Why Site Relationships With Sponsors and CROs Must Evolve Now
By Jim Kremidas, executive director, Association Multisite Research Corporations (AMRC)
For decades, the clinical research industry has accepted a paradox. Sites are central to drug development — we cannot run a trial without them — yet the industry continues to treat them as tactical, temporary instruments. We assemble networks of 40 or 50 sites, push them to their limits, and dismantle them the moment the last patient completes their final visit. Then we do it all over again as if predictability, speed, and quality were purely aspirational goals rather than achievable outcomes.
It’s time to break this cycle. In a recent deep-dive session between members of Association of Multisite Research Corporations (AMRC), sponsors, and CROs at the Innovation Network Gathering (ING) event, it became clear that these groups share more frustrations and ambitions than many assume. The desire for better relationships is real. The barriers are systemic, not personal. And the opportunity to shift from tactical engagement to strategic partnership is both urgent and within reach.
A System Built For Tactics, Not Continuity
The industry’s prevailing model is not the result of unwillingness but of fragmentation baked into our processes. Each Sponsor and CRO operates its own governance structure, tools, training, and definitions of oversight. Governance can vary between therapeutic areas and sometimes even from one protocol to the next. With the intense regulatory focus on the Form FDA 1572, a legally binding document in U.S. clinical research that a PI signs to commit to conducting a study in compliance with FDA regulations, relationships often remain investigator-centric, making it difficult for sponsors to see the broader capabilities of a site or site network.
This structure reinforces a short-term, protocol-specific mindset. Many individuals within Sponsors and CROs are constrained by operational responsibilities that limit their ability to step back and look at the system holistically. Without visibility into what sites experience day-to-day, including high staff turnover, protocol complexity, and administrative burden, decisions naturally default to risk avoidance.
The consequences are predictable: a lack of standardization even within the same organization, limited repeatability from one study to the next, inconsistent feasibility and recruitment performance, and a persistent deficit of trust. Sponsors often halve the feasibility numbers that sites provide. Sites, anticipating this adjustment, inflate their estimates. Sponsors lose confidence. CROs add layers of oversight. And the cycle continues.
However, none of this is driven by bad faith. It’s the logical outcome of a system that rewards execution on individual studies rather than continuity across them.
The CRO Playbook: Lessons Hiding In Plain Sight
Interestingly, we have a blueprint within our own industry for how to fix this. In the 1990s and early 2000s, CROs faced many of the same challenges site networks face today: variability, lack of standardization, and fragmented relationships with sponsors. Their solution was to professionalize the model. They implemented governance committees and standardized expectations, portfolio-level forecasting, and long-term contracts that aligned incentives around shared outcomes.
Today, CROs and sponsors meet regularly at an executive level to review performance, resolve systemic issues, and plan future pipelines. But none of that structured collaboration exists between sponsors and sites, even though site performance ultimately determines trial success.
We see attempts at progress — standardized training programs, site relationship initiatives, and early engagement in some therapeutic areas — but these efforts remain inconsistent. Sponsors still hesitate to accept training conducted by other sponsors because protocol complexity continues to grow. Multisite clinical research corporations (MCRCs) — a term created by AMRC to indicate a site network of five or more sites with centralized functional areas, trials as their primary source of revenue, and at least one FDA approval in the past years — are emerging as sophisticated organizations. Yet, they are still perceived primarily as collections of sites rather than integrated corporations that can streamline operations and speed up research. Everyone expresses interest in partnership; few mechanisms actually support it.
What Could A Strategic Relationship Look Like?
In the ING x AMRC deep dive in Philadelphia, September 2025, participants shared several examples where the tactical model has begun to evolve into something more strategic. These examples were encouraging not because they were radical, but because they demonstrated how achievable the shift can be when the right elements are in place. Sites and sponsors who regularly reviewed pipeline forecasts together saw smoother activation timelines and a willingness on both sides to invest in common infrastructure that helps them reach their shared outcomes.
Networks that met with CROs at a strategic level were able to unblock operational issues before they derailed recruitment. Sponsors that treated site networks as organizations rather than collections of investigators saw more consistency and better data. None of these examples required reinventing the wheel. They simply required a commitment to collaboration and broader knowledge sharing beyond the confines of a single protocol.
What The Future Model Should Embody
A strategic relationship must be grounded in transparency, shared expectations, and mutual investment. Sites need predictable study flow and early engagement in protocol design, along with a clear understanding of what sponsors and CROs expect across trials, not just within them. CROs need clarity on processes, faster decision-making structures, and the ability to plan resourcing against predictable site performance. Sponsors need visibility into site operations, consistency in timelines and reporting, and confidence that feasibility data reflects real capability rather than guesswork. All of this leads to both sides taking accountability for when things may or may not go to plan, which is predicated on trust.
Importantly, a new model does not replace the tactical one. The industry will always need study-specific engagement. Instead, a strategic layer must run in parallel — one that provides continuity, enables trust, and reinforces operational excellence.
Where Do We Go From Here?
The clinical research ecosystem is more aligned than we often recognize. Sites want to deliver reliable performance. CROs want partners who can scale with them. Sponsors want predictability, speed, and quality. Yet we rarely measure the industry’s own operational performance with the same rigor we apply to investigational products. We innovate trial design but neglect the relational infrastructure required to execute those designs effectively.
One of the most striking insights from our deep dive was that some participants said this meeting was the first time they had ever sat across the table from both sponsors and sites simultaneously. That should not be an anomaly but a baseline expectation.
If we are serious about transforming clinical research, we must create the structures that allow honesty, shared learning, and joint governance to thrive. We must build the muscles of partnership, not just express the desire for it. At AMRC, we are committed to facilitating that collaboration. The shift from tactical to strategic relationships is not only possible; it is necessary. The future of clinical research depends on it.
About The Author:
Jim Kremidas, executive director of the Association of Multisite Research Corporations (AMRC), has over 35 years of experience in the healthcare industry. Most recently, he has served as the executive director for the Association of Clinical Research Professionals (ACRP). He has over seven years of experience in management at CROs and spent more than two decades at Eli Lilly and Company, where he started the first patient recruitment department in the industry.