Where it all began: why we wrote ‘The Site Factor’

When we published ‘The Participation Equation’ last year, we set out to better understand how participants experience clinical studies and what shapes their engagement. What quickly became clear was the central role of the study team. Across different trials and settings, participant experience was moulded by the quality of that relationship.

As studies become more digital and decentralised, participants continue to tell us that human connection really matters to them.

That insight led us to a natural next question: if site teams play such a defining role in participant experience, how well do we understand their experience?

Why this research, and why now?

In 2025, we saw sponsors looking for ways to support sites with the increasing strain they are under. Recruitment is tougher, protocols are more demanding, and expectations continue to rise. Sponsors recognise that they must get site support right, but they are often unsure about how or where to start, or what could make the biggest difference in practice.

This was the catalyst for ‘The Site Factor’.

Before adding to the conversation, we wanted to better understand the reality on the ground. How are protocols translated into daily work? Where do challenges show up in interactions with participants? And what support do site teams need to deliver a trial experience that feels good for everyone involved?

We spoke with more than 100 site team members across nine countries, listening closely to where things feel hard, where systems don’t quite join up, and where there’s genuine opportunity to do better. We heard about the importance of alignment and its impact on participant experience, as well as the sponsor cost burden when those things are missing.

Bringing these perspectives together is an important step. It gives us a clear picture of the current landscape and a solid foundation to build on.

A springboard

This report sits alongside ‘The Participation Equation’, adding an important second perspective.

By putting ourselves in the shoes of site staff, we are sparking conversations and practical action towards the shared goal of making trials work better for everyone involved. Not through quick fixes, but through thoughtful, practical real-world solutions.

This is the work we care deeply about — turning insight into action, and data into meaningful change. Because when we listen to what truly matters — to participants and site teams alike — we can design research that works in practice, not just on paper.

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