Pharma has a retention problem. Nearly one in four clinical trial participants never complete their studies, according to recent CISCRP research—a staggering statistic that reflects deeper challenges in how we support both patients and the site teams caring for them. (Full study here.)
Yet most sponsors focus exclusively on patient-facing interventions while overlooking a critical truth: engaged sites create engaged patients.
We’ve spent years working with clinical operations teams who understand this connection intuitively but lack the systematic approach to act on it.
But good intentions aren't enough. Clinical trial timelines are unforgiving, site teams are overwhelmed with competing priorities, and engagement naturally erodes without deliberate intervention. The question isn't whether site engagement matters; it's how to sustain it strategically across months or even years of study execution.
This guide outlines a framework I've developed working with sponsors and CROs who've learned to treat site engagement not as a launch event, but as an ongoing relationship that directly impacts data quality, regulatory compliance and ultimately, patient outcomes.
Contact us if you'd like to explore the platform we equip teams with to execute this playbook across their clinical trials, steering committees, advisory boards, and other engagement initiatives. We'll schedule a free, personalized demo to understand exactly what you need and how our platform can enable it.
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Even the most motivated sites face predictable engagement challenges as studies progress. Site teams juggle clinical care, administrative responsibilities and often multiple concurrent trials simultaneously.
Without structured support, enthusiasm that peaks during site initiation inevitably fades.
The pattern we see is remarkably consistent across therapeutic areas and trial phases:
This isn't a reflection of site quality or commitment. It's a predictable outcome of how clinical research actually works.
The consequences extend well beyond site satisfaction scores. Disengaged sites produce lower-quality data as coordinators rush through documentation. Patient dropout increases when sites lack the resources and enthusiasm to provide exceptional participant support.
Protocol deviations multiply when teams don't fully understand or implement changes. And most critically, these challenges create a cascade effect—stressed sites provide stressed patient experiences, which undermine the very outcomes the trial is designed to measure.
Does any of this sound familiar?
Our work with clinical operations leaders reveals a consistent truth: sponsors who proactively address engagement see measurably different outcomes. Sites that receive structured, ongoing support report higher job satisfaction, better protocol adherence and stronger patient relationships. More importantly, they deliver results: completing enrollment faster, maintaining higher retention rates, and producing cleaner datasets.
We’ve seen sites receiving structured support maintain patient retention rates nearly 20% higher than those with minimal post-initiation contact.
Again, the difference isn’t the quality of sites themselves, but in the systematic approach sponsors take to supporting them throughout the trial lifecycle.
Engaging sites requires different strategies at different points in the trial timeline. What sites need during launch differs fundamentally from their needs six months into recruitment or during final data collection.
Taking a strategic approach here means mapping specific interventions to the evolving challenges and opportunities of each phase.
Here’s a look at the modern playbook we run.
The first 90 days establish patterns that persist throughout the study. More specifically, sites form lasting impressions about sponsor competence, communication style and commitment to their success.
We find that teams who feel confident and supported from the beginning maintain that engagement more readily than those who struggle through early confusion or frustration. You want this first phase to build inertia for the rest of what comes.
To do that, successful launch strategies tend to focus on three core elements:
That typically translates into a few specific launch-phase action items:
This requires moving beyond traditional site initiation visits toward more involved onboarding experiences.
For example:
Instead of cramming all protocol training into a single session, leading sponsors now provide layered education combining live training with on-demand modules, role-specific resources and interactive elements that reinforce understanding over time.
Equally important is establishing communication channels that work for busy clinical teams. Sites need easy access to study documents, clear escalation pathways for questions and regular touchpoints that keep them connected to trial progress.
The sponsors who succeed in this phase create what one investigator described as "feeling part of something bigger"—a sense that their site's contribution matters within a larger scientific effort.
Technology plays a crucial enabling role, but only when it simplifies rather than complicates site workflows. The best platforms provide single points of access for all study resources, integrate seamlessly with existing site system, and reduce rather than increase administrative burden. Sites should spend their time on patient care and data collection, not navigating complex digital interfaces.
