WADA - Optimising Anti-Doping Control System in Cycling in France

Optimising Anti-Doping Control System in Cycling in France

World Anti-Doping Agency Social Science Research Grant Project Report 17/12/2024

Dr Scott McLean, Dr Matthew Morrison, Dr Hugo Kerhervé, Prof. Paul SalmonOptimising Anti-Doping Control Systems in Cycling in France

2

Contents Executive summary ................................................................................................................ 3 Summary of key findings........................................................................................................ 4

Project: Overview .................................................................................................................. 5

Doping as a complex system .................................................................................................. 5 The need for a complex systems approach in the anti-doping research context ............................. 5 Systems ergonomics and the Systems Theoretic Accident Model Processes (STAMP) model ........... 5 Prospective risk assessment using Systems Theoretic Process Analysis (STP A) ............................ 6 Project aims and scope ......................................................................................................... 6 Project phases ........................................................................................................................ 6 Development of a STAMP Control Structure and STPA prospective risk analysis ..................... 7 Methods .............................................................................................................................. 7 Design ............................................................................................................................ 7 Participants ...................................................................................................................... 7 STAMP model development .............................................................................................. 7 Systems Theoretic Process Analysis (STPA) application ........................................................ 8 Results ................................................................................................................................ 9 Validation of the STAMP Control Structure model................................................................ 9 STAMP model ............................................................................................................... 10 Systems Theoretic Process Analysis (STPA) ...................................................................... 13 Identification of new control and feedback mechanisms ...................................................... 13 Discussion ........................................................................................................................ 16 Conclusion ........................................................................................................................ 18 References ........................................................................................................................... 19 Appendices .......................................................................................................................... 21Optimising Anti-Doping Control Systems in Cycling in France

3

Executive summary Doping occurs in a complex and dynamic environment. Often, the sporting system in which doping occurs comprises multiple hierarchical levels that is challenging to fully elucidate. To date, research in doping has typically focused on athletes and athlete support personnel at the sharp end of

3

Executive summary Doping occurs in a complex and dynamic environment. Often, the sporting system in which doping occurs comprises multiple hierarchical levels that is challenging to fully elucidate. To date, research in doping has typically focused on athletes and athlete support personnel at the sharp end of this hierarchy rather than the broader systemic factors that contribute to doping. To understand and optimise the behaviour of complex systems (i.e., the anti-doping system), the application of contemporary systems thinking-based methods has been recommended. Such methods allow for analytical modelling to be conducted to understand and identify the numerous interacting factors that influence system behaviour. This enables the identification of opportunities to intervene and optimise the overall system rather than its component parts. The World Anti-Doping Agency (WADA), through their Social Science Research (SSR) Grants scheme have funded systems thinking-based investigations into doping in sport. In a previous WADA SSR funded project which applied systems thinking-based methods to anti-doping in the football codes in Australia, doping was identified as an emergent property of the broader sports system and leverage points were identified that can exert positive influence and change within the system. The current project was funded as an extension of the Australian football code investigation to apply systems thinking-based methods to understand and optimise the anti-doping system in elite cycling in France. This will enable a direct comparison of anti-doping systems across different sports and different counties and continents. The project was conducted in two phases. In the first phase, a control structure model of the current anti-doping system for cycling in France was developed. This involved adapting a previous control structure for anti-doping in Australian football codes to the French cycling system, using subject matter experts. The second phase applied a risk assessment of the control structure for cycling in France to identify potential control and feedback mechanism failures or inadequacies that may exist within the French anti-doping system.

This research was undertaken to answer the following research questions:

1. Who are the actors (people) and organisations (international organisations, governments)

the control structure for cycling in France to identify potential control and feedback mechanism failures or inadequacies that may exist within the French anti-doping system.

This research was undertaken to answer the following research questions:

1. Who are the actors (people) and organisations (international organisations, governments) involved in implementing control or anti-doping in elite cycling in France?

2. What are the systemic doping controls currently used in elite cycling in France?

3. What feedback mechanisms enable us to judge how well existing doping controls are working in elite cycling in France?

4. How can we predict failures that will prevent controls from being effective in elite cycling in

France?

