I came to professional sport from academic medicine.

In that world, difficult questions keep people alive. In grand rounds, you ask uncomfortable questions to your colleagues. You poke holes in treatment plans. You challenge because the alternative is missing something that matters. I assumed that culture of questioning would translate directly to sport—and in many ways, it does, but the structures look different, the pressures are different, and the dynamics around speaking up operate in ways I hadn’t encountered before.

I started working in professional sport in 2018. I’d grown up as a competitive athlete—sport was not new to me. But working inside professional sport organizations was. I’m a sports psychiatrist, and I was fascinated by what I was seeing—the complexity of how these environments operate, the dynamics between coaches and athletes and front offices, the way information moves (or doesn’t) under pressure. I kept noticing moments where things worked beautifully—where people trusted each other, where problems got solved early, where talent flourished—and moments where the same organizations struggled with the same patterns. I wanted to understand what made the difference.

In academic medicine, when you want to understand something, you ask questions and you look at the research. So that’s what I did. Partly because curiosity has always been how I’m wired—I need to understand why things work the way they do. But mostly because I wanted to be genuinely useful to the organizations and people I was working with, and that meant going beyond intuition. I asked Madeline Antony—who was studying and researching sport psychology at the time, and who would become the co-author of this book—to find out. “I’m seeing this pattern—what does the literature say about it?” She’d come back with a five-page researched document. Sometimes, it was a robust evidence base from sport psychology. More often, it was a finding from organizational psychology, aviation human factors, healthcare team science, or military transition research that hadn’t been widely applied to sport. Sometimes, the answer was: “There’s no evidence in sports—but here’s what they found in healthcare” or “here’s what organizational psychology says.” And sometimes the answer surprised us both. So I’d ask another question. And another. What does the evidence say about silence under selection pressure? About decision-making during losing streaks? About what happens to staff who report concerns upward? About how organizations handle athlete transitions—and what happens when they don’t? Madeline kept producing. I kept asking. The cycle ran for years. Every answer opened new questions. Every application in the field taught us something that the literature alone couldn’t.

By 2022, something had shifted. We’d accumulated years of evidence reviews, applied frameworks, and documents tracking what worked and what didn’t across multiple environments. At some point—neither of us remembers exactly when—one of us said, “We should just write a textbook.” It was half a joke. We’d been building one without realizing it.

But the material wasn’t just a pile of research summaries. The questions had started to organize themselves. They had a dependency logic. I couldn’t answer the question about decision architecture until I’d answered the question about whether anyone could tell the truth. I couldn’t address sustainability until I’d addressed what happens when external stakeholders start screaming. The questions had an order—and that order kept proving itself in practice. When organizations tried to skip a layer, the intervention struggled. When they worked through the layers in order, the architecture held under pressure, and good things followed.

What we had wasn’t a collection of tips or a leadership philosophy. It was an operating system. Seven questions. Seven layers. A way of thinking about organizational culture that helped us—and the organizations we worked with—make sense of what was happening and what to do about it.

This book is what that cycle of observation and evidence review produced. It’s built practice-up—not theory-down. Every chapter starts with what practitioners see in the field, then asks what the evidence says about it, and then translates the answer into something an organization can use on Tuesday morning. It’s a reflection of how the architecture was actually built: one observation at a time, chased through the literature, tested in application, refined, and repeated.

I’m constantly learning, and I feel enormously grateful to do this work. The people I get to work with—the athletes, the staff—are some of the best in the world at what they do, and they’re constantly teaching me. Every environment I enter, I learn something I didn’t know before. The frameworks in this book are better because of the people who trusted me enough to be honest about what they were experiencing. That generosity runs through every page, even where confidentiality means I can’t name them.

A word about the partnership that produced this book. Madeline and I represent two sides of what we call the prac-ademic stance. I’m a clinician. I’m in the room. Madeline found out whether what I was seeing was backed by evidence—and when it wasn’t, she told me.

Madeline is relentlessly curious. I’d hand her a half-formed observation, and she’d disappear into the literature and come back with a five-page document and three follow-up questions I hadn’t thought to ask. She worked extraordinarily hard on this—nights, weekends, across years—and she pushed back when the evidence didn’t support what I thought I was seeing. That made the book better at every stage.

Since we began this work, Madeline has gone on to become a lawyer—which, if you’ve read this far, probably doesn’t surprise you. She builds arguments carefully, interrogates assumptions, and doesn’t let anything through that hasn’t earned its place. That rigor is on every page of this book. What a practitioner sees and what the evidence says don’t always agree—and we tried to be honest about that throughout the book.

The question underneath this entire book is a simple one: what does it take to build a high-performance sport organization that actually works—for everyone in it? That question is what drove us to write it.

Marie Claire Bourque (Dr. MCB)