Our Health Expert Connect™ platform offers customized, secure portal that reflects your branding and gives every site access to a centralized hub for study documents, training materials, and communications. This creates a consistent and professional user experience while simplifying resource access.
Tools for this first phase include:
The maintenance phase is usually the longest and most challenging period of site engagement. The novelty of study launch has faded, but completion remains months away. Site teams face the daily reality of balancing trial requirements with patient care, staff turnover and competing research commitments.
Maintaining the inertia you built in the first phase demands proactive intervention.
The most effective maintenance strategies create ongoing dialogue rather than one-way communication.
Instead of simply broadcasting updates, sponsors facilitate conversations where sites can share experiences, troubleshoot challenges together, and contribute to solutions. This peer-to-peer learning often proves more valuable than formal training sessions, as sites learn practical strategies from colleagues facing identical challenges.
Recognition also becomes particularly important during this phase. We see that sites receiving acknowledgment for enrollment milestones, protocol adherence or creative problem-solving maintain higher engagement than those whose contributions go unnoticed. Recognition doesn't require elaborate gestures—we find that simple, specific acknowledgment of good work often resonates more powerfully than “generic” appreciation.
Here’s a high-level maintenance phase strategy checklist that we help teams operationalize:
Keep in mind that the maintenance phase also presents opportunities to strengthen patient retention through site support. When site teams feel equipped to address patient concerns promptly and confidently, patients experience smoother trial participation.
This creates a virtuous cycle where engaged sites drive engaged patients, which reinforces site satisfaction and commitment.
Clients using our Health Expert Connect™ platform use milestone dashboards and discussion boards to make engagement visible and actionable.
We enable asynchronous discussion threads, reducing the need for constant scheduling while maintaining real-time dialogue between sponsor and site teams.
Tools here include:
The final phase of site engagement often receives the least attention, but it has huge impact on both current trial outcomes and future collaboration potential. Sites that feel abandoned during closeout are less likely to participate in subsequent studies or recommend sponsors to colleagues.
Closeout engagement serves multiple purposes beyond completing final data collection. It provides opportunities to capture site feedback about trial experience, identify process improvements for future studies and recognize contributions that might otherwise go unacknowledged. Done well, closeout strengthens relationships and builds goodwill for future collaboration.
Sites need clear guidance about closeout requirements, realistic timelines for completion, and responsive support for final questions or issues.
They also appreciate transparency about how their efforts contributed to overall trial success. When appropriate, sharing preliminary outcomes or next steps helps sites understand the impact of their work.
Here’s the closeout framework we typically run in our playbook:
Remember that the closeout phase is also a chance to collect valuable insights about patient experience. Sites that maintain strong patient relationships can facilitate exit surveys or feedback collection that informs future trial design.
Our Health Expert Connect™ platform enables the closeout process with structured toolkits, integrated survey modules, and documentation dashboards. It simplifies the collection of patient exit feedback, closeout checklists and site engagement reporting—all in a secure, branded environment.
Tools here include:
The systematic approach outlined above requires more than good intentions—it demands technology that adapts to each phase's unique requirements.
ExtendMed's Health Expert Connect™ platform was designed specifically to support this three-phase framework, providing sponsors with the tools needed to maintain authentic relationships throughout extended trial timelines.
Learn more about Health Expert Connect™ for clinical site engagement »
We see that the most successful site engagement strategies combine human connection with technological efficiency. Technology should eliminate friction from site workflows, not create additional complexity. The best platforms feel intuitive to busy clinical teams and integrate seamlessly with existing processes.
Traditional engagement approaches often fail because they rely on fragmented tools—email chains for communication, spreadsheets for tracking, separate portals for documents, and ad hoc meetings for updates. This fragmentation creates administrative burden precisely when sites need simplicity.
