Clinical Researcher—May 2018 (Volume 32, Issue 5)
GOOD MANAGEMENT PRACTICE
Ted Finlan, PMP, CSM
Time is critical for public and private sponsors of clinical research. As clinical trials take on increasing complexity, clinical research organizations (CROs) must be able to help manage operational data and optimize timelines to support their sponsors’ submission processes and strategic goals.
Consequently, CROs that want to stay competitive must have the operations side of their house in order. This requires deep analysis of performance across every function—from regulatory compliance and information governance to patient recruitment, budgeting, and daily workflows.
Underpinning all operational performance is one non-negotiable cornerstone: quality. CROs are first and foremost information companies, retained for their ability to deliver the highest quality data to support a sponsor’s mission. As such, operational design must work in tandem with this mission to support transparency and data analysis. As CROs consider ongoing process improvement, the following considerations across five key areas can serve as a baseline for best practices.
Pitfall: Failure to understand and plan compliance timelines
Internal and external regulatory groups have varying deadlines, with timelines that often intersect and overlap. For instance, approval for a drug import license can vary from country to country by a matter of weeks or months. Without a clear understanding of approval processes and their impact on the critical path, a study is at high risk of schedule slippage.
Best practice: Clear project planning blueprint
CROs should ensure clarity and alignment between staff responsible for designing a regulatory blueprint (e.g., ethics committees, institutional review boards, etc.) and those responsible for building, managing, and communicating schedules. When approval processes are clearly mapped out to achieve the most efficient response, CROs can expedite the commencement of work.
Information Flow and Governance
Pitfall: Lack of communication between departments and across organizations
Every department maintains critical information that other departments can benefit from. For instance, the Quality unit may be the first to become aware of new clinical trial regulations that impact the study start-up processes. If this information is not shared across the organization, various issues may arise, such as compromised core processes and missed timelines, jeopardizing overall delivery of the study.
This risk can be especially acute when working with new partners or third parties. Misplaced assumptions about “who knows what” or misaligned processes can creep in and drive quality issues or delays if initial and ongoing communication between these entities is lacking.
Best practice: Purposeful communication and collaboration
Clarity is a best practice when it comes to communication, and standard operating procedures should address optimal information flow. This requires every team member and site to have a clear understanding of their own responsibilities, as well as the roles and responsibilities of those adjacent to them. Processes should lend to proactive knowledge sharing as departments recognize how information intersects and how teams can fully leverage intelligence.
Mutually agreed-upon terms of engagement between sponsors, CROs, and vendors can also circumvent downstream quality, compliance, or timeline issues. These communication plans should ensure collaboration across all facets of the project.
Getting a Fast Start
Pitfall: Final protocol delays
Delayed availability of the final protocol is one of the most significant stumbling blocks to patient recruitment. The final protocol is a critical path deliverable that impacts trial supply, site activation, and, of course, recruitment.
In fact, quite often, important work will begin before the final protocol is available. Proceeding “at risk” can lead to rework that can increase the cost and duration of start-up, and, in some cases, could lead to losing access to desirable clinical investigators or institutions. All of which impacts the ability to recruit and can affect the pace of recruitment throughout the study.
Best practice: Transparency and communication
Visibility into the availability of the protocol and expected impacts can significantly mitigate the impacts of delays. By actively planning for the delays and communicating proactively with the sites, a CRO can maintain engagement and be far more agile in adapting to change. This requires proactive communication and strong collaboration between the sponsor and CRO to make the changes needed for strategies, systems, and plans to run as smoothly and quickly as possible.
Pitfall: Improper management of uncertainty
A key characteristic of research is uncertainty. Unfortunately, that reality can make the budgeting process a series of “best guesses.” As noted above, delays in protocol availability can delay studies for unpredictable periods of time, as can the availability of investigational product (IP) supplies.
These, and other unknowns can lead to rework, changing of staff, and other impacts that affect the overall budget, including direct CRO services, grants, and third-party costs. Without effectively forecasting communication and change order processes, studies can run into financial trouble, including an inability to compensate investigators or pay third-party costs.
Best practice: Effective change management
In an ideal world, any CRO would like to minimize risk by matching the level of uncertainty with the right amount of “insurance,” often referred to as a reserve. This is rarely possible, yet the most effective CROs move forward with a considered, deliberate approach for “out of scope” work and a smooth change order process.
Another approach is to financially ensure alignment and motivation through targeted use of bonus clauses, incenting CRO performance by aligning its financial benefit with the goals of the sponsor. For example, hitting aggressive recruitment and retention targets.
It is important to remember that these approaches are two-way streets. Change orders for unused/unrequired spending result in savings for the sponsor and should be communicated just as proactively. As this may be driven by faster recruiting or other “good news,” it may appear to some that the CRO is being punished for exceptional performance. This is another good reason to align incentives and bonuses to match the sponsor’s desired outcomes.
Pitfall: Finding projects short-staffed
Inefficiency is always a concern, and the ability to efficiently allocate staff is a critical factor for service companies. A lack of consistency across organizations, various conflicting or ambiguous definitions for terms and data, misaligned assumptions, and an absence of clarity across processes and organizations can leave projects short of key staff, driving delays, quality issues, and other delivery problems.
Best practice: Aligning key resources
A holistic view of processes and clear data definition across the enterprise is key. This is usually attacked by mapping and integrating core processes, and in the case of services staffing, this is often referred to as the “quote to cash” process. As it sounds, this process takes the proposal and bidding activities into consideration, where staff capacity transitions to the reservation of specific individuals.
Once the formal assignment is in place and resources are used, the process moves into the billing and receivables portion. By clearly illustrating the processes and agreeing to common data definitions and metrics, the CRO can gain greater visibility into its “factory” and more efficiently serve its customers.
Good Business Operations = Effective Trials
Clinical research remains a fascinating, growing field marked by increasingly competitive surroundings. Optimal operations design is critical to future positioning and sustainability. CROs can overcome common pitfalls to study success by adopting some of these fundamental best practices.