Why Site Selection Still Fails And what sponsors, CROs, and sites can do about it
Clinical trials today are more advanced than ever. We have decentralized technologies, adaptive protocols, and real-time data monitoring. But somehow, one of the most critical steps in launching a trial — site selection — still fails far too often.
Despite all the innovation, nearly 40% of selected clinical trial sites still fail to enroll a single patient [1]. And 85% of clinical trials fail to meet enrollment targets [2].
The result?
Delays, blown budgets, protocol amendments, and frustrated teams on all sides.
So why is this still happening?
1. Overreliance on Familiar Networks
Sponsors and CROs often default to what’s familiar:
- Internal site lists
- Academic institutions they’ve worked with before
- Sites that respond quickly to feasibility surveys
But history isn’t always performance. Past relationships don’t guarantee future results. And with growing global access to qualified research centers, limiting selection to a narrow pool of known sites leads to missed opportunities.
2. Incomplete or Inaccurate Feasibility Data
Feasibility surveys are still widely used, but they’re also subjective and inconsistent. Sites may unintentionally overpromise their capacity or underestimate startup timelines.
According to the Avoca Group, only 24% of sponsors fully trust the accuracy of feasibility data provided by sites [3]. That’s a massive red flag, especially when site selection drives trial success.
3. Lack of Standardized Performance Metrics
What defines a “high-performing” site? Enrollment numbers? Regulatory history? Patient diversity?
The industry still lacks a widely accepted standard for site performance evaluation. This leads to inconsistent comparisons and gut-based decisions, instead of data-driven strategies.
4. Limited Visibility into Global Sites
There’s a growing network of highly capable clinical trial sites around the world — many of which aren’t part of the traditional sponsor database.
Without a centralized, searchable platform, sponsors are left to:
- Search outdated directories
- Rely on CRO referrals
- Manually vet each potential site
This process can take weeks — or months — and often leaves strong global sites out of the conversation entirely.
5. Failure to Prioritize the Human Element
Even with great infrastructure, a trial can struggle if the site team isn’t responsive, aligned, or trained properly.
Site selection is about more than equipment and protocols — it’s about communication, collaboration, and trust. Misaligned expectations between sponsors and sites are a leading cause of missed milestones.
So, How Do We Fix It?
At Intune, we believe site selection should be a strategic advantage, not a guessing game. That's why we built tools to help sponsors and CROs:
- Access a real clinical trial site database, not just a spreadsheet
- Filter by verified experience, patient access, and region
- Tap into a global clinical trial network
- Streamline feasibility outreach and compare site proposals faster
- Build transparent, trust-based relationships with high-performing sites
Because when the right sites are matched to the right trials, everyone wins — faster timelines, better data, and less frustration across the board.
What’s Next
In our next InStitute post, we’ll walk through how to evaluate site performance beyond enrollment, including red flags to watch for during feasibility.
In the meantime, if you're ready to modernize your approach, we’d love to show you how Intune can help.
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Schedule a demo and see how fast site selection can actually be
Sources:
[1] Tufts Center for the Study of Drug Development. https://csdd.tufts.edu
[2] BMJ Open. Recruitment and retention in randomized trials. https://bmjopen.bmj.com/content/8/6/e020276
[3] The Avoca Group. 2022 Site Feasibility and Selection Benchmark Report.
