How Can We Save Our Sites? A Call to Action for the Future of Clinical Research

Omni...Omni...Omni...The Save Our Sites movement is more than just a call for site sustainability—it’s a reckoning for an industry that depends on the viability of research sites yet often treats them as afterthoughts. Across our recent roundtable discussions and sponsor interviews, we uncovered a hard truth: if we don’t proactively support research sites, the entire clinical trial ecosystem is at risk.

From financial instability to regulatory burdens, from the fragmentation of technology to workforce shortages, the challenges are immense. But so are the opportunities. What emerged from our conversations with industry leaders was not just a list of problems, but a roadmap for solutions.

The Financial Reality: Are Sites Being Set Up to Fail?

One of the greatest obstacles research sites face is financial instability. While sponsors and CROs depend on sites to execute clinical trials, payment structures and contract terms frequently leave sites financially vulnerable.

ClariVest Asset Management LLC & Boca Biolistics, LLC explored alternative financial models, including hybrid revenue structures and long-term investment strategies, to help sites gain financial stability.

"Sites must think beyond per-visit payments and explore equity partnerships, shared revenue models, and diversified service offerings to stay competitive."

Delayed Payments and the Cash Flow Crisis

Many sites operate on razor-thin margins, making delayed payments from sponsors and CROs a serious threat. Rick Greenfield ( RealTime eClinical Solutions) emphasized the need for modernized site management systems to improve financial tracking and invoicing:

"Sites need streamlined financial tools to track payments and ensure they get paid on time. Too many sites are struggling to maintain operations because of cash flow uncertainty."

Ben Lanning ( Takeda) echoed this concern, calling for a reevaluation of site budgets:

"We must rethink site compensation models. Sites are the foundation of the industry, yet many are left with unsustainable financial conditions. When sites struggle, trials slow down. When trials slow down, patients suffer."

The Pricing Pressure from PE-Backed Networks

Private equity-backed site networks are rapidly reshaping the landscape. While their financial backing provides stability, these networks often place downward pricing pressure on independent sites, making it harder for smaller operations to remain competitive.

This raises an existential question: Will independent sites survive in a world dominated by large site networks?

Revenue Diversification: The Path to Sustainability

Many site owners are beginning to diversify revenue streams—expanding into phase I trials, offering clinical research training, and even investing in decentralized trial capabilities.

Liz Beatty ( Inato) argued that sites should proactively position themselves as essential strategic partners, not just vendors:

"Sites need to market themselves effectively. Those that take a proactive approach to business development and diversify their capabilities will be in a stronger position moving forward."

The Technology Divide: The Sites That Will Survive

Technology is supposed to make clinical trials more efficient—but for many sites, it has only created new complexities. The proliferation of disparate systems, each with its logins and training requirements, has made trial execution less efficient, not more.

Dan Schell ( Clinical Leader)emphasized the importance of media and industry publications in amplifying the voices of research sites as well as keeping sites informed of the most up-to-date information. He highlighted how platforms like Clinical Leader can help sites advocate for better financial models, regulatory support, and visibility in sponsor-CRO decision-making processes.

The Case for Interoperability

Bree Burks ( Veeva Systems) addressed the issue of data silos that prevent sites from working efficiently:

"We need technology that integrates, not isolates. Sites are spending too much time navigating fragmented systems instead of focusing on trial execution."

The future belongs to sites that can seamlessly integrate eSource, eRegulatory, and CTMS platforms, reducing administrative burdens and improving compliance.

AI and Automation: The Next Frontier

AI-driven trial matching and automated recruitment strategies are reshaping how patients are identified and enrolled in studies.

Raymond Nomizu ( CRIO ) shared insights on AI-powered workflows:

"By leveraging AI, sites can move away from outdated recruitment strategies and use predictive analytics to identify the best-fit patients in real time."

Sites that embrace automation and AI-driven efficiencies will gain a competitive advantage in trial execution and patient recruitment.

IQVIA also highlighted predictive analytics for improving site selection and study design, ensuring trials are better matched to site capabilities.

Regulatory Complexity: A Growing Burden for Sites

As regulatory demands increase, sites are drowning in compliance requirements. Every new layer of oversight adds to the administrative burden, slowing down trial initiation and execution.