5. What are stakeholders’ perceptions of optimal interventions to address control failures in elite cycling in France?Optimising Anti-Doping Control Systems in Cycling in France

4

Summary of key findings • The control structure currently in place for anti-doping in French cycling contains numerous actors across various hierarchical levels within the system, indicating doping prevention is a shared responsibility for all anti-doping stakeholders. • Membership of the European Union, dictates the necessity of more stakeholders at higher levels of the control structure that exert influence on the French cycling system, compared to the Australian anti-doping system. For example, organisations such as Union Cycliste Internationale, Union Européenne de Cyclisme, Council of Europe, European College of Sport Science, and European Medicines Agency are present and influence the French cycling system. • Similar stakeholders were identified at the lower levels of the French cycling STAMP control structure and the Australian football codes STAMP, including athletes, athlete support personnel, coaches, doctors, officials, anti-doping educations, and doping control officers. • Interventions may be more effective at reducing anti-doping rule violations if targeted at behaviour change across a combination of stakeholders from all levels in the system. • Education is a key strategy for doping prevention in French cycling, and also Australian football codes, however, there are not currently sufficient mechanisms in place to assess the effectiveness or reach of anti-doping education in both countries.

behaviour change across a combination of stakeholders from all levels in the system. • Education is a key strategy for doping prevention in French cycling, and also Australian football codes, however, there are not currently sufficient mechanisms in place to assess the effectiveness or reach of anti-doping education in both countries. • A comprehensive risk assessment identified a total of 734 potential failures in the French cycling structure, which included 448 control failures and 286 feedback failures. • Potential new controls that could strengthen the elite French cycling anti-doping system include broader awareness/education programmes, funding for broader awareness, implementing school education programmes, and the development of an integrated data collection system. • New feedback mechanisms identified to strengthen the elite French cycling anti-doping system include the development and implementation of an athlete feedback system and mechanisms to assist in understanding the effectiveness and reach of anti-doping education.Optimising Anti-Doping Control Systems in Cycling in France

5

Project: Overview Doping as a complex system The use of performance enhancing substances (PES) in sport poses risks to athlete health and wellbeing, and violates the spirit of sport (1). The use of prohibited substances or methods, often referred to as ‘doping’ includes the administration, use, or manipulation of substances, synthetic or autologous, with the intention of altering sports performance (1). The effects of doping on performance and subsequent physiological adaptations of taking PES have been well documented (1).

Further, the consequences and punishments of doping in sport (2), doping prevention strategies (3), sports management in relation to doping (4), and the perceptions of athletes who have doped (5) have all been reported. Arguments to legalise blood doping have been put forward, with the position that allowing doping to occur would enhance athlete safety (6), a sentiment echoed by the proposed ‘Enhanced Games’ (www.enhanced.org) where athletes are encouraged and provided guidance to take PES and compete. Doping in sport persists, despite advances in PES detection methods, stringent testing

allowing doping to occur would enhance athlete safety (6), a sentiment echoed by the proposed ‘Enhanced Games’ (www.enhanced.org) where athletes are encouraged and provided guidance to take PES and compete. Doping in sport persists, despite advances in PES detection methods, stringent testing protocols, deterrents, and severe punishments for anti-doping rule violations (ADRV). Education is an important component of anti-doping prevention programmes, moving beyond traditional deterrence and detection-based models (7-9). The WADA review of progress in removing doping from sport revealed that human, wider-environmental, and political factors have a considerable influence on doping in sport (10). Consequently, doping in sport represents a complex and dynamic issue. Further, it is important to acknowledge that prevention programmes should be aimed at changing broader societal norms around doping (11). There is a clear need for novel research practices that aim to understand the wider systemic factors that influence individual athlete behaviours. The need for a complex systems approach in the anti-doping research context Given the complexity of doping in sport (12), a ‘complex systems approach’ to understanding a range of systemic issues is required. Traditional research approaches that attempt to understand the intrapersonal determinants of doping behaviours will invariably fall short if the end goal is to prevent athletic malpractices from a population-level perspective. It is critical that lessons learnt from the wider epidemiological, public health, and safety science domains are translated effectively to a sports doping research context. For instance, chronic disease and mental health, once viewed solely as a problem of the individual, are now considered ‘complex systems problems’ requiring consideration of a broader set of societal, organisational, and environmental factors that necessitate alternative scientific approaches. Similarly, the same logic and reasoning should now be applied to doping in sport, an area of sport science research that has been dominated by research applications that reduce down complexity to explicate and justify the beliefs and actions of individual athletes (1). A complex systems approach allows for the mapping of latent factors and systemic determinants of the ‘sports

