When Less Creates More - What limited resources forced a support department to see
In 2016, we moved a professional rugby club from an insurance model to self-pay.
Healthcare costs had become unsustainable. We negotiated bulk purchasing with a scanning centre, agreed fees with orthopaedic clinics and built a specialist network around the club’s needs.
But the biggest change was not how we paid. It was how we decided.
I became more accountable for external healthcare spending. Imaging became a decision to justify, rather than a reflex response to uncertainty. We had to be clearer about the clinical question, what assessment had established and whether a scan would change diagnosis or management.
This was one constraint among several.
The club’s location made recruitment difficult. Central funding was falling, ownership would not cover the gap, and the squad composition shifted. Players often arrived with significant injury histories, limited recent playing exposure or wider personal and performance challenges.
There was no doctor embedded in the day-to-day support team. Staffing, facilities and technology were limited. We had less capacity to absorb unavailability and fewer options to add support.
We did not set out to design a different system. We had to make the existing one work.
What the constraints made visible
With fewer people, ownership and the consequences of decisions were harder to diffuse.
Physiotherapy took greater responsibility for initial assessment, triage, progression and communication. Clinical assessment became a staged process: from the treatment bed to the gym, then exposure on the field.
Each stage informed the next, connecting clinical findings with function, context and the athlete’s response to loading.
This brought physiotherapy, strength and conditioning, the player and coaching into closer alignment. Readiness, workload and the need for further investigation became shared questions.
Without an athlete management system or advanced testing technology, we relied on relationships, observation, contextual information and prioritisation. Higher-risk players received more attention. Lower-risk players were expected to develop greater independence.
The schedule also imposed discipline. Training days could involve double or triple sessions, but days off were protected. Appointments had to be triaged, communication needed to be direct, and meetings needed a clear purpose.
Physical and training standards mattered. Fitness standards had to be met for selection. Repetitions and sets were accounted for, and routine errors were not simply ignored. Individual mistakes could affect the wider group, while a separate points system created internal competition.
These were different mechanisms, but both made expectations visible.
Accountability also needed room for learning. Players and staff could respectfully challenge decisions. Effort was recognised, and reflection offered opportunities to improve judgement and regain trust.
Together, clearer ownership, shared standards and learning supported better decisions around risk, readiness and workload.
The aim was not to stay small
Across several seasons, including promotions, relegations and near misses, internal tracking showed year-on-year reductions in external healthcare spending and diagnostic imaging, alongside improved availability against the league benchmark we used.
That does not establish that constraints caused those improvements. Continuity, competent staff, a core group of young players, a favourable schedule, co-operation and humour all mattered.
But the experience changed how we allocated resources.
Savings and growing trust created room for an additional role, better staff compensation and professional development.
The aim was not to keep the department small. It was to invest in needs the system had made clearer.
Start with the problem, not the resource
High-performance departments can grow through a succession of reasonable decisions.
A problem prompts another specialist. A technology introduces another reporting process. A request for individualisation creates more appointments.
The department becomes more sophisticated. The original problem may remain.
Before asking what to add, define what needs to improve:
Which injuries create the greatest loss of availability?
What physical capacities does the sport, position or playing model require?
Which athletes need the most support?
Where do decisions, communication or progression repeatedly break down?
“Building a world-class department” invites open-ended opinions.
“Reducing avoidable time-loss injuries and preparing this squad for these demands” creates a problem that can be studied, prioritised and managed.
People, technology and expertise should follow that definition, not substitute for it.
Design constraints that improve decisions
Not every useful constraint requires a smaller budget. Some can be designed into how a department works.
Protect time away
Days off should not become an extension of the programme by default.
If a player or staff member needs to attend, someone should own the decision and explain why the work is necessary, why it cannot wait and what it changes.
Otherwise, activity can become protected simply because it looks committed.
Protect shared observation
Protect a regular window in which clinical, physical and coaching staff observe the same preparation-to-field process, with routine activity arranged around it.
The purpose is not another meeting. It is to compare observations, identify bottlenecks and agree what should stay the same or change.
Make activity earn its place
A test, report or meeting should change a decision, resolve a problem or create alignment.
Start with a bounded trial. Pause an activity whose contribution is uncertain, define what would signal a problem and review what changes.
Give the trial an owner, a review point and clear grounds for retaining, modifying or reinstating the activity.
The question is not simply whether the department can cope without it. It is whether the activity earns its place.
More attention is not always better support
Abundance creates its own pressures.
A monitoring tool adds information, but perhaps another dashboard and conversation. A specialist adds expertise, but another opinion to reconcile. More appointments can create the expectation that every athlete needs constant attention.
The same pattern can appear in physical preparation. Increasingly elaborate routines and continual cueing may displace something simpler: athletes understanding basic movements, repeating them consistently and recognising when something feels wrong.
Staff still supervise, support and maintain standards. But support should not automatically become dependence.
Individualisation is not giving everyone more. It is knowing who needs what, when and why.
That may mean intensive support for one athlete and greater independence for another. It may also mean maintaining a plan rather than demonstrating value through another intervention.
Clarity, not austerity
Constraints are not automatically beneficial.
Insufficient staffing, poor governance and inadequate specialist access can create unsafe conditions. Safety, safeguarding and appropriate diagnosis are not candidates for designed scarcity.
A more deliberate approach to imaging becomes harmful if cost overrides clinical need.
Our experience was not an argument against resources. It was a reminder that their value depends on how a system combines, uses and adapts them.
Sometimes the answer is another person, better technology or more specialist support. Sometimes it is clearer ownership, fewer competing activities or a standard that everyone understands.
The lesson was not that every organisation should operate with less.
It was that constraints exposed what was essential and helped us see where more would genuinely matter.
Frequently asked questions
Does working with fewer resources improve a performance department?
Not necessarily. In our experience, constraints exposed unclear priorities and made ownership harder to diffuse, but that does not establish that fewer resources caused better outcomes. Insufficient staffing, poor governance and inadequate specialist access can create unsafe conditions. The lesson is to identify what needs to improve, then allocate resources accordingly.
As a practitioner, how can I make the case for additional resources?
Define the problem before proposing the resource. Explain where current capacity limits safe or effective delivery, what you have already tried, and what additional support would change. Be specific about the expertise or capacity needed, the consequences of leaving the gap unresolved, and how you would review its contribution. Frame the request around need, not what other departments have.
If you’d like to discuss resourcing, adapting to difficult circumstances or decision-making under uncertainty, feel free to contact me.
About the Author
Dan Watson is a physiotherapist and performance manager with leadership experience across elite football, rugby league, cricket and The Royal Ballet. He specialises in improving athlete availability, aligning multidisciplinary teams, and translating risk into high-performance outcomes. His work has delivered measurable improvements in resource allocation and operational efficiency. Connect with Dan on LinkedIn.
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