Stronger Than the Sum of Their Parts
On building a clinical research team
By Danielle Buchanan
Danielle Buchanan has a bachelor of science in biology from Eckerd College in St. Petersburg, Florida and eight years of clinical research experience. Currently, she is a Clinical Translational Research Coordinator at Vanderbilt University Medical Center.
There is no “I” in the word team, as the famous quote says. Teamwork is the most important aspect of clinical research. You work as a team at the site, or program level, in order to bring discoveries to patients.
In reflecting on my life experiences, I have been on a number of teams: in volleyball, in symphony orchestra, as a student resident advisor, and now as a clinical research coordinator. Some teams did not succeed. Others did. Each team I have been a part of has taught me many different qualities for success. These experiences have created a curiosity about what components make a clinical research team and program successful.
Before my current job, I worked on a large team of 13, running oncology clinical trials. Over those years, about 90 percent of that group had resigned, and been replaced. This seemed to be high for such a critical work-flow. Why did this team in particular fall apart? As I started exploring other positions, I formulated a list of desirable attributes to help guide my employment decision. My current role allows me to reflect on those team attributes I find most compelling.
Hiring for Success
Over the past decades, the clinical research coordinator role in the U.S. has changed from one with fairly long tenure, to one where there is high turnover. As I enter my third year working at Vanderbilt University Medical Center, I have had the freedom and responsibility to define key characteristics in new hires that would help ensure a long and productive tenure. Informally, I believe that there are certain characteristics necessary for clinical research: a self-starter, organized, a positive personality, great communication skills, passion for patient care, a commitment for excellence, and a love of teamwork.
In our group, we often use a quote from de Saint-Exupery, who wrote The Little Prince, to capture these attributes: “If you want to build a ship, don’t drum up people together to collect wood and don’t assign them tasks and work, but rather teach them to long for the endless immensity of the sea.” We could train people on how to run a clinical trial, or how to perform a motor exam, but what we cannot teach anyone is how our passion for patients informs our desire to run excellent clinical research trials. This passion must develop (with encouragement) from within.
Retention in a “Stepping Stone” Profession
You can hire the right person, but retaining them is a different matter. The clinical coordinator role is still a transitional one for many, and top people are presented with ample opportunities for other positions. We want people to stay a long time, but losing a great team member is a risk we recognize and accept.
Currently, I am in charge of hiring four clinical research coordinators. These positions are available because coordinators are leaving for graduate school, medical school, and other careers in health care. We are so happy and proud of them for moving to the next step in their journey, but this means finding and training new people, which is time-consuming. It also means a loss of valuable knowledge about our program.
To help guide us in how to keep excellent clinical research coordinators, I have worked with colleagues on a study where we identified statistically significant predictors of retention for this role. We found these nine top factors to be key: work environment, clinical research coordinator (CRC) level, perception of competitive salary, role appreciation, input in protocol development, engagement, collaborative opportunities, respect, and a close working relationship with the principal investigator*.
Since multiple predictors connect back to the principal investigator, it showed us that in order for the team to work as a well-oiled machine, not only do the coordinators have to have to meet a certain standard for success, but the PI needs to engage and support the team.
Teams Sink or Swim on Outlook and Maturity
Positivity is something that can keep a team from sinking when the disappointments, setbacks and emergency deadlines hit. If one person starts to bring bad energy into the office, it can act like a virus and spread quickly. We are constantly working on ways to improve our positive work environment. One of those strategies includes a “zero gossip” policy. If there are any conflicts to be discussed, this needs to be done with a supervisor — and in private, not in front of other employees.
Alongside positivity, we all have to work on conflict management. We work as a multidisciplinary team and must interact with many different types of people, so this job takes maturity and critical thinking skills. Yet, since a clinical coordinator has been labeled as an entry-level position in the research community, it ultimately attracts recent graduates or those without much relevant work experience. Maturity beyond someone’s years, the ability to resolve conflicts, are qualities we look for.
We have learned to be on the lookout for evidence of this before we hire, no matter how qualified a candidate is on paper. In each interview, we stress that we need long-term commitment, a strong work ethic, attention to detail, interpersonal communication skills and critical thinking and problem-solving skills – all qualities that speak to maturity. We know that it is not a process we should rush. Finding the best candidate is worth the wait, and may avert serious problems resulting from a poor choice.
Marrying Attributes to Forge a Strong Team
Reflecting on our coordinators who have come and gone, I realize they have taught us some things about what we can change as we forge future groups of coordinators. Different people shine in different areas and that can often be managed, as long as a “weaker strength” doesn’t translate into real weaknesses.
Running clinical trials is often “organized chaos,” requiring coordinators to have a steady vision of the big picture, yet be quick on their feet — planful, but able to respond quickly and appropriately to a change of plans. These high executive function qualities may not always coexist in someone who has a strong empathetic side. Yet we need people with naturally supportive and patient personalities. Our patients and their families need to know we are committed to them — they need to know we are here to care for them. That takes someone who has compassion and conveys a sense of hope to these families who are dealing with incurable diseases.
Expecting all these attributes within one clinical coordinator is not always realistic. What we are finding, though, is that we can build a team with complementary strengths. While everyone on the team must have a base level of empathy and ability to juggle priorities, different members can take up the slack for one another when needed. Plus, they can teach each other. This can occur naturally or as part of a deliberate leadership strategy.
Looking ahead at training a new group of coordinators, I realize we may never be perfect individuals, but I can work to develop a near-perfect team, making us more and more effective as we move forward.
*Danielle A. Buchanan, Jody Goldstein, Anna C. Pfalzer, Ya-Chen Lin, Hakmook Kang, Daniel O. Claassen, “Empowering the Clinical Research Coordinator in Academic Medical Centers,” Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2020. https://mcpiqojournal.org/article/S2542-4548(20)30197-1/fulltext