It’s time for sites to speak up.

A coordinator sits across from a patient, trying to explain why their travel reimbursement hasn’t come through.

The coordinator didn’t delay the payment. They don’t control the process. Yet they’re the one delivering the news, apologizing with fingers crossed the patient will come back for their next visit.

That's the reality for many sites. They enter research to help patients and keep studies moving, not chase invoices or smooth over contract disputes. But when transactional work piles up, it slows down more than day-to-day operations.

It strains the relationships that hold clinical trials together.

When transactions eclipse relationships

Most people in the industry can rattle off examples: contracts stuck in review with zero explanation, sites waiting months for payment, coordinators forced into the role of explaining a broken process to frustrated participants.

For sponsors, a delayed payment might be an accounting issue. For a site, it’s payroll. It’s rent, maybe whether a coordinator can stay employed. For patients, it’s the gas money that determines whether they even try to make their next visit.

On paper, these are transactions. In practice, they’re moments of truth. Each delay, each misstep, chips away at trust. Once that trust frays, it’s hard to get back.

These moments don’t have to stay invisible. Sites can name them, push for better updates, and challenge partners to respond differently. Silence only guarantees that the same cycle repeats.

What it costs sites

The obvious toll is staff time. Hours that could be spent prepping patients, supporting investigators, or running visits are eaten up by reconciliation reports and email escalations.

The deeper cost shows up in patient confidence. A participant who feels strung along on reimbursements may decide it isn’t worth continuing. Word spreads quickly within patient communities, making recruitment harder down the line.

Sponsors aren’t immune either. A site that feels undervalued or left holding the bag is less likely to lean in on the next study.

These aren’t small inconveniences. They’re cracks in the foundation of site–sponsor and site–patient relationships. And while sites can’t fix broken systems on their own, they can raise the flag earlier, ask for visibility, and press for changes before small cracks widen.

Communication’s the name of the game

Most of these problems don’t come from bad intent, but poor communication. A payment is “in process,” but no one tells the site when to expect it. A contract is “with legal,” but weeks can pass without an update. A patient reimbursement is sent, but the site has no visibility into when it will arrive.

In that vacuum, frustration takes root. Sites end up in the middle, trying to reassure patients while chasing answers they don’t have.

This is where sites have leverage. Clear communication isn’t just something sponsors and vendors owe—it’s something sites can ask for outright. Ask for timelines. Ask for visibility. Push for the transparency that keeps you from being stuck as the go-between.

It sounds basic, but it’s often the difference between a relationship that grows stronger and one that withers.

Balancing systems with service

Transactions are unavoidable. But sites shouldn’t be left carrying the weight of them. Their role is to conduct research, not to untangle finance and contract knots that sit outside their control.

That’s where reliable support structures matter. A trusted intermediary or service layer can absorb the friction (think late payments or contract bottlenecks) so they don’t poison relationships.

Technology has a vital role to play. Automated payments, reimbursement portals, and contract trackers can add speed and transparency. But tech’s not the full answer. When something goes wrong—and it always does—it takes a real person to step in and make it right. The right blend of solid systems and responsive service is worth its weight in gold.

Right now, everyone’s talking about AI, decentralization, and automation. These tools are powerful, and they’re here to stay. But tools alone can’t protect relationships. They only work if sites speak up when gaps appear. Tell your partners when a portal isn’t giving you the view you need, or when a process adds confusion instead of clarity. Systems get stronger when sites push them to improve.

When sites are supported, trials succeed

If the industry is serious about strengthening trials, we must begin by protecting the relationships that make them possible. Keep transactions from dominating the site experience. Make communication essential, not optional. And stop designing processes that leave sites stuck as the middleman.

Systems and service matter, but so does site voice. You’re part of the conversation too. Tell your partners what you need, even if it feels like rocking the boat. A small ask—a clearer update, a simpler workflow— can help spare you the endless back-and-forth and let you focus on the work you want to do.

The payoff is simple. Supported sites support patients. Supported patients stay in studies. And sponsors see retention and data quality improve. Everyone wins when the transactional burden is shared, not left to sites alone.

Trials don’t fall apart because coordinators or investigators stop caring. They unravel when transactions smother the relationships that keep them moving forward. If we want resilient research in the years ahead, the solution is twofold: keep sites at the center, and don’t be afraid to challenge your partners to do better.