Here’s a quick breakdown of the differences between old and new models:
|
Traditional Approach |
Strategic Platform |
|
Email chains and attachments |
Centralized communication hubs |
|
Version control confusion |
Real-time document collaboration |
|
Manual engagement tracking |
Automated participation analytics |
|
Scattered feedback collection |
Integrated survey and feedback tools |
|
Ad hoc meeting scheduling |
Structured touchpoint planning |
Effective engagement platforms provide unified access to all study resources. Sites should find training materials, protocol documents, communication tools, and progress tracking in a single location. The interface should feel familiar and professional, reflecting the sponsor's brand while prioritizing user experience over visual complexity.
Communication tools within these platforms should support both synchronous and asynchronous interaction. Sites need the flexibility to participate in discussions at their convenience, not just during scheduled meetings. Discussion boards, secure messaging, and collaborative workspaces allow ongoing engagement that accommodates varying schedules and time zones.
Equally important are analytics capabilities that help sponsors track engagement patterns and identify sites needing additional support. Platforms should provide visibility into which sites are actively participating, which seem to be struggling, and which might benefit from additional resources or recognition.
Security and compliance remain non-negotiable requirements. Sites need confidence that all interactions and document sharing meet HIPAA requirements, maintain audit trails, and support regulatory submissions. The technology should enhance compliance rather than create additional compliance burdens.
Our experience with pharmaceutical clients consistently demonstrates the power of unified engagement platforms. Consider how a typical sponsor manages site relationships today: protocol documents scattered across email attachments, training materials buried in shared drives, site questions lost in message threads and engagement tracking managed through manual spreadsheets.
The relationship between site engagement and patient retention isn't just correlational—it's causal.
Engaged sites provide better patient experiences, which directly impacts willingness to continue participation. When site teams feel informed, supported, and connected to trial success, they invest more energy in patient relationships and problem-solving.
We see well-engaged sites respond more quickly to patient concerns because they have clear escalation pathways and confidence in sponsor responsiveness.
This connection creates opportunities for sponsors to improve patient retention through site support strategies. Providing sites with patient communication templates, retention best practices and rapid response to patient issues indirectly but powerfully influences patient experience. Sites that feel equipped to support patients effectively become genuine retention partners.
Our experience with pharma clients demonstrates this connection quantitatively. One recent engagement tracked patient retention across sites with varying levels of sponsor support. Sites receiving structured, ongoing engagement maintained patient retention rates higher than those receiving minimal post-initiation support. The difference persisted across therapeutic areas and patient populations.
Case example:
A major pharma company used our collaborative discussion tools to develop patient exit surveys with principal investigators. By involving sites in survey design, they achieved higher completion rates and gathered insights that directly informed their next protocol iteration.
The mechanism appears to operate through what researchers might call "emotional contagion"—engaged sites create engaged patients through their enthusiasm, competence and commitment. Conversely, frustrated or disconnected sites inadvertently communicate their dissatisfaction to patients, undermining confidence and willingness to continue participation.
Clinical trial site engagement succeeds when it evolves from vendor management toward genuine partnership. Sites that feel valued, supported, and connected to trial success become active contributors to both operational excellence and scientific advancement.
The framework outlined here—strategic planning across trial phases, technology-enabled relationship management, and systematic measurement of engagement effectiveness—provides a foundation for this transformation. However, implementation requires commitment beyond process and platform deployment.
Your sites are ready for partnership. The technology exists to enable it efficiently. The only remaining variable is organizational commitment to making site engagement a strategic priority rather than an operational afterthought.
ExtendMed’s Health Expert Connect platform is designed specifically to meet this need. It centralizes training, communication, document sharing, feedback collection, and compliance—all within a branded, user-friendly interface. With its modular architecture and concierge-level service, sponsors and CROs can configure site workspaces to reflect trial phases, study complexity, and participant needs.
The result is faster study execution, fewer dropped sites, and more consistent, high-quality data—all built on trusted site relationships.
Ready to build stronger relationships with your clinical trial sites? Schedule a demo to see Health Expert Connect™ in action.
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