Guest Column | October 10, 2024

What's A Better Tactic For Patient Recruitment — "Unreasonable Hospitality" Or The Same Old?

By Ross Jackson, consultant

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I like to draw inspiration from a range of sources to help deliver effective patient recruitment and retention solutions. One of the richest and most rewarding sources I’ve found over the years is to read — and, more importantly, learn from — business and self-help books.

A recent one with great lessons for the clinical trials industry is “Unreasonable Hospitality” by Will Guidara. (Guidara is also the co-producer of the hit FX TV series “The Bear.”)

A key theme of the book is to recruit people who understand what you’re trying to do and are passionate about achieving the best results. This has led me to develop a hypothetical scenario in which I ask an imaginary set of interview questions aimed at recruiting someone to handle patient recruitment and retention for clinical trials.

I’ve imagined two candidates for the role — one of whom wishes to implement the kind of strategies found in the book, the other entrenched in the same old way of doing things. I always find an inverted approach can help highlight bad practices as well as underline good ones. (You won’t need much of a hint as to which candidate is which.)

Hopefully, you might find some inspiration for adapting some of the suggestions from the interviewer’s questions and the candidate’s answers to help with your own patient recruitment and retention issues.

Candidates Interviews: Old School vs. New School

Interviewer: I’ve identified several of the core elements from the theory of “Unreasonable Hospitality” that could be related to the issues of patient recruitment and retention and have developed suitable questions related to each one. Please answer them based on your understanding of what is likely to help us achieve our goals for this trial, based on your own experiences and issues you’ve faced.

Interviewer: What could you do to understand the individual needs, fears, and desires of your potential trial participants? Could you do anything that might help you understand whether they would wish to participate or not?

Candidate One: I’d look to implement a thorough prescreening process where we not only gather medical histories but also conduct in-depth interviews to understand the personal and emotional contexts of our participants. I’d also make sure we ask about their daily challenges, their expectations from the trial, and any concerns they may have. This would help us tailor our communication and support to address their specific fears and motivations.

Candidate Two: When it comes to clinical trials, I don’t think it’s necessary to focus too much on individual needs or concerns. I’d make sure we provide the same information to all participants, assuming those who are interested will join, and those who aren’t won’t. Given how much else there is to focus on during the course of a trial, I don’t think it’s practical to personalize our approach to every participant.

Another possible element is creating personal touchpoints. In what ways could you add personal touches to your interactions with participants? Could you create personalized welcome kits, tailored to each participant’s interests or health needs?

Candidate One: I would look into the possibility of sending out personalized welcome kits that include not just the trial materials but also items that match the participant’s interests, such as a book related to one of their hobbies or possibly cinema or theater tickets for people interested in those activities. I’d also make sure we include a handwritten note from the lead researcher with these communications to add a personal touch.

Candidate Two: In my experience, I don’t think we’d need to provide more than a standard welcome pack with the necessary forms and instructions. Personal touches like handwritten notes or tailored items might sound all well and good, but I’d say they are unnecessary and take too much time to put into practice, especially with everything else going on. With me in this role, our focus will be on the essentials such as costs and efficiency, not the “nice to haves” such as personalization.

Thirdly, there is a concept that may be called elevating the trial experience. Give me an overview of what an “above and beyond” experience might look like for our trial participants. What do you think about the possibility of surprising them with small, unexpected gestures that could potentially make them feel more appreciated than otherwise?

Candidate One: One approach I would like to take is to introduce milestone celebrations, whereby we provide small events or gifts when participants reach significant points in the trial. For instance, after a particularly challenging phase, we might surprise them with a spa voucher or other gift that matches their interests. I believe these gestures will reinforce how much we appreciate everyone who volunteers to participate in a trial, helping to maintain their engagement and enthusiasm.

Candidate Two: My primary concern is that participants complete the trial and provide data so we can submit the potential treatment for approval. As with other trials, we wouldn’t have the budget or time to focus on surprises or extras. I believe that participants should be sufficiently motivated by the compensation or expenses they receive, as well as the opportunity they have to contribute to developing treatments. The other things are simply unnecessary gestures that detract from the serious nature of the trial.

Empowering your team is another factor to consider. How would you empower your team to think creatively about patient care? Are there any obstacles you can see that might prevent your staff from going the extra mile, and, if so, how could those be removed?

Candidate One: In previous organizations, I ensured we empowered our staff by creating a “patient experience fund,” which they could use at their discretion to enhance the participant experience. This resulted in such things as arranging transportation to and from the research site and even organizing special events. I also implemented regular brainstorming sessions where the team could propose new ideas for making the trial experience more patient-friendly.

Candidate Two: The team has specific protocols to follow, and I would discourage anyone from deviating from them. It’s my experience that creativity can lead to inconsistencies, and in the world of clinical trials, it’s essential to have a standardized approach. For maximum efficiency, staff would be expected to focus on their assigned tasks and not spend time on things outside their scope of work.

The fifth area is building emotional connections. What are some ways you might forge deeper emotional connections with trial participants? What’s your opinion of incorporating storytelling or shared experiences to make participants feel more connected to the purpose of the trial?