sport, an area of sport science research that has been dominated by research applications that reduce down complexity to explicate and justify the beliefs and actions of individual athletes (1). A complex systems approach allows for the mapping of latent factors and systemic determinants of the ‘sports doping system’ whilst also striving to conceptualise and interrogate the dynamic relationships across levels of the sports doping hierarchy. This includes investigating the political and legislative structures and services that enable or inhibit the more salient athletic behaviours observed at the sharp end of the doping system (e.g., the actions of the athletes that are expressive of the symptoms of a deeper underlying cause). It can be concluded that a complex systems approach is needed to take doping prevention further. Systems ergonomics and the Systems Theoretic Accident Model Processes (STAMP) model Systems ergonomics refers to the study of ‘sociotechnical systems’, which examines the interactions between people, and a range of organisational, societal, and technological factors that influence their beliefs, decisions, and behaviours (13). Systems ergonomics methods are purpose-built to understand complexity and are gaining popularity in sport (9, 14-16). Specific applications of systems ergonomics methods include domains such as performance (17, 18), injury (19, 20), decision-Optimising Anti-Doping Control Systems in Cycling in France

6

making (21), and sport system design and re-design (22, 23). Using systems ergonomics methods to understand the inherent complexity within sport requires a detailed understanding of the interacting and interdependent relationships that exist between system components that shape the overall behaviour of a system (24). One method that has been applied in sport and anti-doping (9) is the Systems Theoretic Accident Model and Processes (STAMP) method (25). The theoretical basis of STAMP is derived from systems and control theory, and promotes the view that adverse events result from inadequate control structures and deficiencies surrounding the enforcement of safety-related constraints (25). In a sporting context, doping is an emergent and irreducible property that is directly controlled and

from systems and control theory, and promotes the view that adverse events result from inadequate control structures and deficiencies surrounding the enforcement of safety-related constraints (25). In a sporting context, doping is an emergent and irreducible property that is directly controlled and influenced by policies, procedures, culture, people, and products. STAMP is a suitable approach for mapping systemic factors and processes that underpin doping behaviours and has been applied to doping control structures of Australian football codes (9). Further, STAMP has been used to model the control structures in place to manage concussion in rugby union (26) and running injury (19). Prospective risk assessment using Systems Theoretic Process Analysis (STP A) Modelling the control structure of the elite French cycling system allows for a prospective risk analysis to be conducted. The STPA is a proactive risk analysis method that was developed to be used in conjunction with the STAMP control structure to prospectively examine failures in the control and feedback mechanisms present within a system. By applying the STPA risk assessment tool (27) to the modelled French anti-doping control structure, existing controls and feedback mechanisms can be strengthened and new controls and feedback mechanisms can be identified to improve the anti-doping system in elite French cycling.

Project aims and scope The overarching research aim comprises the following specific questions:

1. Who are the actors and organisations involved in implementing controls for anti-doping in elite cycling in France?

2. What are the systemic controls to doping that are currently in place?

3. What feedback mechanisms enable us to judge how well existing controls are working?

4. How can we predict failures that will prevent controls from being effective?

5. What are the optimal interventions to address control failures?

Project phases The project included the following two phases:

1. In the first phase, a control structure model of the current anti-doping system for cycling in France was developed using STAMP. This involved adapting a previous control structure for anti-doping in Australian football codes to the French cycling system, using subject matter experts.

1. In the first phase, a control structure model of the current anti-doping system for cycling in France was developed using STAMP. This involved adapting a previous control structure for anti-doping in Australian football codes to the French cycling system, using subject matter experts.