The Case for Standardized Workflows

Sites often face inconsistencies in regulatory expectations from different sponsors and CROs. One solution is for the industry to move toward standardized workflows and compliance frameworks.

Jose Tula Zamora, FMD, CCRP ( eClinPro CTMS) proposed a collaborative model where sites, sponsors, and CROs co-develop standardized regulatory processes:

"Regulatory complexity is one of the biggest barriers to site efficiency. We need to streamline the process through better alignment between all stakeholders."

FDA's Diversity Guidance: Challenge or Opportunity?

The FDA’s new Diversity Action Plan requirements are reshaping how sponsors and sites approach patient recruitment and site selection. While this presents new challenges, it also creates an opportunity for sites that have deep community connections and can access underrepresented populations.

The Clinical Research Justice League with Mitchell Hilbe Addison Gumbert MaryAnn Bowman advocated for policy changes that would provide greater site autonomy in budget negotiations, reduce administrative burdens, and ensure fair treatment in sponsor contracts.

"Sites must unite and push for standardized contracting practices that protect their financial and operational interests."

Hadi Danawi, PhD, MPH د. هادي ضناوي (MENASA GROUP) emphasized that diversity efforts must be rooted in community trust:

"Patients need to feel like partners in the research process, not just subjects. If we don't build trust, recruitment efforts will fail."

Sites that can demonstrate strong community engagement and diverse patient enrollment strategies will be in high demand moving forward.

The Workforce Crisis: Retaining Talent in Clinical Research

Clinical research sites are facing a workforce crisis—burnout, high turnover, and a lack of clear career pathways are making it difficult to retain staff.

The Clinical Research Referral Club (CRRC) with Elizabeth Tabor emphasized a community-driven approach to patient recruitment, connecting research sites through investigator networks to increase trial awareness and boost enrollment rates.

"A well-connected referral network can help sites fill studies faster while ensuring diverse patient populations."

Investing in Workforce Development and Patient Recruitment as the Key

Angel Pettitt (Clinical.ly ) stressed that training and mentorship programs are crucial for site sustainability:

"We need to invest in CRCs and investigators. Without a strong workforce, sites will struggle to keep up with demand."

Alisha Moore (ASCP)CM emphasized the importance of strong leadership and collaboration in navigating the evolving clinical research landscape. She highlighted the need for sites to take ownership of their success by proactively engaging with sponsors, leveraging networks, and adopting best practices from industry leaders.

"Sites that take a proactive role in advocacy and collaboration will be the ones that thrive. Success comes from building strong relationships, not just waiting for opportunities to come."

Improving Patient Retention & Experience

Recruitment is only one part of the equation—retention is equally crucial.

Scout discussed how logistical support services (e.g., travel coordination, concierge services, patient reminders, and financial reimbursement systems) can improve retention rates and reduce dropout rates:

"We can’t just focus on getting patients in the door—we need to ensure they stay engaged throughout the full trial. The best recruitment strategy is retention."

The Future of CRC Training

Jess Thompson, MS, MBA, PMP highlighted the need for formalized training programs and mentorship pipelines to reduce turnover and ensure a steady flow of skilled coordinators and investigators.

"We need to treat CRCs as future site leaders, not just as employees filling a role. Investment in training is investment in site longevity."

The Path Forward: A Unified Industry Vision

If sites are to survive, the industry must adopt a proactive, collaborative approach. Sponsors, CROs, technology providers, and regulators must align to create a site-friendly ecosystem that fosters innovation, reduces burden, and ensures fair financial treatment.

The solutions exist—but they require action.

Join Us at the Save Our Sites Conference!

The best way to advance these discussions is by coming together in person. We invite you to join us at the Save Our Sites conference, March 13-15, at the Omni Hotel in Oklahoma City.

This event will feature: ✅ Industry leaders sharing real-world solutions ✅ Panels on financial sustainability, technology, and regulatory challenges ✅ Exclusive networking with sponsors, CROs, and tech providers

👉 Register now and book your stay at the Omni! Don't miss this opportunity to be part of the movement that is shaping the future of clinical research.

The Time to Act Is Now

By implementing these strategies—financial sustainability, technology adoption, regulatory efficiency, diversity, workforce investment, and patient engagement—we can ensure the survival and success of research sites.

Are you ready to take action? Join us in a few days and be part of the solution.