Limited Sponsor-Site Collaboration Impacts Sites and Patient Experience

Jan 02, 2026 | Gareth Sully and Aidan Gannon

Despite a shared industry goal of advancing patient care, clinical research sites continue to face the same operational challenges year after year. During our recent roundtable — with leaders including Dr. Clare Grace (EMS Healthcare) and Sujoy Chowdhury (Novo Nordisk) — one theme stood out: fragmented collaboration. Not caused by any one sponsor or approach, but by a system where each study introduces unique, non-standardized processes. The result is cumulative complexity for sites juggling multiple concurrent trials. Sites described persistent issues– administrative burden, fragmented technology, and poor protocol planning — that slow operations and reduce efficiency. When sites must manage disparate systems, redundant requests, and complex payments, patients feel it:—slower recruitment, higher attrition, and inconsistent experiences To break this cycle, sponsors and CROs need more aligned design decisions, stronger partnership models, and trial experiences that work better for both sites and patients.

Challenges facing clinical sites directly affect patient participation

While these issues are often framed as “site burden,” the downstream impact is unmistakable: When sites are stretched thin, patients encounter longer appointments, rescheduled visits, slower responses, and rigid protocols, making trial participation feel difficult or unappealing.

Sponsor technology proliferation

Sites are still managing numerous non-standardized sponsor systems. Multiple logins, inconsistent interfaces, and support models create operational drag. When staff spend time troubleshooting systems instead of engaging with participants, patient interactions become rushed and fragmented.

Non-standardized processes

Redundant trainings and repeated requests for the same data add unnecessary workload. For patients, this translates to screening delays, inconsistent communication, or last-minute scheduling changes – eroding trust and increasing perceived inconvenience.

Administrative burden

Frequent protocol amendments, late payments, and increasingly complex inclusion – exclusion criteria remain significant hurdles. These challenges contribute to longer screening timelines and greater disruption to patients’ daily lives, often making trial participation feel unrealistic.

“We find that the inclusion-exclusion criteria are just getting more and more complicated, so we have pages and pages and pages of criteria to sift through, to find a perfect candidate.” Clinical operations manager

Insufficient site payments

As Dr. Grace noted, startup fees (often only $5K–$12K) rarely cover the true costs of contract negotiation, hiring, training, and workflow setup. Sites often end up subsidizing the early phases of a study. When resources are stretched, staff time for patient support inevitably shrinks.

Strategic Actions to Achieve Site Success

1. Simplify technology and operations

• Enable single sign-on: Reduce friction by offering seamless login experiences, including through initiatives like Site ID.
• Consolidate vendors: Limit the number of vendors per trial, aiming for one or two that can manage multiple Decentralized Clinical Trial (DCT) components.
• Standardize systems: Configure core systems consistently across studies – even across different CROs – to provide a predictable user experience.

2. Improve upfront planning and protocol design

• Involve sites early: Engage sites and patients finalizing protocols to identify operational and patient-burden concerns.
• Encourage protocol simulations: Practice screening, randomization, and early visits to minimize first-patient errors and improve retention; ensure sites budget for this time-intensive step.
• Simplify protocols: Distinguish between procedures essential for endpoints and those that are merely “scientifically interesting.” Overly complex criteria and high visit frequency continue to drive attrition.

3. Reform payment and reimbursement

• Increase startup fees: Ensure payments reflect the true cost of early study activities.
• Streamline payments: Reduce the administrative burden of granular, procedural-based payment reconciliation. Discussions are ongoing about moving toward milestone-based payment mechanisms — especially with trusted partners — to take admin out of the equation.
• Compensate patients: The industry is increasingly aligned around compensating patients for their time which is one of the most effective levers for improving participation.

Elevating Sponsor-Site collaboration: Transforming the CRA role and Building Strategic Trust

A recurring theme was the need to elevate the role of the Clinical Research Associate (CRA) and foster true, trusting partnerships with sites.

Advancing the CRA role

The CRA is often inundated with administrative, and tech-support tasks leaving limited bandwidth for high-value activities:

• Flip the task ratio: Shift the CRAs from spending 70% of their time on low-value tasks to 70% on high-value activities like risk identification and relationship building.
• Provide better tools: Develop investigator-focused dashboards that show holistic patient data, supporting PI oversight obligations under ICH E6 (R3).
• Leverage AI: Use AI agents to handle common protocol and IT-related queries, freeing CRAs to focus on the science and site partnership.

What great collaboration looks like

True partnership requires trust and strategic alignment:

• Shared success model: Move from study-by-study interactions to a portfolio-level approach. Sponsors that share pipeline visibility enable sites to plan resources across upcoming studies.
• Build efficiencies together: Integrating site eSource with sponsor EDC can significantly reduce administrative work and improve patient throughput.
• Reach the patient: Adopt DCT solutions—such as in-home drug delivery or remote data collection—that minimize patient travel and improve accessibility.

“One of the big things for us is as a site… come to us very early on and open your pipeline… And we can have a really strategic discussion about how we operationalize that study and deliver it… in the most efficient way for that sponsor.” Dr. Grace, CEO

The message is clear: trial success requires a fundamental shift in the sponsor-site dynamic. By simplifying technology, improving early planning, and modernizing payment models, the industry can reduce site burden, strengthen data quality, and—most importantly—deliver a better patient experience.

Read more about a Top 20 pharma’s strategy for engaging site to improve trial execution.