2. The second phase applied an STPA to the STAMP control structure for cycling in France to identify potential control and feedback mechanism failures or inadequacies that may exist within the system.Optimising Anti-Doping Control Systems in Cycling in France

7

Development of a STAMP Control Structure and STPA prospective risk analysis Methods Design The study included a multi-phase approach to develop and validate a control structure model (for an example, see Figure 1) of anti-doping in French cycling using STAMP. As shown in Figure 2, the control structure model was developed based on data derived from multiple sources, including a previous STAMP analysis of the anti-doping system in football codes in Australia, anti-doping stakeholder websites, policy documents, anti-doping strategies, peer reviewed literature, and subject matter expert (SME) review. A comprehensive risk assessment using the Systems Theoretic Process Analysis (STPA) was applied to identify the range of STAMP control and feedback failures that could occur within the current doping prevention system in cycling in France. Participants In this project, nine participants (7 female, 2 male) with experience in anti-doping (9.09 ± 7.05 years) contributed as subject matter experts to develop the STAMP control structure of French cycling. Participants held positions at the French Anti-doping Agency (AFLD) and the National Institute of Sport, Expertise, and Performance (INSEP). Participants held various current and previous roles in anti-doping and sports performance, including leadership roles (Director, Manager), education and prevention, WADA accredited laboratory, WADA communications, research, elite cycling, sport psychology. Two participants declined to provide descriptive demographic data but consented to participate in the study. STAMP model development

roles in anti-doping and sports performance, including leadership roles (Director, Manager), education and prevention, WADA accredited laboratory, WADA communications, research, elite cycling, sport psychology. Two participants declined to provide descriptive demographic data but consented to participate in the study. STAMP model development A draft control structure model of the French anti-doping system was developed by the research team based on a previous control structure model of football codes in Australia (9). This included modifying the control structure from an Australian to a French context and including or removing stakeholders, controls and feedbacks. In addition, publicly available sources, including antidoping stakeholder websites, anti-doping policy documents, anti-doping strategies, media, and peer reviewed literature were used to develop the draft control structure. To accurately reflect the antidoping system, the STAMP model was adapted to include an international level, which is commonplace in other STAMP analyses (9). Three separate in-person SME workshops were conducted to review and refine the control structure model. The workshops were facilitated by the research team who have extensive experience in conducting workshops for complex system model development and validation purposes (9, 28). The draft control structure model and instructions on how to interpret the model were sent to the participants two weeks prior to the workshops. During the workshop, participants were asked to review each of the hierarchical levels of the control structure model to determine the accuracy of the actors and organisations included in the model, and to identify any missing stakeholders. This involved starting at the international level of the control structure and working down through the levels. Participants were then asked to review each of the controls and feedback mechanisms included in the model to determine their accuracy and to identify any missing control and feedback mechanisms. This involved first starting at the top of the control structure and working down through the control mechanisms, and then back up through the feedback mechanisms. Two members of the research team (MM, SM) then refined the model based on the feedback from the SME reviews. The refined model was sent back out to the workshop participants via email for additional comments, and further revisions were made resulting in a final validated control structure

Two members of the research team (MM, SM) then refined the model based on the feedback from the SME reviews. The refined model was sent back out to the workshop participants via email for additional comments, and further revisions were made resulting in a final validated control structure model of anti-doping in French cycling. The final component of the workshops was obtaining feedback on how the French anti-doping system could be strengthened from a systems thinking perspective. Participants were prompted by theOptimising Anti-Doping Control Systems in Cycling in France

8

research team to think about areas of weakness in the current system and devise potential intervention strategies. Participant responses were collected through notetaking during the workshops from the research team.

Figure 1. Conceptual control structure of the Australian football codes anti-doping system adopted from Leveson (25) and McLean et al (9). Controls are represented by solid arrows which are enforced down through the system. Feedback, represented by broken arrows represents information being communicated back up the system. Control and feedback mechanisms are passed between levels and across levels. Therefore, each level includes a description of the relevant actors that play a role in system design or operation. Control and feedback mechanisms demonstrate what controls are present in the system and where they are enacted down the system hierarchy and what information about the status of the system is sent back up the hierarchy.

