6 Pillars To Support Community Hospitals' First Steps Into Clinical Trials

By Suzanne J. Rose, MS, Ph.D., CCRC, FACRP, executive director of research, department of research and discovery, Stamford Health

Community hospitals are often seen as centers for clinical care delivery and not as sites for research activities. Clinical trials need not only be conducted in academic medical centers; they can be strategic assets that elevate reputation, attract talent, strengthen community trust, and generate new revenue streams for community hospitals as well.

For leaders at institutions like Stamford Health, the challenge with embarking on clinical research can lie in justifying the value of clinical trials to the C-suite. Executives must weigh investments against competing priorities, and research programs can be misunderstood as costly or peripheral. However, when properly supported, clinical trials deliver measurable returns — financial, operational, and reputational.

This article outlines six pillars community hospitals can leverage to make a compelling case for clinical trials: dedicated infrastructure, community engagement, technology platforms, financial support, strategic partnerships, and physician engagement.

1. Dedicated Research Infrastructure

For the C-suite, infrastructure is not an expense but an investment. It enables faster trial activation, reduces compliance risks, and positions the hospital to engage with our community while attracting industry-sponsored studies. Building a strong and diverse team is only made possible by allocating funds specifically for research in the fiscal budget, which demonstrates institutional commitment.

To that end, Stamford Health established a research team¹ that consists of dedicated clinical research coordinators, regulatory specialists, data managers, a research pharmacist, and a research financial analyst to ensure compliance and efficiency. The staff is centralized to create visibility and streamline operations but is mobile enough to support principal investigators and patient care at various off-site locations.

2. Community Engagement

Additionally, research demonstrates that equitable representation improves trial outcomes and patient trust.^2,3 Therefore, we knew recruitment strategies must reflect the city of Stamford’s diverse population.⁴ National recommendations emphasize that adequate representation of women and underrepresented racial/ethnic groups is both an ethical and scientific imperative.⁵ To reach our community, we utilize educational programs that build trust and dispel myths about research using our Community Healthcare Worker Program.⁶ Another powerful method is to utilize patient stories through sharing testimonials that demonstrate tangible impact through our various social media platforms. For the executive team, community engagement strengthens our reputation and fulfills our mission to support the community in which we serve.

3. Technology Platforms

Modern research requires modern tools. Two essential tools worth their initial investment are a clinical trials management system (CTM) and an electronic regulatory binder solution:

• CTMS: Implementing a CTMS is a critical move for revenue integrity and risk mitigation, which has effectively transformed our research operations from a manual liability into a disciplined revenue center. Previously, reliance on spreadsheets exposed the hospital to financial leakage through missed invoiceable items and created federal compliance risks regarding Medicare double-billing. Along with a research billing compliance program,⁷ the CTMS helps ensure we capture every dollar owed while safeguarding against costly audit penalties. Because the subscription costs are offset by increasing administrative fees charged to sponsors, along with obtaining monies earned, the system effectively pays for itself while securing the hospital’s bottom line.
• eRegulatory solution: Implementing eRegulatory is a strategic necessity that transitions the hospital from a reactive, paper-heavy liability to a proactive, audit-ready research hub. By digitizing regulatory binders, the hospital eliminates the physical storage costs and administrative burden of manual filing, directly empowering coordinators to redirect time back to patient recruitment and care. eRegulatory systems enable remote monitoring capabilities, which can reduce on-site monitor visits and their associated operational disruptions, while simultaneously positioning the hospital as a preferred site for sponsors who prioritize rapid, remote-accessible data. The ROI is realized not just in hard cost savings on paper and archival fees but in accelerated study start-up times — often cutting weeks off the site activation phase — allowing the hospital to open trials faster and capture enrollment revenue sooner than manual competitors.

Executives should view these platforms as risk-reduction tools. They minimize errors, enhance efficiency, and improve throughput — ultimately increasing competitiveness in securing trials.

4. Financial Support

Clinical trials often require up-front investment before external funding begins to flow. A program does not have to start with a large number of trials or participants, but it must invest in highly interested and qualified principal investigators and create centers of excellence from which research programs can grow. One or two trials with strong recruitment and budgeting can quickly demonstrate the value of one clinical research coordinator and one principal investigator. By growing the program on high-producing PIs, a site can recruit other investigators and mentees of established PIs. When a growing trial portfolio demands additional staff, a clinical research workload staffing tool is of great value.⁸ In addition, private funders and research-oriented foundations are a possible avenue for philanthropic and grant support.

5. Strategic Partnerships

Stamford Health’s centralized Department of Research and Discovery provides a broad range of high-quality studies, including National Cancer Institute trials and pharmaceutical-sponsored protocols.¹ Our partnership with Dana-Farber Cancer Institute provides our cancer patients access to cutting-edge, complex clinical research trials while receiving care in the community hospital they know and trust. This directly fulfills the community hospital mission of providing equitable, high-quality care close to home.

Our diverse research portfolio is critical to ensure the department is both scientifically relevant and financially sustainable within the Connecticut healthcare landscape. Pharmaceutical-based research guarantees a steady, diversified revenue stream for the department, as industry-sponsored trials are typically fully funded and offer competitive overhead. By combining prestigious academic access for reputation and advanced care with pharmaceutical funding for financial stability, Stamford enhances recruitment efficiency, attracts top clinical staff and physicians, and solidifies its standing as a leading regional provider. For the C-suite, partnerships mitigate risk and amplify impact by allowing community hospitals to offer patients access to therapies typically reserved for large academic centers.

