3 Ways to Manage Excessive CRA Turnover
Ross Weaver, Managing Director of Clinical Trial Insights, Clinical Score
CRA turnover is a problem in the industry. Finding qualified CRAs can be a problem for many companies. It then takes time to train and educate them on policy, procedures, and protocols. If that asset then leaves the company, you are back to square one.
This is a problem I hear from many of my study coordinators In speaking to them, you can get a clear sense of their frustration. “Even a mediocre CRA is better than dealing with constant turnover,” said one. “When I have to brief my CRA on the correct protocol, that is a problem,” notes another.
Most CRAs are employed by CROs, and having stability in that position is also a benefit to sponsor clients. Unfortunately, the problem within those service providers has gotten to the point where an article last year referenced a “war on talent” that now exists in the market. The CRA turnover rate increased from 14.2 percent in 2013 to 19.4 percent in 2014, an increase of 37 percent. The turnover has also caused many CROs to raise salaries and implement signing and retention bonuses. Unfortunately, salary increases alone will not solve the problem, as there is no one-size-fits-all solution. Increasing salaries does not increase the sense of loyalty an employee has to a company, which is one reason many may choose to stay put.
Excessive CRA turnover delays trials. Our analysis shows that excessive CRA turnover is an important factor differentiating “unsuccessful[1]” studies from “successful[1]” ones.
For a single two-year study, more than one-third of your sites will deal with CRA turnover. That should be a concern for anyone conducting clinical trials.
So what can you do to manage excessive CRA turnover? And, really, should managing CRA turnover even be a part of your job?
In my opinion, CRA turnover is part of your job, especially if your responsibilities include ensuring clinical trials are completed on time, or if you are part of the team managing relationships with CROs. So, what can you do?
Here are three ways I recommend for ‘managing’ excessive CRA turnover:
1. CRA Training on Your Protocol
Ensure CRAs are well trained on your protocol. They should know the protocol in detail. They should be able to answer common questions, and also know how to access answers to less common questions that arise. If every CRA is well versed in your protocol, the loss of one of those individuals will be less disruptive to your study. If your protocol is well known to just one key CRA, their loss can bring your study to a crawl.
2. Provide a conduit between sites and the sponsor
Sites should be permitted to communicate with sponsors, especially on issues relating to CRA and monitor personnel issues. If sites are not allowed to communicate with sponsors, is it realistic to expect your CRO to highlight excessive personnel turnover? An open line of communications with both CROs and sites will help you to keep on top of any issues relating to CRAs and turnover.
3. Develop metrics to monitor CRA turnover
Do you know how many CRAs have been assigned to work on your study? Do you know the turnover rate for CRAs at your CRO, and for your study in particular? Even if you know those figures, what amount of CRA turnover is acceptable to you? What amount would you consider to be excessive? And what are those rates at other CROs you are using? Are they comparable or substantially different? Without proper metrics to monitor, you might never know.
I recommend developing realistic metrics. Once you have them, share them with your CRO so they know your expectations. Of course simply setting expectations and then forgetting them will not cut the rate of turnover or the problems caused by it. Therefore I also recommend getting commitments from your CROs to provide monthly updates on CRA staffing. Any deviations from expected figures should be analyzed and discussed.
[1] ‘Unsuccessful’ studies randomized less than 75% of targeted patients. ‘Successful’ studies randomized 75% or more of targeted patients.