Investigator Site Turnover: The Importance of CRO Support

November 01 2017  

Challenges of retaining investigator sites: CROs invest a great deal of time, effort and money into discovering and grooming investigator sites to conduct clinical trials. While this is a challenging task, CROs face an even larger hurdle in retaining those sites whom they have recruited. All too often this effort falls short, and the site ceases to participate in further trials. In fact, PharmaVOICE indicated that, “since 2006, 55% of PIs in Europe, 53% in Asia/Pacific, and 40% in North America have not conducted another clinical trial” [and as a result] “the pool of experienced investigators is shrinking by 3% every year.”

Addressing the burden of manual site payments: Turnover typically occurs at the hands of naïve sites who are not fully prepared for the commitment required to execute a clinical trial. Sites often don’t have a proper understanding of how to balance between everyday activities and study requirements.  One major hurdle is the site payments process, which can lead to overwhelming administrative burdens and financial distress, particularly for naïve sites. As the clinical trial expert, CROs can leverage their experience to provide suggestions for how to streamline the payment workflow to reduce administrative headaches and improve efficiency.

Strategies for process improvement: The Clinical Trials Transformation Initiative (CTTI) has defined specific recommendations focusing on “decreasing the number of ‘one and done’ clinical trial site investigators”[1], two of which relate to improving payment processes:

  • Optimizing trial execution and conduct
  • Improving site budget and contract negotiations

“Optimizing trial execution and conduct” directly refers to the need for CROs to work with investigator sites to implement process improvements. Integrating technology solutions has become a preferred methodology among CROs and sponsors, having proven to streamline workflows, including site payments. By introducing technological efficiencies, site staff can spend more time on trial related tasks, refining execution for a better outcome.

“Improving site budget and contract negotiations” is critical to a site’s financial stability. It has been shown that an increasing number of sites prefer to be paid on a monthly basis to alleviate financial strain. According to a study conducted by SCRS, in 2016 66% of sites reported having less than three months operating cash in the bank. Sites are quickly becoming proponents of technology that enhances the payment/cashflow processes, specifically regarding the automation of timely payments and invoice generation based on real-time data. Innovative solutions like Greenphire’s eClinicalGPS are built to increase financial visibility and provide detailed reconciliation, ultimately reducing the financial burden and manual/redundant work for both CROs and sites.

Conclusion: Retaining investigator sites whom CROs have spent much time and effort grooming for clinical trials is vital and has proven to be a significant challenge. Tedious manual payment processes continue to be a leading factor in naïve sites’ reluctance to conduct additional studies. By implementing a solution that streamlines and automates the site payment process, CROs can offer superior value-add by enhancing a site’s clinical trial experience for improved outcomes, strengthening the relationship and positioning sites for future trial success.



Dave Espenshade
Vice President of CRO Partnerships

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