When I finished up at the first CRAnecdotes event where I was one of two guest speakers, I was still buzzing from the energy of connecting with all the wonderful clinical professionals. On top of that, the Q&A session was filled with some great questions. One of them was really relevant and a great example of some of the daily struggles of a CRA.
The question was:
Maybe you could quickly tell us how would you advise to deal with sites that are not motivated to recruit or just respond to CRA’s emails?
My immediate answer was:
That’s an excellent question and unfortunately all too common for CRAs. So much so that one of my courses is almost exclusively covering this topic, the At Site course. In short I think it boils down to the motivation of your site staff. They are most likely working on different studies with different CRAs with different deadlines. They need reasons to want to do better for you and your study. Find those reasons.
And while I felt that answer was pretty good on the spot, it really is a deep and encompassing issue. As I mentioned at the time, my At Site course covers this exact topic in the full depth that it deserves, but I also wanted to share here some of the ideas and advice that I have on how to tackle unresponsive sites.
There are two scenarios that pop into the front of my mind: when you just took over a new site from the outgoing CRA and when you’ve already been a monitor for this site for a while.
When you just took over a new site from the outgoing CRAThis is the ideal and best time to establish a great relationship with the site staff. Show them that you are there to make their life easier, that you recognise their hard work and that you are a reliable monitor. Make it known to them that you respect their time, so always communicate with them in a clear and concise fashion. Observe them and listen to them. Tailor your approach to them depending on what they are like, e.g. some site staff like a good joke, some want to get straight to resolving queries, some respond well to quick reminders by email, some prefer a phone call. Adjust your approach to what works for them and what keeps them motivated.
When you’ve already been a monitor for this site for a while
This is a much more difficult scenario. I would first look at the possible reasons why they are not responding to your emails. I would try to analyse the situation to see the potential reasons for this. You can break that down into the following areas:
1. Your relationship with site staff
Analyse your relationship with the site staff up until now. Has it always been rocky? Has something happened over that time to demotivate them? See what you can do to help them here. Perhaps talk to the Study Coordinator about it to find out more. You shouldn’t expect to solve this on your own, but you can at least try and ask questions.
Are they too busy in their job or are they overwhelmed with other studies? If this is the case, then you have solid information to raise with the PI to see if it’s possible to get more site staff resources to work on your study. Remember to keep your study management and your line manager in the loop. They might have some advice as well. Also during this time approach site staff with the understanding that they are swamped, and be as efficient in your communication with them as possible.
2. Your communication with site staff
Take a look at how you communicate with your site staff. This goes for communication between site visits, as well as during your site visits. In the period between site visits, are you regularly in contact with them? Regardless of whether it is mainly emails or calls – do they respond well to that type of communication? Perhaps they prefer one method over another.
When you send emails, are they concise and to the point? When a super busy person looks at your email, is it quick and easy to see what is their action item? Is it easy to see who should do what and by when? If you’re not sure, you can run your emails by a fellow CRA or your line manager to get their feedback.
When you send a long list of tasks that they are required to complete, is that list organised based on the priority of items, or is it just a raw dump of action items pulled from CTMS? By doing a bit of filtering and ordering yourself, you’re saving the site staff precious time (not that your time isn’t precious!) and thus making their lives that little bit easier. Make sure you let them know that you have ordered the list in the order of priority, so that your efforts don’t go unnoticed though.
Try to put yourself in their shoes. If you were a busy site staff, how would you like CRAs to communicate with you? What kind of relationship would you find most beneficial to achieving the common goal of success of the study?
Hopefully going through these questions will help to pick up some issues or patterns that you can address.
3. The value of a sounding board
There is a helper that you should be able to rely on; your line manager. Keep them in the loop of your issues with the site staff and they may offer you advice or they may have some idea on how to improve the situation that you haven’t thought of. If you don’t have a line manager then perhaps your mentor or a colleague can give you some tips on how to go about improving your relationship with site staff. Maybe someone else in your company already worked with that site staff and knows how they work and what they respond to well. Maybe they can share some insight there. Know that you are not alone and like Simon Sinek says “together is better”.
Motivation, motivation, motivation
A CRA’s job is to influence, not to command site staff. You are not their manager. They do not report to you. A CRA’s toolkit when motivating site staff is based on soft skills, genuine relationships and an honest and open communication with site staff.
Also remember, even if you are a great monitor and spotting all deviations, if you don’t pay attention to motivating site staff and appreciating them, they will not cooperate to their fullest and this will affect your overall efficiency. So be their cheerleader and support them. Everyone will perform better if their effort is recognized, even in the smallest ways.
Do you have any other ideas on how to deal with unresponsive sites? I would love to hear from you!