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John Neal

Commitment to Training as a Predictor of Performance

By May 12, 2014April 27th, 2021No Comments

What is it, really, that can be used to predict the performance of clinical research sites? Certainly past performance provides a clue to possible future performance. Of itself though, past performance does not guarantee future performance. Many sponsors have been frustrated after selecting a site because it had performed well on a prior study, only to fail on a current study. Why does that happen?

It is necessary to look deeper; to look at what made the site a top performer to begin with, and then to determine if the same conditions exist today.

Ultimately, a clinical research site is a team working in unison to conduct a series of clinical research studies. Like any team, there are leaders and followers. Intended or not, a culture exists that affects the team’s performance – for good or bad.

In organizations that sustain a high level of performance over long periods, the culture emanates from the core leadership’s beliefs and deep-seated values. These may be embodied in a mission statement or may simply come to be understood over time, but they form the basis for a culture of integrity; a drive to succeed; a commitment to do things well, every time.

As Dr. Connie R. Curran, President of Curran Associates, a healthcare consulting company stated, “These organizations have rejected the myth of the single, isolated, superhero.” 1 Instead, they recognize that long-term, sustainable performance depends on having a broad range of well-trained professionals who consistently follow effective, efficient processes in pursuit of achieving the best possible outcomes. They “start the race with the finish line in sight”2, envisioning and planning for what they want to be and to be known for, and then build each of the elements necessary to allow them to achieve those goals.

Processes and People

At the core of consistency are processes. When effective processes are created and implemented, you can expect to begin to see consistent results. We are all familiar with standard operating procedures (SOP’s), which in clinical research become the site’s operating equivalent to the Bible, but what I am speaking of goes even further. It is more than simply who does what, and when. It gets down to the level of attitude and sets expectations right down to how people are greeted in the lobby or on the phone. Many notable organizations come to mind when you think of companies that have achieved this level of consistency and success. Among them are Southwest Airlines and Nordstrom.

Hire for Attitude; Train for Success

What companies like Southwest Airlines and Nordstrom have successfully done is make a painstaking effort to create practical, effective processes which they then train carefully selected personnel to carry out flawlessly time and again. . . with a smile on their face. They know that the secret to that smile is to hire for attitude, and then train for specific application of their processes. Hiring someone because s(he) possesses certain needed skills, while sacrificing the critical ingredient of attitude, has led to many an unproductive and often uncomfortable environment.

Companies often have difficulty putting specialized skills second on the priority list, particularly in the medical industry where skill and credentials carry so much weight. Nevertheless, the business of clinical research sites is just that; Business. And the keys to success are no different from other industries. Each person hired must possess the basic skill to qualify him or her for the position, but that is only the starting point.

How do You Choose?

So, how do you choose competent people who also buy into your organization mission and possess the right attitude to succeed? Successful large companies usually have human resources recruiting specialists skilled at this, but that does not help the small clinical research site. However, there are some things small sites can do that can help them hire the right people.

Many small sites have found that using the services of a human resources specialist on an hourly or consulting basis to interview prospective employees can be quite effective. Business owners (including physicians) are often too close to the trees to see the forest, so an unbiased third party can bring refreshing clarity to the process.

Other sites have found that using one of the available “profiling” tools helps them see the applicant through a different filter, gaining valuable insight that might otherwise go unnoticed. One such tool is the DNA Profile by Team Interplay, developed based on the research of P. John Brunstetter, Ph.D., which is used by such notable companies as The Ken Blanchard Co’s, DuPont Pharmaceuticals, and Warner Brothers, as well as this author. Going beyond the simple personality and integrity testing of many other tools, the DNA Profile gives insight into how the person tends to act under certain circumstances. This is particularly helpful if you are hiring people who will work in high pressure or stressful situations.

Which Comes First?

After the right people are hired comes the ingredient missing in too many organizations; effective continuous loop training. This may seem obvious, but while training is a popular topic, too often it is only given lip service. That is because it comes at a cost, both in dollars and time. Sites continue to struggle with dwindling study budgets and, unfortunately, training assumes the position in too many sites as a tolerated necessity rather than a cornerstone of quality.

If yours is one of those sites struggling with too small budgets and too many organizational mouths to feed, which comes first? Better finances or better training? In the end, better training begets, better performance, which begets better budgets, so it would appear that training must come first. Training must become so much a core value that it is inconceivable not to do the very best job at it possible. Once training assumes that position, the resources will be found, because it is no longer considered optional.

Predicting the Future

Individuals within any organization change over time. Employees come and go. If the value and knowhow of a site rests merely in the individual talent of the site, rather than in engrained values and processes, then the past performance of a site is no more a predictor of the future than a throw of the dice. If, on the other hand, the site’s performance is the result of deeply engrained values embodied in effective processes and skills honed via proper and persistent training, then past performance can be relied on to predict future performance.

Sponsors would do well to seek out sites that have embraced training as a core value and have developed effective processes, the result of which is a site that performs effectively and consistently regardless of who fills any particular role in the organization. They would also do well to reward those sites with better budgets in support of their superior work and then continue to select those sites to conduct their studies.

Copyright ©2011, 2014 John P. Neal. ALL RIGHTS RESERVED WORLDWIDE.


1Connie R. Curran, 2002. Commitment vs. compliance: the key to sustainable change, Nursing Economics, July-August 2002

2 Linda Pinson and John P. Neal. 2006. Develop an Exit Strategy: Start the Race with the Finish Line in Sight. Anatomy of a Business Plan.