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What Clinical Research Professionals Told Us About Visibility, Start-Up Speed, and Performance in 2026

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Most site leaders feel confident in their operational visibility. The data tells a more complicated story. 

That tension sits at the center of the RealTime Reports: Trial Start-Up, Visibility and Performance Benchmarks Survey, a study of clinical research professionals across independent sites, multi-site networks, and large site organizations. Respondents aren’t early-stage operations. They’re managing significant complexity: 43% are running more than 100 active studies simultaneously, and nearly 40% represent large site networks with 11 or more locations. 

What they told us about how they manage visibility, trial start-up, and performance metrics is worth an honest read, whether you’re running a two-site network or a portfolio of 50. 

Respondents span roles across executive leadership, site directors, research operations leaders, study start-up and contracts teams, and data and analytics professionals. They represent independent research sites, multi-site networks, and large site organizations. The findings reflect what mature operations actually look like from the inside. 

The Visibility Problem in Clinical Trial Oversight

Here’s the finding that stops most people:  

  • 86% of respondents said they are moderately or very confident in their real-time visibility into trial progress, pipeline status, and operational performance across all their sites. 
  • 76% are still capturing performance metrics manually or with partial automation. 

Both of those numbers come from the same survey. That’s not a contradiction. That’s the problem. 

When a team has operated in a manual-reconciliation environment long enough, the workarounds become invisible. The CTMS export into a separate spreadsheet feels like just how it works. The weekly status meeting feels necessary. The process of pulling three systems together to answer a leadership question feels normal, because it’s always been that way. 

Only 5% of respondents are operating from a single unified platform. The rest are working across CTMS reports (76%), spreadsheets (52%), email and messaging tools (43%), SharePoint and shared drives (33%), and project management tools (33%). 

The real test isn’t whether your team feels informed day-to-day. It’s how long it takes to answer an unexpected question from a sponsor or executive. Pick a question your team doesn’t get asked every week: ‘Which of our sites has the slowest feasibility response time this quarter?’ Time how long it takes to produce a reliable answer. 

If the answer comes back in minutes, your visibility infrastructure is working. If the answer requires pulling from multiple systems and chasing updates from three people, the issue isn’t process. It’s data infrastructure. 

The Top Operational Pain Points, Ranked

When respondents were asked to identify their top operational pain points, two findings rose to the top. 

  • Enrollment visibility gaps ranked first, named by 52% of respondents.  
  • Pipeline visibility gaps ranked second, at 48%.  

Both outranked study start-up delays (43%), manual metric collection (33%), and every other operational challenge on the list. 

That ordering tells us the sector’s primary frustration isn’t just that execution is slow. It’s that leaders can’t see what’s stuck until it’s already a problem. 

Pair those rankings with the confidence data, and a clearer picture emerges. Respondents report high confidence in their visibility and still rank visibility gaps as their top pain. The findings may point to something more concerning: an industry that has adapted to fragmented information for so long that incomplete visibility has become the norm. 

Before investing in process automation, map where your visibility actually breaks down. If it takes three systems and two follow-ups to produce a reliable enrollment number, the infrastructure is   your bottleneck. 

Study Start-Up: Where the Time Actually Goes

Only 14% of respondents operate mostly automated, workflow-driven start-up processes. The majority, 62%, use a mix of manual processes and tools. That configuration typically means key dependencies live in email threads and individual memory rather than a shared, visible workflow. 

Contract and budget turnaround tells a similar story. The largest single group, 38%, lands in the 8 to 14 day range. But nearly one in four organizations still averages 31 to 60 days. And for more than half of all respondents, contract and budget negotiations delay study activation at least sometimes. 

When asked where delays most often occur, feasibility turnaround and scheduling/SIV logistics tied at the top, each named by 29% of respondents.  

The third most common answer is the one worth paying attention to: ‘Visibility, no one knows what’s stuck’ at 24%. For nearly a quarter of organizations, the delay isn’t the process itself. It’s the inability to see where it’s stalled. 

Feasibility turnaround and scheduling delays require different interventions. Feasibility is a responsiveness issue. Scheduling is a coordination issue. Treating them as the same problem leads to solutions that fix neither. But identifying which one is driving activation delays requires exactly the kind of visibility most organizations say they’re missing. 

What Best-in-Class Actually Looks Like

The survey data makes it possible to see the gap between where most operations land today and where top performers are operating. 

The gap between the norm and best-in-class is significant across every metric. But the organizations achieving best-in-class results aren’t using fundamentally different processes. They’ve invested earlier in centralized visibility infrastructure that allows them to identify and close gaps faster than their peers. 

The Reactive vs. Proactive Operations Framework

The findings point to a clear dividing line between two operating modes. 

Organizations on the proactive side aren’t working harder or running better meetings. They’ve built systems where the data surfaces automatically instead of being assembled manually. 

Use this as a self-assessment. For each characteristic, honestly place your organization on the reactive or proactive side. If you land reactive on more than three, you have a systemic visibility infrastructure gap, not a collection of isolated process problems. Address the infrastructure, and many of the individual pain points resolve. 

What the Data Is Telling Us

The survey findings tell the story of organizations succeeding despite the limitations of the infrastructure they rely on every day. 

Most of them feel confident. Most of them have workarounds. Most of them have normalized a level of manual work that creates real risk the moment complexity increases, a sponsor asks an unexpected question, or a study misses a milestone. 

The organizations pulling ahead aren’t doing it by working harder. They’re doing it by getting better signals, faster. 

Download the full RealTime Reports: Trial Start-Up, Visibility and Performance Benchmarks Survey for complete findings, benchmark tables, and a detailed breakdown of how top-performing organizations compare across every metric measured. 

 

Source: RealTime Reports Survey (2026). Percentages reflect only respondents that answered each question. Data is self-reported. 

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