Staffing and retention topped the list of site struggles in 2023, with such terms as “rusting out,” quiet (and loud) quitting and “bare-minimum Mondays” now figuring prominently in the workforce lexicon. To weather these challenges, sites should cross-train their staff on all aspects of their protocols, experts say.

Sites overwhelmingly named staffing and retention as their biggest challenge in WCG’s 2023 Site Challenges Survey Report, with nearly two-thirds of respondents (63 percent) naming it their top issue, beating out such familiar hurdles as patient recruitment and enrollment (48 percent), trial complexity and study startup (both 36 percent).

And while there have been positive developments in the workforce, including signals indicating voluntary healthcare resignations are slowing down, the loss of tenured staff and addition of less experienced hires present significant challenges to sites and their study teams when it comes to critical trial elements, Jamie Harper, vice president of solutions and engagement for WCG, explained during a WCG webinar on site capacity. More than two-thirds (69 percent) of healthcare organizations have hired a CRC with less than two years of experience, according to findings from a 2022 Tufts study.

“Consequences of the high turnover [we’re seeing] can add to the already overburdened study staff who may have less experience now,” Emily Boornazian, site services specialist for WCG, said. Sites are facing a number of challenges in this area, she added, including capacity, priority and technology management, electronic data capture (EDC) and technology portals, and a lack of indication knowledge among staff.

To deal with these challenges successfully, sites should regularly cross-train all study team members on every protocol active at the site, Boornazian advised. Doing this will ensure that the team truly understands the demands of each protocol and can transition and cover trials effectively when staffing changes make it necessary.

Cross-training confers many benefits, such as encouraging the growth of site staff and building flexibility within a team. For example, it gives less experienced team members the chance to expand their skillsets and work on more complex protocols they otherwise wouldn’t have been considered for and offers valuable contact with PIs, clinical teams and the institution overall.

In addition, it reduces the pressure that may be felt by team members at capacity-strained sites and can potentially improve staff retention rates, Boornazian added.

“If cross-trained, the team has more flexibility and can leverage their strengths in areas [in which] they excel but also build new skills,” she said. If site staff members have more opportunities to work on more complex trials and expand their skillset, they can use those experiences to leverage promotion and growth opportunities, which, Boornazian said, “we hope can lead to increased employee retention.”

Three specific nuances that differ between protocols should be top of mind for study teams during cross-training:

• EDC portals, which often vary significantly in how they capture data and are set up;
• Schedules of events, specifically visit windows, adverse event/serious adverse event criteria and footnote details that could go unnoticed during fast-moving transitions; and
• Sponsor-specific processes, including points of contact that can be hard to keep track of between trials, escalation processes and/or communication pathways for important trial duties.

For more insights on site capacity, watch the full webinar here.