For many workers, December is not just the holiday season. It’s the season of the holiday bonus.

But in the clinical research industry, the issue of bonuses can be a bit complex. On the site level, the matter is fraught with controversy and risk, said Christine Pierre, chief executive of 17-year-old site network RxTrials, and founder of the annual Site Solutions Summit, a popular meeting at which sites, sponsors and CROs come together to share ideas and best practices.
This year, as part of her annual survey conducted just prior to the summit, Pierre asked sites whether they give bonuses, and, if they do, on what criteria those bonuses are based.

To her surprise, almost 70 percent of the 129 sites responding said they give bonuses. The real shock—just over 40 percent give bonuses to employees for meeting enrollment goals. Pierre said this is tantamount to inviting site employees to behave unethically.

“Basing bonuses on enrollment targets is putting the emphasis in the wrong place,” she said. “This is a slippery slope that can get a site in a lot of trouble.”

Part of Pierre’s shock comes from the fact that several years ago, sponsors were in the habit of offering sites financial incentives for meeting such targets, and many sites were insulted and appalled. It was no surprise, then, when some less-than-ethical sites began enrolling subjects who didn’t actually meet eligibility criteria just to get the bonus.

Pierre is against not just enrollment-based bonuses, but all bonuses for site employees.

“In today’s world, with the FDA and IRBs watching so closely, why would you risk giving bonuses at all?” she asked, adding that in her work as a consultant to sites, when she scrutinizes operations the way an FDA compliance officer might, the first thing she considers is whether employees are somehow financially incentivized to behave in an unethical manner. Bonuses—whether tied to enrollment goals or not—could draw unwanted scrutiny.

One principal investigator on the other side of the bonus debate is Jeff Kingsley, chief executive of Columbus, Ga.-based Southeast Regional Research Group. He gives out bonuses to each of his sites’ 30 employees in December as well as at random times throughout the year. One recent Friday, after all of his coordinators had a very rough month, he walked around handing out checks to them. Last year, he hosted all employees and their families at a cluster of cabins in the North Georgia mountains. “I cooked steak and potatoes and served everyone,” he said.

“We believe in doing bonuses; we believe in having some sort of employee incentive plan because if the company makes money, the employees should make money as well,” he said. “It’s just good business practice. But it has to be done right; it can’t be tied to an individual protocol, enrollment or randomization.”

Instead, he bases bonus amounts on employees’ level of seniority and overall performance. How does he ensure that employees do not behave unethically near bonus time? Kingsley said the answer is two-fold. First, hire very carefully, bringing on only people you feel very sure are not apt to be involved in any misconduct. And secondly, be very strict about ethics.

“If I have good evidence of unethical behavior, the person is fired on the spot,” said Kingsley. “If I have evidence that someone has stretched the truth, they will be cautioned and watched like a hawk.”

Pierre, for her part, said it’s not all about money for employees. “It may not be the motivator that everyone thinks it is,” she said. “What do employees want? Historically, surveys have shown that it’s primarily recognition, autonomy and time off. Money is usually much further down on the list.”

Outside of the ethics issues, Pierre said she worries some sites give bonuses because they can’t afford to pay their staff at industry-average levels, so they try to make up for it with periodic cash infusions when the sites get a large payment from a sponsor. This isn’t good business practice, she said.

In next year’s survey, Pierre plans to ask sites more questions about bonuses. “We will delve much more deeply into it, asking how the bonuses are distributed—to a person or to a group? How are they weighted? When are they given—at an annual event? Do all employees get them, or just coordinators? Are they adjusted by salary, tenure? What makes a difference in who gets them? And, are staff compensated at industry averages throughout the rest of the year?”

Said Pierre, “There’s a lot we need to learn about this.”

—Suz Redfearn