Site networks

Why 40% of North American sites never activate, and how networks fix it

By TrialNotice · Updated
Sponsor clinical operations team reviewing site maps and performance charts on a large screen
Short answerTufts CSDD reports the North American site activation rate has fallen to 62%, meaning about 40% of sites sponsors look to engage never activate. Ken Getz attributes it to sites that never get through contracting and budgeting or never get IRB approval, alongside rising protocol complexity. Networks improve activation by centralizing contracts, budgets, and regulatory work; independents can match them by preparing those steps in advance.

What does the 62% mean?

At the 2024 SCOPE Summit, Ken Getz of Tufts CSDD reported the North American activation rate had fallen to 62%, suggesting about 40% of the sites sponsors look to engage will not activate (Clinical Trial Vanguard). The same research found the total number of investigative sites in pivotal trials up 60.1%.

Why do sites fail to activate?

How do networks activate more reliably?

  1. Central contracting and budgeting with templates and negotiated master terms.
  2. Regulatory teams that prepare IRB submissions in parallel.
  3. Standard SOPs and systems across locations.
  4. Scale: buyers value networks for the enrollment velocity and consistency they deliver (Objective IBV).

Can an independent site match that?

On the steps it controls, yes: an internal budget ready before the offer, standard documents on file, fast turnaround on every draft, and an IRB pathway planned in advance. See why startup takes so long.

What happens after activation?

Activation is only the gate. A site that activates with no patients waiting becomes the zero enroller sponsors remember. Networks and independents alike pull ahead when patient sources, including local referring physicians, are briefed during startup. Network leaders can standardize this across locations; see standardizing recruitment across a network.

Get your study in front of the right local physicians

TrialNotice builds a physician referral pipeline around one active study. We identify relevant local physicians within driving distance of your site, send study aligned direct mail, follow up by email and LinkedIn, track engagement with recipient level QR codes, and route warm responses into your site team's workflow.

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Sources

  1. Clinical Trial Vanguard, "Tufts CSDD: New Insights on The Clinical Trial Industry" (SCOPE 2024)
  2. Applied Clinical Trials, "New Benchmarks for Trial Initiation Activities" (Tufts CSDD)
  3. Bourne Partners, "Update on the Fundamentals of Clinical Trial Sites" (SCRS Global Site Solutions Summit takeaways, October 2025)
  4. Clinical Leader, "Getz: Site Activations Hurt By Commodity Mentality"
  5. Objective Investment Banking and Valuation, "Valuation of Clinical Research Sites: What Buyers Look For"

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