The Habit That’s Quietly Running Your Trial

By Nick Spittal, Chief Operations Officer, Velocity Clinical Research

Most sponsors and CROs talk about slow sites, hard-to-find patients, and protocol complexity putting their studies at risk. Those issues are all real, and they frequently share the same underlying cause: the disparate operating model used across individual study sites. In my experience, study risk often lives less in any one site and more in how the sites are selected, connected, escalated, and managed as a system.

Here's the habit: you pick sites one at a time, negotiate each relationship separately, and manage the resulting patchwork. That's not a bad way to run a trial. It's the only way when every site is an independent operation with its own SOPs, systems, cultures, and versions of "on track." For most of this industry's history, there was no other way, so the habit made sense.

It's less true than it used to be. And we see that a bigger risk in many trials now isn't a new investigator or a rocky start-up - it's selecting individual sites, one at a time, instead of leveraging a cohesive multi-site solution. The result is a roster that looks assembled but isn't connected.

A Different Question to Ask

Today's question isn't, "Which sites should I pick?" It's "Am I managing this site relationship in a way that de-risks delivery?" The difference can have an immense impact on results.

We saw this impact a year ago when a third of the enrolling sites on one study were in the greater Los Angeles area when wildfires hit. After first ensuring the safety of trial participants and our staff, we moved quickly, extending working hours at all our other sites, gathering and relocating lab kits and investigational product, and accelerating patient recruitment efforts so that we could absorb the remaining enrollment elsewhere in the country. Having this built-in contingency meant a quick pivot to not only keep the study moving, but to finish enrollment on time despite losing a third of the capacity for weeks. Nothing about the individual sites changed. What changed was the underlying operation: they were managed as one connected network.

Just having the footprint isn't enough. That is why Velocity built a delivery model, with a dedicated Project Delivery Lead (PDL) actively managing across the entire spectrum. This isn't a service tier. It is an operating model designed to make multi-site delivery one accountable relationship: start-up, enrollment, data quality, risk, and database lock. The value for a sponsor or CRO is not a cleaner org chart. It is clearer ownership, faster escalation, and more predictable execution across sites.

Why the Old Habit Is the Real Barrier

I don't think sponsors keep picking sites one at a time because it's working better. I think it's because it's familiar, and familiar feels safe. Every site selected individually is another connection the sponsor or CRO must build and maintain themselves, instead of leaning into one that already exists. That was simply what the job required when multi-site networks were hard to come by. That's no longer the case. Today, I'd bet on the predictable de-risked results that some sponsors are starting to experience with a smaller number of deeper site relationships.

Why This Wasn't an Option Before

For most of this industry's history, there hasn't been a real choice. If one needed geographic spread or a specific patient population, it came from one boutique here, another there. A single network didn't have the necessary reach yet.

Site organizations like Velocity have grown their geographic and demographic reach substantially in just the past few years, while building the robust infrastructure to deliver at scale. That does not mean that every protocol should default to a single network, and there are excellent performing individual sites. Therapeutic fit, patient access, and past execution remain critical. The evaluation should also consider whether one or more networks can reduce the sponsor's management burden and improve delivery accountability across the study.

The patchwork approach isn't the only way anymore.

Worth a Second Look

The PDL model is one piece of what maturity looks like in practice. We've begun introducing the Velocity PDLs on LinkedIn so you can meet some of the leaders working to deliver results for sponsors and CROs today. Get to know our team - where they came from, what they've accomplished, what the PDL role actually looks like week-to-week. And then come get to know Velocity and learn more about how you can achieve predictable results with less risk through one easy to manage relationship.

Curious to learn more? Email [email protected].