High performing teams

Podcast – High Performing Teams with Dan Dworkis at Tactical Trauma 24

Listening time: 16.55

Synopsis

In this episode of thIn this episode of the St Emlyn’s podcast, hosts Iain Beardsell and Liz Crowe welcome Dan Dworkis, an ER doctor from Los Angeles and host of the Emergency Mind podcast. Dan shares his expertise on optimizing team and individual performance in high-stress medical environments. The discussion delves into the concept of excellence beyond merely avoiding negative outcomes, using a rosebush metaphor to illustrate the need for proactive growth. They explore how teams can benchmark and improve performance, the importance of creating a culture of continuous improvement, and strategies to maintain positivity and energy even in challenging conditions. Dan also highlights the Mission Critical Team Institute and its role in supporting teams in life-or-death situations. This episode is essential listening for medical professionals committed to pushing the boundaries of excellence in their practice.

Episode Breakdown
00:00
Introduction and Guest Welcome
01:06
Defining Excellence in Medicine
02:29
Measuring and Achieving Team Performance
06:13
Small Changes for Big Impact
10:03
Maintaining Positivity and Energy
15:30
Mission Critical Team Institute
16:33
Conclusion and Farewell

What makes a team truly high-performing, especially in critical environments like emergency medicine? In this episode of The St Emlyn’s Podcast, Dr. Dan Dworkis, emergency physician and host of The Emergency Mind Podcast, explores excellence, decision-making under stress, and how teams can improve every shift.


1. Defining Excellence: Beyond Avoiding Mistakes

Many teams define excellence as the absence of bad outcomes—but true excellence goes further.

Key Concept: The Rosebush Metaphor

  • Removing weeds doesn’t grow flowers—just as avoiding mistakes doesn’t automatically lead to high performance.
  • Teams must actively cultivate excellence by defining what success looks like beyond just minimizing failure.

Key Insight: Excellence is more than the lack of bad things—it’s the deliberate pursuit of better outcomes.


2. How Can Teams Measure and Pursue Excellence?

Moving Beyond Benchmarking

  • Many teams rely on benchmarking against peers (e.g., door-to-balloon time, sepsis protocols).
  • But true excellence requires dreaming bigger—asking: What is the best possible performance, and how do we get there?

Two Yardsticks for Excellence:

  1. Internal: Are we better today than yesterday?
  2. External: How do we compare to the best anyone can achieve?

Key Insight: Elite teams push boundaries rather than settle for “good enough.”


3. Learning from Elite Teams in Different Sectors

Dr. Dworkis’s work with the Mission Critical Team Institute spans military special forces, aerospace, and emergency medicine. Across these fields, the best teams:

  • Are obsessed with continuous improvement.
  • Embrace discomfort and critique.
  • Debrief honestly and regularly.
  • Test themselves in controlled stress environments.

What Emergency Medicine Can Learn from Special Forces:

  • Adaptability: Being prepared for dynamic and evolving problems.
  • Decisiveness under uncertainty: Making the best possible decision with incomplete information.
  • Resilience training: Managing stress to maintain peak performance.

Key Insight: The best teams borrow lessons from high-performance cultures beyond medicine.


4. How Can Teams Improve in Time-Limited Environments?

The “Fix the Door” Philosophy

  • On an overwhelming shift, a rusty door in the department was loudly shrieking every time someone passed.
  • Despite all the chaos, Dan and his team stopped, got some WD-40, and fixed the door.
  • The next team had one less stressor to deal with.

Key Takeaway: “We can’t fix the whole system in one shift, but we can make it a little better every time.”

Micro-Improvements: The 1% Rule

  • Fix one small inefficiency per shift.
  • Set up the next team for success—whether through small environmental changes or improved handover.
  • Create a culture where tiny improvements compound over time.

Key Insight: Improving workplace culture isn’t about giant changes—it’s about making things slightly better, shift by shift.


5. Avoiding Stagnation: The Problem with “Good Enough”

Many teams feel they’re performing well enough—but this mindset can be a barrier to excellence.

Shifting from Comfort to Growth Mindset

  • Elite teams regularly ask: What does better look like?
  • If a team’s goal is simply to maintain performance, improvement stalls.
  • The best teams never stop evolving.

Key Insight: Excellence isn’t a destination—it’s a process of continuous improvement.


6. Psychological Resilience and Team Mindset

Reframing Stress: Orbiting Your Center

  • Performance isn’t about perfect balance; it’s about staying in an optimal orbit.
  • You may get knocked out of rhythm by a tough shift—but elite teams have strategies to return to their center.
  • Self-awareness and team awareness help manage stress before it derails performance.

Avoiding “The System is Broken” Mindset

  • Healthcare teams work in flawed systems—complaining doesn’t fix them.
  • Instead, teams should focus on controlling what they can.
  • Every shift, there are small wins—find them and build on them.

Key Insight: Mindset is everything—high-performance teams focus on what they can improve, rather than what they can’t control.


7. Final Takeaways: Cultivating High-Performance Teams

  1. Define excellence beyond avoiding mistakes—set aspirational goals.
  2. Use internal and external benchmarks—push beyond “good enough.”
  3. Learn from elite teams across different fields.
  4. Fix small problems each shift—micro-improvements build resilience.
  5. Never stagnate—improvement should be continuous, not occasional.
  6. Reframe stress and focus on what you can control.

As Dan emphasizes:

“You don’t have to fix the system overnight. Just leave things a little better than you found them.”


Podcast Transcription


The Guest – Dan Dworkis

 Dan Dworkis, MD, PhD, FACEP is the Chief Medical Officer at the Mission Critical Team Institute, the founder of The Emergency Mind Project, a board-certified emergency medicine physician, and an assistant professor at the Keck School of Medicine at USC.

His work focuses on the optimal development of mission critical teams in and out of emergency departments. He completed the Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital / Brigham Health, and also earned an MD and PhD in molecular medicine from Boston University School of Medicine. Dr. Dworkis is the author of The Emergency Mind:  Wiring Your Brain for Performance Under Pressure.

Dan Dworkis

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Cite this article as: Iain Beardsell, "Podcast – High Performing Teams with Dan Dworkis at Tactical Trauma 24," in St.Emlyn's, March 12, 2025, https://www.stemlynsblog.org/high-performing-teams/.

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