Craig Pickering

Sports Science Quarterly – Q1 2022

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For the last 6 years we’ve delivered you insights into the latest sports science research every month. For 2022 we’re making a little change: our sports science updates will be released on a quarterly basis. Below is our first update of the year, where we look at lessons on briefing and debriefing from the military, the coach’s eye, working with Gen Z, foam rolling, and more.

As always, the full Sports Science Quarterly is available exclusively to HMMR Plus Members. You can browse the past topics on our archive page. The first topic below is free to everyone, but sign up now to read about all the latest research. To get an idea of what Sports Science Quarterly is all about, the April 2016 edition is available in its entirety for free.

This Month’s Topics

Briefing and debriefing to enhance performance

Quick Summary – Debriefing is crucial for high performance, and yet it’s something that is rarely done well. This paper explores what the Israeli air force do within their debriefs, and provides a guide for how we might approach debriefs within our own practice.

And now time for something completely different; the first paper we’re going to take a look at this month comes from the journal Human Resource Management, and explores processes that take place in the military, applying them to a medical setting. On the surface, it’s easy to question what this has to do with sport; however, if we want to improve what we do, we need to more open minded about taking ideas and processes from other domains and applying them to ours. In sport, this is most typically done in transferring business ideas into sport, which is the initial genesis here (Human Resource Management is a journal focused on HR, which is a key pillar of any successful business organisation). However, high performance occurs across a variety of domains, including the military and medical settings, where the cost of poor performance isn’t defeat, but death. As the stakes are higher, the processes are typically better, and, as such, there is much we can learn from these areas in guiding our own high-performance behaviours.

As you might imagine, mistakes within a healthcare setting can be very costly; just under 100,000 patients in the US alone die each year due to errors made in hospital. As anyone who has ever made a mistake at work will know, the initial response is to try and hide the error so that we don’t get punished. However, these actions in and of themselves perpetuate the mistakes; if we don’t understand what has gone wrong and why, we can’t prevent it from happening in the future. If you’ve watched Dr Death, you’ve seen this in action; here, a spinal surgeon who was largely inept was able to continue to operate on patients—despite killing more than one—because the hospitals he was working at didn’t want to admit mistakes and open themselves up to litigation. Whilst this is less of an issue in countries with public healthcare and less litigious cultures, there are many examples, from across the globe and from across different spheres, of mistakes occurring, being covered up or avoided, and the same issue continuing to happen. This is especially true where there is a hierarchy in play, with junior ranks typically unwilling (or unable) to point out mistakes or dangerous behaviours demonstrated by their superiors; the crash of Korean Air Cargo Flight 8509 is a great example of this, in which the 33-year old First Officer was unwilling to challenge the 57-year old Captain, ultimately leading to his own death.

Many medical procedures, and especially surgeries, are carried out in team units. The team unit is now a common feature across multiple domains; the UK Special Forces, for example, work in four-man teams as standard (the Australian Special Forces work in teams of five). The same is true in sport. Most obviously, we have team sports, which, as the name suggests, are formed of teams. But even in traditionally “individual” sports, we are beginning to see the emergence of teams; in athletics, for example, at the high level there is a whole support team around a given athlete and coach—and, in the relays, there are even team events. Given the prevalence of teams as the functional working unit across multiple domains, an understanding of team effectiveness, and the structure and processes that underpin such effectiveness, is becoming increasingly important.

Research into effective teams has identified the importance of something called team reflexivity. Reflexive teams naturally reflect on their actions, which allows them to enhance their levels of performance. This is important because, through enhancing the performance of a team, we can enhance the performance of the umbrella organisation. Taking an example from track and field; the better we can improve the performance of each relay team, the greater the likelihood of winning more medals – typically a key organisational KPI. Similarly, reflection allows for learning, which—again through enhancing the knowledge of teams—in turn drives organizational learning. Team reflexivity is comprised of three key stages; reflection, planning, and adaptation. In the reflection stage, team members identify any differences between what the hoped performance was, and what the actual outcome was. This informs the planning stage; here, team members identify ways to better ensure that actual performance is as close as possible to the hoped performance. Finally, they implement these changes in the adaptation stage, before starting the activity again; in this manner, reflexive teams are continually analysing performance and updating what they do.

It can be hard to develop reflexive teams. Firstly, team reflexivity requires high levels of psychological safety; all team members need to both feel comfortable in providing and receiving challenging feedback, in a way that is primed to optimize performance. Secondly, many teams operate in complex environments; in a hospital, for example, surgical teams tend to be fluid and dynamic (depending on who is on shift) and multidisciplinary. This transient nature of team members can challenge the development of psychological safety. Similarly, strict hierarchies can also inhibit the development of reflexive teams, as such hierarchies often discourage the questioning of key assumptions or decisions made by those on top of the hierarchy.

