being Person-of-the-Year-level amazing. Energized: by innovation and new forms of collaboration, by the hope of vaccines, and by societal awakening as to the harms of legacy systems. And, anticipating heavy demands of more surge, new strains, not to mention pressure to recoup the losses of the last year. The signs of both regression and promise all around us make up the kind of particularly messy mix of things distinct only to moments of true transition.

In the spirit of “reset,” below is a brief round-up of insights from our 2020 Performance Profiles that have struck me as most relevant to healthcare over the past year. In particular, three profound shifts:

  1. From the Individual to the Collective
  2. From the Physiology of Patient to the Physiology of all the Humans in the Room
  3. From Tech-Distracted to Tech-Enabled


It may take a group of Navy SEAL teammates to point this out, but it’s astonishingly true and misaligned: clinical mastery is developed by way of highly individualized tracks, though its delivery — its performance — happens in the context of the team.

Elite performers, those obsessed with pushing the limit of human potential, understand the power of mastery in the context of the team. Elite gymnast turned Cirque du Soleil performer turned director Gregg Curtis describes viscerally a “seminal moment” in his life, that of his true transformation as an artist. It happened in the context of the collective of the Cirque dance troupe. Having reached the stage of no longer needing to push himself to master gymnastics, he became keenly focused on the collective unit of the dance itself: to the light and the music and the shape of the performance. He describes, “it was just a wonderful place to see and respect everything going on around me. Everything was becoming. Everything was fertile.”

Key to the team is selecting people who are “accountable to the team,” notes Jurgen Heitmann, Director of Performance at Arena Labs. Critically, what accountability actually means, as Jurgen describes, has to do with care for others and care for self. Accountability is where self-care and care-for-others aren’t at odds, but converge, in a way that is 100% reliable to all on the team. Once a team can be fully accountable in this way, it becomes fully entrustable to make it through anything. As Jurgen describes, “collaborating with those who share this understanding has allowed me to step into environments and situations for learning I would have never imagined.

At the organizational level, team performance depends on leaders’ abilities to transcend the individualism of healthcare, as Patty Brandmaier identifies based on her track record at the CIA. “Organizational performance and success depend on a leaders’ ability to leverage the best, the strengths, the divergent, and diverse talent and thinking of a team.” Patty’s interview is truly a Cliff’s Notes on high performance leadership philosophy and practicals, emphasizing in a raking light the criticality of environments and conditions for success.

The knowledge of this ecosystem of performers inspires much vision as to the potential for mastery in medicine and what it could look like — and more importantly, could do — were it actually developed in the context of a team. Mastery of craft is likely just the tip of the iceberg of improvement in our culture plagued by individualism.


“What happens to the human being during a stressful medical event? Not the patient, but the providers. What does my heart rate do when the patient is really sick, or when there is a code, when the heart stops?”

What a simple question, asked by CT Surgeon Dr. Doug Johnson. Doug’s question reflects that “accountability to team” described above by Jurgen, although some might mistake it for being “selfish.” Why is it so counter-culture to wonder about the physiology of the frontline teams, in addition to that of the patient? Moving the needle on a culture that supports the thriving of frontline teams is dependent on better understanding the stress, fear, and anxiety dynamic within all of us. And because transformation begins with an inside job, better performance can only begin by learning from the ways in which fear, stress, and anxiety work in the body individually and in collectives.

Kristen Holmes, one of the most successful field hockey coaches in Ivy League history and now leader in performance science, takes this question to the next level with the unique perspective of how a coach considers a roster and what it might mean for healthcare: A coach cares about their athletes’ capacity, and looks at it in a very strict light. Let’s say that for a couple days in a row, my athlete is run down. If I put that athlete in a position where they have to compete, the chances of them getting injured or injuring someone increases exponentially….It seems really clear that you wouldn’t want to put a surgeon in a position to perform where the statistical probability that a medical error can occur increases.”

One of the things we see more and more is the influence of language, specifically self-talk, on our ability to convert stress into fuel for performance and recovery. Skier Jamie Mo’Crazy’s interview with Brian Ferguson is an absolute masterclass in the internal work of stress management and resilience, and a perfect example of the kind of care to self that Jurgen identifies as accountability to teams. It’s also simply radiant. The language of Jamie’s self-talk is not self-pity, it is a divine cocktail of swagger and curiosity, with a dash of the Buddha’s lovingkindness Imagine the thriving we’d see in our care sector if folks on the frontline spoke to themselves as Jamie does, and could rely upon their colleagues to do the same.


As medicine evolves, there is no shortage of technology that can be put in OR’s and clinical environments,” explains Arena Labs CEO Brian Ferguson in conversation recently with Will Ahmed. Yet “at what point is too much data ineffective, contributing to cognitive overload?” As Brian highlights, the far more effective approach is to first identify the basic principles of peak performance– humans at their very best, and what they can do with others also at their best — and from there deploy technologies that catalyze that excellence, rather than focusing on technology as the solution and then leaving people overwhelmed.

At a time when the lions’ share of physician time is spent with the EMR, this is a critical distinction to make. What could our system of care do if we identified what humans and teams could do at their best, and used technology to catalyze that?


The culture of most US healthcare today seems to suggest that focus on the wellness of its corps of caregivers is somehow in direct conflict with a focus on the patient. This is a myth. A better paradigm is recognizing the wellness of medicine’s frontline teams as the keystone asset it is, baking that into expertise and mastery, and allowing wellness at the frontline and patient-focus to work as a single driving force.

Perhaps most notably is the importance of normalizing a conversion around fear. How do you navigate stress and pressure individually and as a team? How do you recognize and manage fear, stress, and anxiety within yourself and your team? With the recognition of the pandemic-level risk to health of racism, a phenomenon driven by unchecked fear, the consequences of normalizing a conversation around fear and the stressors that trigger it could not be greater. Across the worlds of performance, medicine, and society, there is a major opportunity here for those who model expert learning the best to trust into the principle that our collective achieves its fullest expression of potential by nature of its being diverse–and to bring others along.

Medicine is traditionally focused on the “what,” while leaving the “how” to chance. Performance is a conversation about the how as part of the what, together as a collective. How do you care for self so that you can show up for others? How can we embrace the fundamental principle that our collective peak is realized by the nature of our being diverse? How do we recognize that rare ethos of service and align environments and technology to support it to go further than we imagined?

With pandemic challenges accumulating on top of healthcare’s pre-existing problems, rendering many to question their longevity within their chosen fields, these are key shifts that will serve us well.

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