> ## Content Index > Fetch the complete content index at: https://7.cr/llms.txt > Use this file to discover other available public pages before exploring further. # Site Sustainability After SCRS 2026 - URL: https://7.cr/site-sustainability-after-scrs-2026/ - Published: 2026-10-21T15:23:47.000Z - Updated: 2026-10-21T15:24:22.000Z - Description: The clinical research industry gathered at the Signia by Hilton Orlando Bonnet Creek from October 15 to 18, 2026 for the Society for Clinical Research Sites (SCRS) Global Site Solutions Summit. - Author: Kevin Sindhu - Tags: Business Development, Clinical Trials Industry, Clinical Trials, Clinical Trial Technology ## Four days in Orlando, one recurring question Sponsors, CROs, technology vendors, site networks, and independent investigators filled the halls for four days of sessions, booth meetings, and the kind of hallway conversations that rarely make it into a press release. We went to listen. Our team spent the summit in back-to-back meetings with site engagement leads from large pharma, feasibility and site identification teams from global CROs, operations leaders from site networks, and founders building the next generation of trial technology. We sat in sessions, compared notes over coffee, and asked the same question again and again: what is actually breaking, and what is working? One theme dominated almost every conversation, whether the person across the table worked for a top-ten sponsor or ran a two-investigator practice: **site sustainability**. Not in the abstract sense of a conference tagline, but in the hard, operational sense of whether research sites can keep the lights on, keep their coordinators, and keep saying yes to new studies. That matters to everyone. Sites are where trials succeed or fail. A sponsor can design an elegant protocol and a CRO can build a flawless monitoring plan, but if the site cannot activate quickly, staff the study, and enroll the right patients, the timeline slips and the cost climbs. When sites struggle, drug development slows down for all of us. What follows are the nine lessons we brought home from SCRS 2026\. Some confirm what the industry has known for years. Others point to shifts that are only now becoming visible. All of them carry practical implications for sponsors, CROs, and sites planning their 2027 portfolios. A note on how we wrote this: these are our own observations and synthesis from many conversations. We have deliberately avoided attributing comments to individuals or companies, because the most candid remarks were made off the record. --- ## The 9 lessons we brought home from SCRS 2026 ### Lesson 1: Site economics are the industry's quiet crisis Ask a site director what keeps them up at night and the answer is rarely science. It is cash flow. Sites carry the cost of a study long before they are paid for it. Coordinators are hired and trained, regulatory documents are prepared, equipment is calibrated, and investigators block time, often months before the first patient is randomized. Start-up fees, where they exist, rarely cover the true cost. Payments for completed visits can take a full quarter or longer to arrive, and invoiceable items such as screen failures, unscheduled visits, and protocol amendments are frequently disputed or simply missed. The result is a sector where many sites operate on thin margins and some operate at a loss, subsidized by a clinical practice or a parent health system. Several site leaders told us they had quietly started declining studies, not because they lacked patients, but because the budget could not support the work. The lesson for sponsors and CROs is uncomfortable but simple: **if you want sites to say yes, you have to make the economics work.** That means realistic budgets built on time-and-motion data, non-refundable start-up fees paid at contract execution, monthly payment cycles, and automated payment for every visit captured in the EDC. The sponsors that already do this are earning a reputation, and sites are prioritizing their studies accordingly. ### Lesson 2: Study start-up is still the biggest bottleneck The industry has talked about study start-up for more than a decade, and it remains the stage where the most time disappears. Contract and budget negotiation, IRB review, essential document collection, system access, and site initiation can stretch for months. What struck us in Orlando was how much of the delay is self-inflicted. Sites described receiving budget templates with line items that did not match the protocol schedule of assessments. Contracts bounced between sponsor legal, CRO legal, and institutional legal with no single owner accountable for the timeline. Essential documents were requested in different formats by different vendors on the same study. The organizations making real progress are doing three things. They are standardizing contract language through master agreements, so each new study only needs a short work order. They are publishing budgets that sites can accept with minimal negotiation because the numbers are fair to begin with. And they are measuring cycle times from the site's perspective, not just their own. **Our take:** every week saved in start-up is a week of enrollment gained. Sponsors focused on speed should look hardest at the months between site selection and site activation, because that is where the time is. ### Lesson 3: Feasibility is broken, and everyone knows it Few topics drew more frustrated laughter than feasibility questionnaires. Sites routinely receive long surveys, often dozens of questions, sometimes with overlapping or contradictory content, for studies they may never be selected for. They complete them unpaid. Many never hear back. Sponsors and CROs, for their part, acknowledged that feasibility data is often unreliable. Sites overestimate their enrollment potential because they want the study. Scoring models reward historical volume over genuine patient access. Promising sites get filtered out by an algorithm before a human ever looks at their response. The better path, discussed in several sessions and many hallway conversations, is evidence-based feasibility. Instead of asking a site to guess, ask it to run a de-identified query against its own patient records for the actual inclusion and exclusion criteria. Combine that with real-world data on disease prevalence in the site's catchment area. Then talk to the site. **Our take:** feasibility