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What is integration, and why is it important?
Integration is the process of combining smaller components into a single system so they function as a cohesive, singular unit. Houses are constructed as skilled professionals integrate a host of materials, using specialised tools, to build a home. Similarly, athletes are surrounded by a variety of professionals from sports medicine and the sport sciences, who (hopefully) integrate with coaches to manage the athletes’ health and performance.1 Ideally, this creates a situation where ‘the whole is more than the sum of the parts’. In many cases, however, support team professionals and coaches may operate without coordinated direction and in ‘silos’, possibly with conflicting agendas, redundant procedures and in worst-case scenarios, ‘turf wars’, summing to even less than their individual parts.2
Integration of the support team and coaching staff is demanded by the interconnected nature of performance—it is dependent on a multitude of factors combining to produce an outcome.3 Performance is dynamic, changing daily as fatigue, recovery, training status, health and well-being fluctuate. This is further accentuated by individual differences in physiology, injury and training history, and the impacts of personal lives. With the unified goal of performance success, coaches design the technical and tactical strategies for the athlete or team, while support staff are responsible for ensuring that athletes possess the health, physical and mental capacities necessary to fulfil their role within this system.
It is not enough to simply have a group of individual practitioners surrounding the athlete and calling it an integrated performance team. Integration is an active process that requires commitment (from the support personnel, coaches and the team/organisation), time, teamwork and leadership. Recently, the question was posed: ‘Can physical preparation and medical be teammates?’2—we propose that they must and do so in collaboration with coaching staff using an integrated approach anchoring on health and performance-focused outcomes.
What does integrated performance support look like?
Clear ‘multi-lingual’ leadership—similar to how our house analogy needs a general contractor responsible for coordinating the various professionals to finish the house, so does the support team need a leader. It is critical that he/she speaks the language of the different disciplines and both understands and respects the practitioners’ skillsets in order to better facilitate collaboration, focus and efficiency. Equally important is that this leader understands and respects the coaching process and can deliver information in a manner that coaches and athletes understand.
Distinct skillsets, evidence-based, collective decisions—each member of the support team and coaching staff brings a specialised skillset best suited to manage specific aspects of athletes’ health or performance. True integration happens when decisions are reached collaboratively, with individuals bringing to the table their specific perspectives and ‘toolkit’, while leaving egos and agendas at the door. Importantly, these decisions should carefully combine practitioner and coach experiences and intuition with the best-available evidence.4 As the shear volume and complexity of data collected in sport increases, it is crucial not to lose sight of the value of blending experience with proper data interpretation in collective decision making.5 6
Shared and shifting responsibility—collective discussions allow responsibility to be shared and allocated among members on a decision-by-decision basis. In many instances, there is a case to be made for input from multiple individuals, with primary responsibility often resting on one. For example, following an acute injury, responsibility may initially rest with the sports medicine physician,1 with input from the dietitian, physiologist, physiotherapist and possibly the psychologist. As the athlete recovers, responsibility may shift to the physiotherapist and eventually the physiologist or strength and conditioning coach. Throughout, the support team works together with the coaching staff to ensure workloads are high enough to drive recovery and adaptation while avoiding excessive spikes that may increase reinjury risk.7 8 In this way, decisions are shared across the team while the primary responsibility shifts between individuals depending on whose ‘skillset’ is best suited for that specific time.
Context-dependent—while the principles remain the same, the make-up of every performance team will vary, depending on the sport, objectives, resources, personnel and budget. More important than the exact team composition is the process whereby they operate.
Facilitating an integrated performance approach
Two of the most common barriers to integration include (1) the individuals within the team and (2) the overall team culture. It is of paramount importance to hire individual team members and leaders who embrace a collaborative approach to performance management. Furthermore, with the right people in place, a culture of integration needs to be continuously fostered. Open communication must exist between team members and coaches, and adequate time must be allocated for group discussion and decision making. Finally, clear responsibilities and roles should be established for all individuals within the team, with overall health and performance objectives openly identified. However, even with the right individuals and culture, the demands of high performance sport can take its toll. It is equally important to have strategies in place for when the pressure of a losing streak, or a run of non-preventable injuries, begins to break down communication and derail integration. Strategies that have been successful include regular non-breakable debrief meetings that include practitioners and coaches, using a dynamic approach to planning, and anchoring decisions on key health and performance objectives that balance both process and outcome.
Successful elite performance is the product of many different factors, all interacting and changing over time. However, an integrated team of practitioners and coaches effectively working together can increase the likelihood of predictable high performance (figure 1).
Contributors BCS was responsible for the conception, drafting, writing and reviewing of the manuscript. JW contributed to the drafting, writing and reviewing of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.