Leadership in High-Stakes Spaces

Author: Kaleb Lachenicht, Chief Clinical Officer of ROCKET and Director Epic EM

“The loser has more in common with the winner than with the person sitting on the sidelines.” - James Clear

This line stopped me. I have heard it in so many different ways before today, but for some reason today it meant something more to me.

In aviation, in medicine, in leadership, the people who step into the arena understand something the spectators never will.

The Leadership Arena Is Uncomfortable

When you:

• Lead a team through a difficult case

• Publish an opinion

• Change a protocol

• Call out unsafe practice

• Start a new course

• Take responsibility for a bad outcome

• Admit you are not sure about something and ask for help

You expose yourself.

And when you expose yourself, you will get hit.

Not always by the problem, usually by the people sitting in the stands, on the sidelines, in the cheap seats. Franklin Roosevelt wrote about the "man in the arena" and Brene Brown has spoken on this writing by Roosevelt many times, all saying the same thing, but for some reason I have missed the feeling around this for so long.

The Cheap Seats Are Loud

If you’ve ever:

• Escalated a patient early and been told you’re overreacting

• Cancelled a flight because it wasn’t safe and been accused of being risk-averse

• Challenged dogma in a training room

• Implemented Just Culture and been told you’re “soft”

• Taken a stand in a meeting

You’ll know this feeling.

Criticism from people who were not carrying the weight of the decision.

It’s easier to comment than to command. Easier to critique than to carry risk. Easier to sit than to stand.

The Loser and the Winner Are Teammates

The winner and the loser both took the responsibility of stepping up, they put themselves into the arena, they made a call to action with imperfect information and started doing something, rather than waiting it out. They accepted uncertainty and were willing to put themselves out there, to be judged. They both showed up.

The only difference is outcome, and honestly, the outcome is the least important part of the process. In high-performance environments, especially prehospital and critical care, outcome is pretty much NEVER always under your control.

Weather changes. Pathophysiology surprises you. Humans make mistakes. Systems fail. But the courage step up... that is a choice!

Being the “Man in the Arena” in EMS

In retrieval medicine, this is very real.

You decide:

• Do we fly?

• Do we intubate?

• Do we push?

• Do we stop?

These are not abstract debates. They are lived moments with consequences, and sometimes, even when you do everything right, it doesn’t go your way.

But the person who never activates, never escalates, never speaks up, never leads will also never be criticised.

They are safe, but they are not in the arena.

To the teams I am so lucky to work with:

If you’ve ever been criticised for stepping forward good, it means you were in the arena.

And the truth is this:

The person who tried and failed is infinitely closer to mastery than the person who never tried at all.

The cheap seats don’t move the system forward.

Both winning and losing require the courage to play, sitting and watching is not extending yourself, its not trying, its not participating. No risk....no reward.

Growth happens in the discomfort