should be a conversation, not a form. Sponsors who invest in shorter, smarter questionnaires and who close the loop with every site, selected or not, will build a far more accurate picture of where patients actually are. ### Lesson 4: The workforce shortage has not gone away Clinical research coordinators are the backbone of every study, and the industry still does not have enough of them. Site leaders described persistent turnover, long ramp-up times for new hires, and the constant risk that a coordinator who knows a study inside out will be recruited away by a CRO or a sponsor offering a higher salary and remote work. The investigator pipeline is a parallel concern. The pool of experienced principal investigators is aging, and too few physicians are entering research early in their careers. Sessions on developing tomorrow's investigators were well attended, which tells you something about how seriously the community takes this. What works, according to the sites that retain staff well: clear career ladders from assistant coordinator to lead coordinator to site manager, protected time for training, fair workloads measured in active patients per coordinator, and a culture where coordinators are treated as clinical professionals rather than administrative support. On the investigator side, mentorship models that pair experienced PIs with sub-investigators, and health systems that build research into physician roles, are expanding the bench. **Our take:** staffing is not just a site problem. Every protocol that adds visits, procedures, and data points adds coordinator hours. Sponsors that design leaner protocols are, in effect, investing in the workforce. ### Lesson 5: Technology is helping and hurting at the same time There was no shortage of technology on the exhibit floor. eConsent, eSource, remote monitoring, eISF, patient engagement apps, payment platforms, and AI tools of every description competed for attention. Yet the most common technology complaint we heard from sites was not a lack of tools. It was too many. A single study can require a coordinator to log into a dozen separate systems, each with its own credentials, training requirements, and support desk. Multiply that across a portfolio of studies from different sponsors and the burden becomes enormous. Sites called it portal fatigue, and it is real. The winning vendors were the ones that reduced work rather than relocating it: tools that integrate with each other, that sit on top of systems sites already use, and that remove a manual step entirely. **Our take:** before adding a new system to a study, sponsors should ask a simple question: whose work does this remove? If the honest answer is the sponsor's work, moved onto the site, it is not a solution. ### Lesson 6: ICH E6(R3) is an opportunity to simplify, if we use it The revised Good Clinical Practice guideline, ICH E6(R3), was finalized in January 2025 and has been phasing into practice across regulatory regions since. Its emphasis on quality by design, risk-proportionate approaches, and fitness for purpose gives the industry formal permission to stop doing things that add effort without adding value. The interesting conversations at SCRS were not about what E6(R3) says but about whether organizations will actually change their behavior. Sites expressed cautious optimism mixed with skepticism. They have heard the language of risk-based monitoring for years, yet many still experience 100 percent source data verification and monitoring visit reports full of findings that do not affect patient safety or data integrity. **Our take:** E6(R3) gives sponsors, CROs, and sites a shared language to have honest conversations about what matters. The organizations that use it to trim low-value procedures, focus monitoring on critical data, and reduce documentation burden will see faster studies. Those that simply rewrite their SOPs with new vocabulary will see no difference at all. ### Lesson 7: AI is arriving, but practically, not magically Artificial intelligence was everywhere at SCRS 2026, in session titles, booth banners, and nearly every vendor pitch. Beneath the hype, the conversations were more grounded than a year earlier. The use cases gaining real traction at sites are narrow and practical: screening electronic health records against eligibility criteria to identify potential participants, drafting and reconciling regulatory documents, summarizing protocols for site staff, and automating repetitive data entry. These are tasks where AI saves hours without making clinical decisions. Site leaders were clear about their concerns: data privacy, validation, accountability when an algorithm gets something wrong, and the risk that AI tools become one more login. Several also noted that AI pre-screening only helps if the site has the staff to follow up on the patients it identifies. **Our take:** the sites that will benefit most from AI are the ones with clean data, connected systems, and well-defined workflows. AI amplifies operational maturity. It does not replace it. ### Lesson 8: Relationships still beat RFPs For all the talk of data-driven site selection, one of the clearest lessons from Orlando was that relationships still decide a remarkable share of placements. Site engagement leads at sponsors and site relationship managers at CROs repeatedly told us they rely on sites they know, sites that have delivered before, and sites that communicate honestly when things go wrong. That is both a strength and a weakness. It rewards reliability, but it also makes it harder for capable new sites to break in. Many first-time conversations at SCRS were about exactly this: how does a site with strong patient access but limited sponsor history earn a first study? The answer we heard most often was persistence paired with proof. Sites that arrive with a crisp capabilities summary, real patient population data, investigator CVs ready to send, and fast feasibility turnaround get noticed. Those that follow up consistently after the conference get studies. **Our take:** sponsors and CROs should build structured on-ramps for new sites, such as a first study with extra support or a preferred-site pathway with clear criteria. Relying only on familiar sites concentrates risk and limits patient diversity. ### Lesson 9: Patient access is the new currency The final lesson ties all the others together. In a world of complex protocols, narrow eligibility criteria, and