Candidate One: Bearing issues of privacy and anonymity in mind, I would suggest introducing a “patient story series” where participants could share their own stories, such as why they joined the trial, their experiences, and their hopes for the outcomes. These stories could be shared with other participants, potential participants, and our broader team to create a sense of community and shared purpose. I’d suggest we could also host regular check-in calls where the focus is less on data collection and more on how the participant is feeling and coping.

Candidate Two: I don’t really see the need to build emotional connections. A trial is a professional engagement and should be treated as such. Participants are fundamentally only involved to contribute data, so I don’t think we should be looking to blur the lines with personal stories or emotional involvement.

Next, we come to incorporating the unexpected. What are some creative, unexpected acts of generosity that you could introduce to your trial process? Could you offer experiences or rewards that go beyond the traditional forms of compensation?

Candidate One: I’d be looking to see if we could partner with local businesses to offer participants unique experiences, such as maybe a day at a local museum or a cooking class. These unexpected rewards would not only surprise participants but also provide them with a much-needed break from their routine. I believe this could foster goodwill and encourage them to stay engaged with the trial.

Candidate Two: I’ve always believed the compensation offered should be sufficient, and that additional rewards or experiences would only complicate the process. Participants should already be aware of what they are getting into, so I don’t see the need to go beyond that.

Now think about leveraging technology for personalization. How could you use technology to create more personalized experiences for your participants? Have you explored using apps, digital platforms, or other tech solutions to enhance the way participants engage with a trial?

Candidate One: I know of organizations that have developed mobile apps that offer personalized reminders, health tips, and motivational messages tailored to each participant’s progress in the trial. I think we could take that a step further and have the app also feature a virtual concierge service where participants can ask questions or request support at any time. Additionally, in the longer term, I’d look to explore the use of virtual reality to simulate trial environments, which could be used to help participants feel more comfortable before they begin.

Candidate Two: I think it gets too complicated — for the people operating the trial as well as the participants — if you look to use more than just basic email and phone communication. I wouldn’t be looking to invest in apps or other digital platforms, as they are costly and time-consuming to develop. The current methods work well enough, and I don’t see a fundamental need for more personalized digital engagement.

Another area is considering the patient's support network. How could you engage with the families or caregivers of your participants? Could you extend your acts of hospitality to them as well, making them feel supported and appreciated for the role they play?

Candidate One: In my current role, we’ve started involving caregivers more directly by offering them resources tailored to their role — such as informational sessions on how to support their loved ones during the trial. We also send thank-you notes and small tokens of appreciation to caregivers to recognize the crucial role they play in the trial process.

Candidate Two: I take issues of privacy very seriously, so I wouldn’t intend to interact with participants’ families or caregivers unless it’s absolutely necessary. Communication would be strictly with the participants — I don’t see the need to involve their support networks beyond what is required for consent or emergency situations.

And finally, I’d like your views on sustaining the relationship beyond the trial. What happens after the trial ends? How do you maintain the relationship with your participants? Could you continue to engage them in ways that make them feel part of a larger community?

Candidate One: I’ve always liked the idea of establishing a “trial alumni” program where participants receive regular updates on the trial’s progress and outcomes, as well as invitations to related events or webinars. I would also look to send out a six-month or yearly report that highlights how their participation has contributed to advancements in the field, ensuring they feel their contribution was meaningful and worthwhile.

Candidate Two: Once a trial ends, I’d say our involvement with participants should typically end as well. It’s standard procedure to send a final follow-up and then close out the file, after which I don’t see the need to maintain ongoing relationships. For maximum efficiency, the focus should then shift to the next trial and the next group of participants.

The Cost Estimate Of Implementing “Unreasonable Hospitality” Ideas

Of course, adopting the approach suggested by candidate one — based on the concepts to be found in “Unreasonable Hospitality” — will come with additional costs. This could include, for example, developing personalized communication strategies (custom welcome kits, handwritten notes, etc.), offering transportation and childcare assistance, delivering surprise gifts, hosting community events, developing apps, etc. Altogether, this could add $100,000 or more to the cost of the trial.

However, this expense compares favorably with the potential costs involved with the trial delays we’re all familiar with due to underperforming patient recruitment activities. Extended timelines, multiple project change orders, reduced time for the potential treatment to be in the market, etc., are estimated to cost between $40,000 and $500,000+ per day!

Trials Are Expensive, So Where Should The Money Go?

Implementing the patient recruitment ideas based on principles described in “Unreasonable Hospitality” will come with an up-front investment of time and financial resources. But the upside is considerable when it comes to being able to attract and retain participants through to trial completion.

Everyone involved in patient recruitment and retention should take time to reflect and review your practices, as well as read the book to see if you can glean additional insights for improving your own results.This is the first article in a new series: Inspired Patient Recruitment — Taking Inspiration from Business Advice Bestsellers.

About The Author:

Ross Jackson is a patient recruitment specialist and author of the books “The Patient Recruitment Conundrum” and “Patient Recruitment for Clinical Trials using Facebook Ads.”

Having started out with digital marketing in 1998, Ross quickly developed a specialty in the healthcare niche, evolving into a focus on clinical trials and the problems of patient recruitment and retention.

Over the years Ross branched out from the purely digital and now operates in an advisory capacity helping sponsors, CROs, sites, solutions providers, and others in the industry to improve their patient recruitment and retention capabilities — having advised and consulted on over 100 successful projects.