Preparing for High Performance in Unpredictable Situations

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On mission-critical medical teams, we don’t get a countdown before the start of the race.

One moment, we’re restocking a supply cart. The next, we’re doing compressions. The pager doesn’t wait for our calendar, and trauma doesn’t follow a fixed schedule. This unpredictability—of timing, of volume, of need—is one of the defining challenges of the work.

Most elite teams don’t face that. Athletes train for scheduled games with defined durations. Aerospace engineers rehearse rocket launches down to the second. Startup teams prepare for product releases, board meetings, and pitch days. These teams align their preparation, recovery, and intensity around known moments of demand.

But what if they couldn’t?

In June 2025, I delivered the keynote at the Teamworks Human Performance Summit. It was an excellent opportunity to share what we’ve been learning at Mission Critical Medicine with performance leaders from sport and tactical teams. But the conversation that stuck with me most happened off stage, over lunch.

John Wagle, Senior Director of Sports Performance at Notre Dame, had just walked the room through their remarkably sophisticated approach to supporting athletes across dozens of sports. Their systems are engineered to peak at the right time. Recovery and stress are managed precisely. The whole structure works because game day is a known quantity.

So I asked: what if you didn’t know when game day was?

For teams operating in crises like emergency departments or rapid-response teams, that’s the reality. We don’t get to plan for a specific moment. We have to be ready all the time. Maybe game day is in a week, or maybe it’s right now.

This unpredictability necessarily changes how we think about staffing, training, and performance. If we can’t forecast the “demand” for high performance, how do we prepare the “supply”?

There are no perfect answers, but here are three principles we’ve been working with centered around elevating your team’s performance in the face of uncertain demand.

Sustaining performance can look inefficient.

In environments where failure is unacceptable and demand is irregular, we have to prepare for what might happen, not just what usually does. That means staffing beyond the average load. Having extra hands during slower shifts. Building flexibility into systems that are constantly pressured to optimize and run lean.

To outsiders, this might look like waste. But what looks like waste can actually be readiness. Spare capacity is what allows you to respond without hesitation when the crisis spikes.

What conversations are you having with leaders and partners to reframe strategic readiness as high performance instead of inefficiency?

High performance is always contextual.

It’s easy to compare your team to a top-tier trauma center or a Division I sports program. But that can be misleading. A rural emergency department, a neonatal transport crew, and a large academic medical center all face different constraints. Excellence won’t look the same in each.

That’s why one of the first responsibilities of leadership is defining what high performance means in your specific context. Your resources. Your risks. Your mission.

Specifically, if the demand for your performance is irregular and difficult to predict, you can’t compare yourself to teams with regular schedules and easy-to-predict operations. Figure out what excellence looks like for your team playing your game, and get after it.

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Have you defined what success looks like for your team today, in your reality?

Not all “unpredictability” is the same.

Emergencies aren’t totally predictable, but that does not mean they are totally random either. Trauma cases rise on weekend nights. Firework injuries spike around the Fourth of July. Respiratory problems surge after wildfires or during flu season. These aren’t perfect predictions, but they are useful patterns that can be extremely valuable in complex systems.

In high-pressure work, spotting weak signals is a leadership skill. If you wait for clarity, it’s already too late. Teams that build sensitivity to noisy trends tend to posture better and recover faster.

What signals is your team already seeing? How are you acting on them before certainty arrives?

So, if your team had the resources of a powerhouse Division I program behind it and the opportunity to work against a fixed, knowable schedule, what would you change?

In the absence of that, when demand is irregular, performance needs to be maintained over long periods, and resources are low, what can still be improved?

These are questions we’re still working through, and we’d love to hear what you’re learning.