intense competition for patients in therapeutic areas such as obesity, metabolic disease, dermatology, and respiratory disease, the sites that win are the ones that can reliably reach the right patients. That is shifting attention toward site models that sit closer to where people already receive care. Research programs embedded in community health systems, primary care networks, and urgent care networks see high volumes of patients who have never been offered a trial. Several sponsors told us they are actively looking for these sites, both to accelerate enrollment and to improve the representativeness of their study populations. We explore this theme in depth in our companion article on the patient access problem in clinical trials. **Our take:** the future of site selection will be driven less by who has done the most studies and more by who can demonstrate access to the right patients, quickly and ethically. --- ## What sponsors and CROs should do next If you sit on the sponsor or CRO side and you want better sites, faster start-up, and fewer rescue studies, the to-do list from SCRS is short and not glamorous. 1. **Measure your own cycle times from the site's point of view.** Track days from site selection to executed contract, from executed contract to first payment, and from first visit to payment for that visit. Publish those numbers internally. What gets measured gets fixed. 2. **Fund start-up properly and pay it early.** Non-refundable start-up fees paid at contract execution tell sites you are serious. They also buy priority on a coordinator's calendar. 3. **Consolidate the technology stack, or at least the logins.** Every new portal you add to a study has a cost the site absorbs. Ask whether it is truly necessary, and if it is, support single sign-on. 4. **Bring sites into protocol design.** A one-hour review of draft eligibility criteria and visit schedules by two or three experienced sites routinely catches problems that would otherwise surface as amendments. 5. **Expand your site footprint beyond the usual names.** Community-based sites, health-system-embedded research programs, and urgent care and primary care networks see patients that traditional dedicated sites never meet. They need a fair shot in feasibility, not a scoring model that rewards only historical volume. 6. **Treat relationship management as a function, not a courtesy.** Assign named owners for strategic sites. Hold quarterly reviews. Close the loop on non-selections. --- ## What sites should do next Sites are not passive in this story. The ones that left Orlando with full pipelines are doing a handful of things consistently. 1. **Know your numbers cold.** Patient population by indication, historical screen-fail and randomization rates, start-up timelines, query resolution times. Sponsors trust sites that show their data. 2. **Lead with patient access, not square footage.** Your differentiator is the patients you can reach and the speed at which you can reach them. Say that first. 3. **Negotiate budgets with evidence.** Build a time-and-motion model of what a visit actually costs you, and bring it to the table. Request start-up fees, screen-fail payments, and holdback terms in writing. 4. **Invest in staff retention before you invest in growth.** A stable coordinator team is worth more than a new site location. 5. **Get your quality house in order for E6(R3).** Document how you identify and manage risk at the site level. Be ready to explain it to a monitor. 6. **Build a business development rhythm.** Feasibility responses within 48 hours, a capabilities deck that is current, regular contact with site engagement leads at your top sponsors and CROs, and a CRM that tracks every thread. Most sites still run BD out of an inbox. The ones that do not are winning. --- ## Frequently asked questions **What is the SCRS Global Site Solutions Summit?** It is the annual flagship conference of the Society for Clinical Research Sites, a global advocacy organization for research sites. It brings together sites, sponsors, CROs, and solution providers to work on the operational problems facing clinical trials. The 2026 summit was held October 15 to 18 in Orlando, Florida. **What does site sustainability mean in clinical research?** Site sustainability describes a research site's ability to operate profitably and consistently over time: covering its costs, retaining trained staff, and continuing to take on new studies. It depends on fair budgets, timely payments, manageable workloads, and a steady pipeline of appropriate studies. **Why do clinical trial sites struggle financially?** Sites typically incur costs for staffing, training, and start-up work months before they are paid. Budgets often underestimate the true time required per visit, payments can lag by a quarter or more, and items such as screen failures and amendments are frequently underpaid or disputed. **How can sponsors speed up study start-up?** The biggest gains come from master agreements that reduce contract negotiation, fair budgets that sites can accept quickly, standardized document requests, fewer separate technology systems, and measuring start-up cycle times from the site's perspective. **What is ICH E6(R3) and how does it affect sites?** ICH E6(R3) is the revised international Good Clinical Practice guideline, finalized in January 2025\. It emphasizes quality by design and risk-proportionate approaches. For sites, it creates an opening to reduce low-value documentation and monitoring burden, provided sponsors and CROs actually change their practices. **How is AI being used at clinical research sites?** The most practical uses today are electronic health record pre-screening for eligibility, drafting and reconciling regulatory documents, summarizing protocols for staff, and automating repetitive data entry. --- ## Work with Seven Health Seven Health helps sponsors, CROs, and research sites turn lessons like these into results. We support site network strategy, feasibility and site selection, study start-up optimization, sponsor and CRO business development for sites, and operational readiness for ICH E6(R3). If you met us in Orlando, thank you for the conversations. If you did not, we would welcome the chance to compare notes. [Contact the Seven Health team](https://7.cr/contact/) to talk about your 2027 portfolio, or subscribe to receive our next article, a deep dive into the patient access problem in clinical trials.