By Adam Samson, President, Advocate Health National Center for Clinical Trials
Before a patient can consider a clinical trial, a great deal has to happen behind the scenes.
An investigator needs an appropriate study to offer. Contracts and budgets need to be completed. Regulatory documents need to be collected and maintained. A research team needs the capacity to conduct the study and support the patients who participate.
We spend a lot of time asking how to enroll more patients in clinical trials. We should spend more time asking whether we have built a system capable of bringing those trials to them.
Clinical trial infrastructure is not a building or a single technology. It is the combination of people, processes, data and operational support that allows an investigator to turn a research opportunity into an open study for patients. If we want to expand access to clinical trials, we need to strengthen that infrastructure.
Recent industry research underscores the challenge. In a 2026 article in Applied Clinical Trials, Kenneth Getz and Kenneth Kaitin of the Tufts Center for the Study of Drug Development reported that the average time from protocol approval to the first patient’s first visit had increased by 30% to 45% since 2015. They identified fragmented accountability, insufficient training and coordination challenges among the barriers to effective trial execution.
Health systems are uniquely positioned to address part of this problem because they bring together patients, clinicians, researchers, data and longstanding relationships with the communities they serve. Many also have experienced investigators and established research programs.
The opportunity is to connect those strengths and make it easier for local research teams to conduct high-quality trials.
Make clinical trials an enterprise capability
At Advocate Health, our research programs have developed over decades across different institutions and markets. They bring substantial expertise. Extending trial opportunities across a large health system, however, requires us to connect that expertise through shared infrastructure.
That is the work behind the National Center for Clinical Trials: building clinical trials as an enterprise capability, supported by a central team with experience conducting multisite studies.
The purpose is practical. Investigators and coordinators should be able to focus more of their attention on patients and study delivery rather than navigating administrative processes. Centralized support for contracts, budgets, regulatory submissions and other functions can help make that possible.
But centralization by itself is not the goal.
Research programs have different needs, histories and ways of working. Moving a service into a centralized structure does not automatically improve it. Central teams need to work alongside local research teams, understand their workflows and build support around what investigators and coordinators actually need.
At Advocate Health’s National Center for Clinical Trials (NCCT), we’re seeing what this infrastructure can make possible. When a pharmaceutical company recently approached us about an cardiovascular trial, it did not have preferred investigators in mind. Within a week, our team met with the sponsor and used a data dashboard to identify physicians with relevant expertise and patient populations. Dedicated study startup staff then worked with investigators and site teams to assess interest and coordinate sponsor conversations.
The sponsor awarded the study to the first site just 40 days after NCCT received the opportunity, a milestone on the path toward opening the trial to patients, and a second site was awarded the study only a few weeks later.
That distinction matters. Infrastructure should not create another layer between investigators and their work. Done well, it should remove barriers from their path.
Connect trial opportunities with local capacity
Historically, a clinical trial might begin with a sponsor contacting an individual investigator with whom it already has a relationship. Those relationships remain valuable.
A coordinated health system can complement them by helping sponsors see possibilities beyond the investigators and sites they already know.
A sponsor interested in working with an investigator in one market may have an appropriate opportunity for another team elsewhere in the system. Making those connections requires visibility into investigator experience, research-team capacity and patient populations.
A single entry point can begin that conversation. The infrastructure behind it determines whether an opportunity can actually move forward.
Technology can make this process better. Health record data can help research teams assess study eligibility, understand where potentially eligible patients receive care and inform decisions about potential sites. Once a study is open, that information can also support local teams as they identify patients who may be appropriate to approach.
I began my career doing manual chart reviews as a research coordinator. Anyone who has done that work understands the value of better tools.
But technology is useful only if it makes the work easier. We need systems designed around the workflows of investigators and research teams, reducing reliance on emails, spreadsheets and repetitive tasks while giving people better information to inform decisions.
Technology supports clinical judgment. It does not replace the expertise required to interpret information and turn it into action.
Build capacity deliberately
Stronger infrastructure requires investment, and it requires choices.
No health system can provide every research service to every program overnight. Our initial focus has been on supporting existing investigators and better integrating services into established research programs. Over time, expanding access will also require developing new investigators and preparing additional sites to conduct studies.
For health systems pursuing similar work, I would start with three priorities:
- Invest in shared operational support. Reduce the administrative burden on investigators and local research teams so they can spend more of their time conducting studies and supporting patients.
- Build technology around the people doing the work. Start with the needs and workflows of research teams rather than introducing tools for their own sake.
- Expand local capacity deliberately. Growth should happen at a pace that allows sites and investigators to conduct high-quality research and provide a strong experience for participants.
Health systems cannot do this alone. Sponsors also have an opportunity to think differently about where and how they place studies.
Building strong relationships before a specific trial opportunity arises can help sponsors better understand a health system’s patient populations and research capacity, while giving health systems insight into sponsors’ pipelines and needs. That shared understanding can also help identify additional qualified sites across the system when opportunities emerge.
Community engagement belongs alongside these investments. Making a trial available does not mean a patient will choose to participate. Education about clinical research should begin before someone is approached about an individual study and build on relationships and conversations already taking place in communities.
Measure what the infrastructure makes possible
Ultimately, stronger infrastructure needs to produce meaningful results.
At Advocate Health, our new operating model is delivering measurable progress as it scales. We are on track to start greater than 30% more clinical trials in 2026 than in 2025, prior to the launch of NCCT. Clinical trial agreement turnaround times are approximately 25% shorter than our 2025 baseline, and our research network continues to expand.
We measure the value of this infrastructure by what it enables for local research teams and the patients they serve: making clinical trials easier to conduct, opening trials more efficiently and offering appropriate research opportunities to more patients.
Health systems cannot control every factor influencing where sponsors place clinical trials. But we can address operational complexity within our own organizations and strengthen our ability to conduct research.
If we want clinical trials to reach more patients, we cannot focus only on what happens after a study opens. We have to invest in everything required to open that study in the first place.
Patients, wherever they receive care, should have the opportunity to consider an appropriate clinical trial with their care team. Building the infrastructure that makes that possible is work health systems, sponsors and research partners can take on together.