6. Physician Engagement Initiatives

The PI serves as the indispensable leader in every clinical trial, responsible for the study's execution, regulatory compliance, and most critically, the participants’ welfare. However, establishing fair and compliant compensation while ensuring physicians are engaged in research remains a persistent challenge for research sites at community hospitals. Securing competitive compensation is vital to attract, retain, and motivate the highly qualified investigators necessary to drive clinical research forward.

As most physicians at community hospitals and systems are compensated on a relative value units (RVU)-based model, it is not always possible to allocate protected time for PIs with a demanding clinical schedule. To combat the inherent tug of war between work RVUs and research, a site can create research RVUs (rRVUs) for clinical research-related activities with billable Current Procedural Terminology (CPT) codes. Hospitals can then integrate clinical research into their physician management and compensation systems. Investigators earn a set number of rRVUs for clinical research activities, ensuring clinical research is not viewed as competing with standard of care visits.⁹

Along with the rRVU, fixed fees can be utilized for costs that are consistent from study to study, such as site initiation or monitoring visits. To accommodate assessments in the clinical trial that are only research-related without corresponding CPT codes, a fee-for-service model can be utilized for study procedures because they would be variable from visit to visit and study to study. This system is consistent with the study’s financial success while remaining within regulatory guidelines. ⁹

Our physicians are powerful messengers and influencers in community health initiatives, and their engagement accelerates progress. From a leadership perspective, physician engagement improves recruitment, retention, and morale.

The Future Of Clinical Trials Includes Community Hospitals

Clinical trials are not cost centers; they are strategic investments. For community hospitals like Stamford Health, the value lies in infrastructure, technology, financial support, partnerships, physician engagement, and community outreach.

By framing clinical trials as vehicles for innovation, reputation, and sustainability, hospital leaders can move beyond skepticism and embrace research as a core part of their mission. The message to the C-suite is clear: Clinical trials are essential to the future of community healthcare.
References:

1. Department of Research and Discovery. Stamford Health. https://www.stamfordhealth.org/care-treatment/research/
2. Reopell L, Nolan TS, Gray DM, et al. Community engagement and clinical trial diversity: Navigating barriers and co-designing solutions—A report from the “Health Equity through Diversity” seminar series. Hood K, ed. PLOS ONE. 2023;18(2):e0281940. doi:10.1371/journal.pone.0281940
3. Hosely M. Diversity, Equity, and Inclusion in Clinical Research. Advarra. September 19, 2024. Accessed December 7, 2025. https://www.advarra.com/blog/diversity-equity-and-inclusion-in-clinical-research/
4. Stamford, CT | Data USA. Accessed December 7, 2025. https://datausa.io/profile/geo/stamford-ct#:~:text=The%205%20largest%20ethnic%20groups,%2DHispanic)%20(7.03%25).
5. Corneli A, Hallinan Z, Hamre G, et al. The Clinical Trials Transformation Initiative: Methodology supporting the mission. Clin Trials. 2018;15(1_suppl):13-18. doi:10.1177/1740774518755054
6. Stamford Health implements community health worker program to increase health care access. Stamford Health. January 11, 2024. Accessed December 8, 2025. https://www.stamfordhealth.org/healthflash-blog/stamford-health-staff/stamford-health-implements-community-health-worker-program/
7. Rose, Suzanne J. Maximizing Clinical Research Billing Compliance: One Site’s Journey to Success. Compliance Today Mag. Published online April 2024. https://bit.ly/4aelOjc
8. Cramer G. Adapting Productivity Models to Improve Efficiency and Progress in Clinical Research Practice. ACRP. April 14, 2020. Accessed December 8, 2025. https://acrpnet.org/2020/04/14/adapting-productivity-models-to-improve-efficiency-and-progress-in-clinical-research-practice
9. Rose, Suzanne J. How Are PIs Paid? All The Options For Clinical Research Investigator Compensation. Clin Lead. Published online May 16, 2024. https://www.clinicalleader.com/doc/how-are-pis-paid-all-the-options-for-clinical-research-investigator-compensation-0001#:~:text=At%20academic%20medical%20centers%2C%20PIs,negotiate%20indirect%20costs
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About The Author:

Suzanne J. Rose, the executive director of research for Stamford Health, and holds an M.S. and Ph.D. in biomedical science from Albany Medical College. She was inducted into the 2021 class of Fellows of the Association of Clinical Research Professionals (ACRP).

Her role as executive director entails overseeing the Department of Research and Discovery, which includes the Clinical Trials Office, Center for Simulation and Learning, Office of Academic Research, and Office of Grants. Dr. Rose is also an assistant professor in the Department of Medical Sciences, Quinnipiac University, and an adjunct professor for the Sacred Heart University Master of Physician Assistant Program.

Dr. Rose is an avid speaker at conferences and webinars on various topics, including team building, leadership, principal investigator compensation, billing compliance, and clinical research coordinator workload assessment tools. Her publication focuses include best practices in clinical research and health outcomes rese