Systems Theoretic Process Analysis (STPA) application A member of the research team (MM) conducted the STPA, which was subsequently reviewed by two senior researchers on the project (SM & PS). The STPA was adapted from previous anti-doping STPA of Australian Football Codes (9). The STPA involved assessing each control and feedback mechanism from the STAMP control structure for credible risks associated with four failure modes. The STPA considers each control and feedback mechanism identified in the control structure along with an unsafe control actions taxonomy that comprises four failure modes (29): 1) Control of feedback action is not provided or followed. 2) An unsafe (incorrect) control or feedback action is provided.

modes. The STPA considers each control and feedback mechanism identified in the control structure along with an unsafe control actions taxonomy that comprises four failure modes (29): 1) Control of feedback action is not provided or followed. 2) An unsafe (incorrect) control or feedback action is provided. 3) Control or feedback action is provided too early or too late (wrong time or sequence). 4) Control or feedback action is stopped too soon or applied too long (for continuous control actions, not discrete ones).Optimising Anti-Doping Control Systems in Cycling in France

9

An example of a control and feedback risk identified is provided below: For the control, ‘compliance reports’ is enacted from the international influence level onto the parliament and legislatures level, and the potential control failures could include: 1) Action required but not provided. No compliance reports provided resulting in inability to determine if countries are compliant with WADA code resulting in deterioration of the antidoping system. 2) Unsafe action provided. Inappropriate compliance reports provided meaning incorrect international guidance for anti-doping. 3) Wrong timing and/or sequence. Compliance reports provided too late resulting in delayed reporting of compliance activities to inform KPIs, risks, and challenges. 4) Control stopped too soon or applied too long. Compliance reports are provided too early, prior to identifying new risks and challenges For the feedback ‘education attendance data & statistics’ potential failures for the feedback mechanism from the operating equipment, environment, and processes level to the local management and supervision level could include: 1) Action required but not provided. No education attendance data provided resulting in an inability to determine who is attending education and compliant with current education requirements. 2) Unsafe action provided. Inaccurate education attendance data provided leading to an inaccurate understanding of who has been attending education. 3) Wrong timing and/or sequence. Education attendance data provided too late to accurately capture stakeholders who attended. 4) Feedback stopped too soon or applied too long. Education attendance data recording stopped too soon, and attendees are not recorded leading to them being viewed as having not received

1. Wrong timing and/or sequence. Education attendance data provided too late to accurately capture stakeholders who attended. 4) Feedback stopped too soon or applied too long. Education attendance data recording stopped too soon, and attendees are not recorded leading to them being viewed as having not received anti-doping education.

Results Validation of the STAMP Control Structure model The STAMP model validation process is presented in Figure 2. Subject matter expert feedback was used to refine the model by adding or removing actors, controls, and feedback mechanisms.

Figure 2. The STAMP model validation process showing the development and refinement of actors, controls, and feedback mechanisms identified by the SMEs at each review phase.Optimising Anti-Doping Control Systems in Cycling in France

10

STAMP model The validated control structure of French cycling is presented in Figure 3. The model presents the actors involved at each level, as well as the control and feedback mechanisms. The control mechanisms are indicated by the labels shown adjacent to the solid arrows propagating down through the hierarchy whereas the feedback mechanisms are represented by the labels adjacent to the dashed arrows propagating up through the hierarchy. A total of 132 actors, 115 control mechanisms, and 77 feedback mechanisms that are responsible for the performance of the anti-doping system in elite French cycling were identified. At the international level, there were 28 actors identified that exert influence on actors at all levels of the elite French cycling anti-doping system hierarchy through several control mechanisms, such as Union Cycliste Internationale, WADA, and European Medicines Agency. Control mechanisms (n = 37) included WADA International Standards, Reasoned Decisions (Court of Arbitration for Sport), compliance reports, the WADA code, WADA ethics, and WADA policy and procedures, among others (Figure 3). Feedback mechanisms used in the French cycling anti-doping system to provide information to the international actors (n = 20) include auditing, research reports and findings, and investigation reporting, among others (Figure 3).

among others (Figure 3). Feedback mechanisms used in the French cycling anti-doping system to provide information to the international actors (n = 20) include auditing, research reports and findings, and investigation reporting, among others (Figure 3). At the parliamentary level, there were eight actors identified who impose seven controls on level two actors (e.g., Government agencies, industry associations), including Congress of the French Parliament, Sports Ministry, and State councils. Control mechanisms included advocacy, accreditation, testing and collection, substance information, among others. Feedback mechanisms provided to level one actors (n = 13) from lower levels in the system included advocacy, research reports and findings, and sanction data and statistics, among others (Figure 3). At the Government agencies, industry associations, user groups, courts, and universities level, 26 actors including French National Olympic and Paralympic Sports Committee, French Accreditation Committee (COFRAC), and the French sports code, among others, were identified who impose 3