Can Anyone Fix Low Site Performance?
Medidata and MSD show how 80% of patient enrollment comes from just 20% of selected sites.
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Every day a clinical trial is delayed costs the industry $56,000. Yet, inefficiencies in site selection continue to slow progress, impacting both timelines and global health outcomes.
The 80/20 Enrollment Dilemma
At the recent SCOPE-EU 2024 conference, Medidata and MSD presented a staggering statistic: 80% of patient enrollment comes from just 20% of selected research sites. This imbalance is driving the current strategic focus of large pharmaceutical companies. Instead of expanding site networks, they’re doubling down on identifying and retaining high-performing sites. But is this strategy sustainable?
The Risks of Narrowing Focus
While prioritizing top sites may seem logical, it comes with hidden risks that could compromise long-term success. Clinical trial volumes are growing by 8% each year, and the competition for sites is intensifying. Relying heavily on the top 20% of sites introduces significant risks:
1. Site Saturation: With companies competing for the same high-performing sites, portfolio overlap becomes a major issue, leading to internal cannibalization and inefficiencies.
2. Market Dynamics: Betting on top sites is effective only in a stable market, and history shows that markets are never static. What appears successful today may become unsustainable in the future.
In short, while this approach may yield short-term wins, it could create major challenges a decade from now.
Two Social Implications
Beyond operational risks, this strategy also poses social challenges, such as geographical disparities in trial access and patient misalignment:
1. Reduced Geographical Access: Limiting trials to a few top-performing sites forces patients to travel longer distances, creating disparities in trial access.
2. Patient Misalignment: Patients might not have access to the most appropriate trial for their medical needs but instead only to trials offered by the site’s preferred sponsors.
It’s a balancing act: Keeping non-recruiting sites is inefficient, but so is expanding blindly to underperforming ones.
Rethinking the Solution: Scaling Site Performance
The core issue remains: low site performance significantly delays drug development and access to life-saving treatments. Two strategic solutions could help address this:
Strategy 1. Finding and Empowering New Sites
The Challenge: Currently, only 5% of research sites conduct 70% of clinical trials, and among those, 37% fail to recruit even a single patient. Meanwhile, 95% of active research sites express a desire to run more trials.
The Opportunity.
1.1. Site Recruitment and Assessment Services
There’s a crucial missing piece in clinical trials: site recruitment. The world is full of patient recruitment solutions, but what about the sites where research actually happens?
We need smarter site recruitment services that include:
Auditing site infrastructure for research-readiness
Collecting critical performance metrics, such as patient enrollment rates, patient flow, and staff retention
Providing data-driven insights to identify and strategically invest in high-potential sites
While Site Management Organizations (SMOs) and site networks have traditionally supported these activities, they must evolve toward performance-based models. Well-established infrastructure and streamlined Study Start-Up (SSU) processes are no longer enough.
Emerging technology platforms like Inato are advancing the industry by qualifying community research sites and improving access to diverse patient populations. Further partnerships between data intelligence companies, such as Citeline, GlobalData, and Medidata, and SMOs could optimize site selection and deliver data-enhanced decision-making.
1.2. Research Site Enablement Services
The future of clinical trials depends on enabling the right sites. Facilities with strong patient populations but no research experience need tailored, dynamic support. Life sciences companies should adopt flexible and adaptive strategies, which may include:
Providing medical devices, specialized staff, and tailored training programs to transform healthcare facilities into capable research sites
Allocating grants for infrastructure enhancements, such as state-of-the-art lab equipment or patient-friendly amenities
Establishing mentorship initiatives, where high-performing research sites offer guidance and share best practices with emerging sites
These investments will create a scalable, efficient network of research-ready sites while fostering long-term, sustainable partnerships.
1.3. Data-Driven Site Selection
Data has the power to change everything, but a fundamental challenge remains: data transparency. For the industry to unlock the full potential of predictive analytics, recruitment data must be consistently shared and updated among stakeholders.
Imagine a world where site recruitment data is openly shared, setting a new standard for efficiency. Regulations must play a role in making this a reality. Implementing policies that require sites or sponsors to report recruitment data in near real-time, ideally within five days, would:
Improve the cost-efficiency of site selection
Establish a higher standard of performance across all research sites
At Yendou, we manage thousands of research sites. Site operators view their roles through a business lens, prioritizing operational clarity, key performance indicators (KPIs), and reliable partnerships over one-off projects. They want to know the benchmarks. By enhancing data transparency and fostering a culture of performance-based metrics, we can empower both sponsors and sites to make more informed, strategic decisions.
Strategy 2. Increasing the Performance of Current Sites
The Challenge: Approximately 80% of research sites struggle with consistent performance, hindering recruitment and trial efficiency.
The Solution: The next newsletter will explore actionable strategies to boost site performance.
The Future of Clinical Trials Is Ours to Accelerate
Every day a clinical trial is delayed is a day we let inefficiency win over progress. We need to rethink our approach to site selection and recruitment. Instead of sticking to what’s easy and familiar, we must go further. We must go bolder. The time for minor tweaks is over. We live in a new era of shifting world orders, evolving ideologies, and disruptive technologies—an era of transformation that empowers us to push the boundaries of what’s possible and accelerate the pace of innovation.
Imagine a world where clinical trials launch in record time, where research sites are fully engaged, and where innovation knows no barriers. I believe in that Future. At Yendou, we believe in that future, and we’re building technologies to empower the Future we want to see. Then the stakes are too high to settle for anything less.
The race to bring treatments to patients isn’t just important—it’s everything. Let’s move faster, think bigger, and make an impact. Together, our industry is capable of redefining what’s possible.
It’s time to lead the way and transform site engagement for better performance.
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