One tool that has been shown by research to enhance team reflexivity is that of team pre-briefings and post-action reviews. Pre-briefings, as the name suggests, occur before a given action occurs; typically, they set out and confirm the roles of each team member, along with both individual and overall expectations, strategies, and key performance issues. Post-action reviews, occurring after the activity, allow for a systematic sharing of observations around individual and team performance. Pre-briefings and post-action reviews are common in military settings. For example, since the mid-1980s, the Israeli Air Force (IAF) has utilised both as part of their routine, a process they adopted from UK and US armed forces, who have been utilising both since the early 1900s. Utilising the processes of the IAF, the authors of this study attempted to transfer the pre-briefing and after-action review processes to hospital surgical teams—something likely of interest to us if we want to utilise such processes within sport.

At the core of after-action reviews is the idea of double-loop learning. Typically, learning happens in a single loop fashion; we do something, we learn a lesson, and we therefore update how we do things in future. Double loop learning, in contrast, occurs when an error is detected, and then corrected, in a way which requires us to update how we do things—in terms of shared norms, organizational policies, or objectives.

For this study, the authors collected data from both the IAF and from a hospital aimed at understanding what key factors underpin effective briefing and debriefing behaviours in the IAF, and how this might transfer to a healtcare setting. In addition, they carried out interviews with 40 people from both the IAF (base commanders, pilots, navigators) and hospitals (surgeons, anesthetists, nurses, and management), and observed both IAF briefing sessions and hospital surgeries.

So what goes into an IAF briefing? Firstly, there is an outline of general information; for example what the mission is. Then come a key set of constraints; for example, the altitude designated for flight, or the weather forecast. Next are the key aspects of the coming flight, such as the rules of the exercise, or the duration; this is then followed three specific goals for flight, a review of what happened yesterday (which informs the main points for the day), a discussion around safety and risk management, and, finally, a brief mention of what needs to be prepared for the debrief. In the debrief, the team review their objectives, and discuss the degree to which they were met; they then review video and data from the flight, which informs their discussion around what they can do to improve their future performance. Finally, they finish with a summary of the key lessons learned.

In reviewing the debriefs that took place in the IAF, the researchers noted some key things. Firstly, rank had no influence on feedback, with the highest-ranking officer just as likely to be criticized as the lowest. Secondly, the primary focus of the review was on detecting and analysing errors, but the pilots also focused on acknowledging good performance. Finally, there was a focus on organizational improvement through double-loop learning; after an incident on one mission, the whole air force grounded flights the next day so all bases could carry out a specific debrief on the issue at hand. This all links back to some of the key concepts of team reflexivity; reflection, planning, and adaptation.

Next, the researchers attempted to utilise the IAF’s brief-debrief approach within surgical teams at hospitals. Much like combat flying, surgery can be a highly stressful experience, with much at stake. Surgery—like dog fighting—can also be complex, with unexpected and unusual things occurring, and comprised of teams with different individual roles. However, there are some key differences. Unlike in the IAF, where rank doesn’t matter when it comes to receiving feedback (both in content and tone), surgical teams are highly hierarchical in nature, with a team leader and team members. This isn’t necessarily a problem, but the hierarchy often persists post-surgery, meaning that feedback cannot always be freely shared—or even encouraged. Observing these hospital teams, the researchers noted that junior doctors and nurses often only spoke once spoken to, with tension between senior and junior team members.

The end result of the study was that the briefing-debriefing cycle utilised in the IAF could be successfully implemented in a hospital setting, enhancing team reflexivity and performance. The study outcome is perhaps not as important to us as the exploration of the concept of briefing and debriefings, something that we could easily implement within sport. Mimicking the IAF process, a pre-training briefing could outline the content and goals of the session, highlight how this fits into the overall bigger picture, and then discuss personal risk management—the risk of injury and/or underperformance from each individual athlete in this specific session. This can be a useful way for the coach to understand how each athlete is presenting, both physically and mentally, prior to the session, and then making modifications accordingly. In addition, by understanding the role the specific session plays in the overall development, athletes may be more engaged in the training processes, enhancing their outcome.

Similarly, once the training session has been completed, a quick debrief may be useful. This could be a discussion from the coach as to whether the training session’s goals were met—and, if not, why not—along with identifying some further areas for improvement. Similarly, athletes could provide feedback to the coach(es) as to how they delivered the session, what worked well, and what didn’t, as a means of enhancing their session delivery next time. Video can also be reviewed of the session to further drive home the key points and highlight positives and negatives.

Such a process would allow for the athlete and coach “team” to become more reflexive in nature, updating practices as they go based on their continued feedback. Often, we wait for key milestones—such as the end of the season—to carry out a full review, when more frequent mini-reviews, such as after each training session or training week, would allow for issues to be caught sooner. Have such a briefing/debriefing approach requires the coach to be very vulnerable and open to feedback—something which may not sit easy with many of us. Hearing feedback can be confronting and difficult, but it is a crucial part of getting better—as coaches, you all want your athletes to be better, and so being open to feedback, and improving as a result of this feedback, is crucial. Similarly, developing psychological safety within your “team” is also important; athletes need to feel like they can provide the coach with feedback without being punished as a result of providing that feedback.

In summary, I think most of us in sport could harness the IAF’s briefing and debriefing approach as a means of supporting athlete performance and promoting learning. This paper outlines what the process is, and why it is important, and I think there is likely something we can all take away from this to improve our practice.

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