Clinical Research Doesn’t Need More Money, It Needs Better Execution
More Funding Will Not Save Us
Everywhere I go in the clinical research world, from conference panels to boardroom discussions, I hear the same refrain. If only there were more money, more trials would succeed. If only budgets were larger, timelines would shorten. If only we could raise another round of funding, we would finally bring treatments to patients faster.
It sounds reasonable, but it is wrong.
If money alone could fix clinical research, it would have been fixed decades ago. We are already spending billions each year on trials that fail or underperform. We are already seeing significant investments from governments, venture capital, and philanthropy. And yet, according to multiple studies, half of all clinical trials still fail to meet their primary endpoints. Of those that technically succeed, many run over budget, over time, and with compromised data quality.
The bottleneck is not capital. It is execution.
In my 20 years leading over 350 trials across continents, I have seen the same problems repeat in different countries, therapeutic areas, and organizational structures. They are operational problems. Problems of planning, process, oversight, and focus. Problems that no amount of extra funding will solve unless the underlying execution is fixed.
This article will highlight why and how. I will share complex data, real-world examples, and lessons from running trials in some of the most challenging environments. I will also share the operational principles that consistently deliver faster, cleaner, and more cost-effective trials without simply throwing more money at the problem.
Trials Fail for Executional Reasons
Globally, 50 to 60 percent of clinical trials fail for reasons that have little to do with the underlying science. The leading causes include:
Poor trial design that does not match operational realities.
Low patient recruitment and retention because the sites chosen cannot deliver the enrollment needed.
Inadequate site management, with investigators juggling multiple roles and research being treated as a side activity.
Data integrity issues are caused by poor oversight and inconsistent workflows.
Lack of contingency planning for inevitable changes in protocol, regulatory feedback, or site-level challenges.
And beyond these well-known factors, the list is far longer than most realize: wrong study design, wrong sample size, lack of proper medical monitoring, subject appropriateness review, wrong country and site selection, and inappropriate or insufficient site support are all recurring executional failures.
Many of these failures occur despite ample funding. I have personally seen multimillion-dollar trials collapse not because the drug candidate lacked promise, but because the sites could not recruit, the monitoring was reactive instead of proactive, or the patient pathway was so inconvenient that retention rates dropped below viability.
Execution is not a glamorous topic. It is not as exciting as breakthrough science or a headline investment round. But without it, every other part of the drug development process suffers.
What the Data Shows
Let us look at the complex numbers. According to industry analysis, between 50 and 60 percent of Phase I, II, and III trials fail due to operational reasons. Technical issues such as poor trial design, inappropriate patient selection, or weak data management are among the top causes.
Recruitment is a particularly stubborn problem. In many therapeutic areas, more than 80 percent of trials fail to meet enrollment targets on time. Every month of delay can cost sponsors millions in lost opportunity, extended payroll for study teams, and postponed revenue if the product eventually reaches market.
The financial impact is enormous. Later-phase trials can cost tens to hundreds of millions to run. Missing recruitment targets or failing a trial due to avoidable operational errors wastes not just that budget, but also the years of preclinical work and earlier-phase investment that led to that point.
The human impact is worse. Every month of delay is a month when patients who might benefit from a new therapy are left waiting. In the case of life-threatening conditions such as cancer or neurodegenerative diseases, those delays can mean the difference between life and death.
Why I Stopped Believing in More Funding as the Solution
When I founded my first private clinical research center in Hungary in 2007, the industry structure in Central and Eastern Europe was rigid. Private research within government hospitals was unheard of. The standard assumption was that if you wanted to improve trial throughput, you needed more budget and more infrastructure.
I took a different approach. I focused on executional efficiency. I built a model where 100 percent of the staff and facilities were dedicated to research. No doctors splitting their time between inpatient care, teaching, and research. No competing priorities. Every process is designed around the single goal of running trials as effectively as possible.
Within two years, our small center in a provincial hospital outperformed the most prominent medical universities in the country in both patient numbers and project delivery. We did this with a fraction of their resources.
The lesson was clear. You can outperform institutions with ten times your budget if you execute better.
Surviving and Thriving in the COVID-19 Crisis
The pandemic was the ultimate stress test for clinical research operations. In early 2020, I owned clinics in Hungary, Germany, and Vietnam. Within a single week, government emergency measures shut down all clinics. Facilities were requisitioned for COVID care. Staff were reassigned. Access was revoked overnight.
It would have been easy to accept the shutdown as a total loss. Instead, we reorganized.
In Hungary, when we regained partial access to facilities, we immediately implemented strict infection control, reorganized patient flow, and invested in safety measures that allowed us to continue research when most centers globally had stopped. We ran COVID vaccine trials, provided free PCR diagnostics, and kept other biotech projects alive for partners who could not find any other site able to operate.
We even gained new clients during this period because we were one of the few groups still able to deliver. That was not about the budget. That was about adaptability, process discipline, and the ability to reconfigure operations at speed.
What Better Execution Looks Like
Executional excellence is not an abstract concept. It is the disciplined application of specific practices that increases trial speed, quality, and predictability. At CRU Global, our operational model is built around five pillars:
Dedicated Research Infrastructure
Whether in owned facilities or embedded in partner hospitals, our research units operate as standalone entities focused entirely on trial execution. Staff are trained, scheduled, and incentivized to work only on research. This eliminates the dilution of effort that plagues sites where research is an add-on to routine care.Proactive Risk Mitigation
We anticipate problems before they occur. This includes real-time data review, tailored monitoring plans, and contingency strategies for recruitment slowdowns, protocol amendments, or site disruptions. The aim is to solve issues while they are still small and inexpensive to fix.Patient-Centric Logistics
One of the most straightforward yet most powerful changes we made early on was to operate our own patient transport service. This ensures patients arrive on time, in comfort, and with confidence in the process. It dramatically reduces missed visits and boosts retention rates.Embedded Expertise
Our leadership and senior staff have worked on both the sponsor and site sides of the industry. This 360-degree perspective allows us to align operational plans with sponsor priorities and anticipate the hidden constraints that can derail a trial.Lean and Flexible Business Models
Post-COVID, we shifted from capital-intensive ownership of infrastructure to agile partnerships. We lease space, bring in our own teams and equipment, and retain operational control without being exposed to the risks of fixed asset ownership. This allows rapid scaling into new geographies and therapeutic areas without years of construction or sunk costs.
Why Money Without Execution is a Waste
Imagine giving a poorly run site twice the budget. Will they suddenly recruit faster, capture cleaner data, and meet milestones? Or will they simply spend more to achieve the same poor outcomes?
Without fixing the operational model, more funding just increases the size of the waste. Larger budgets can make some teams less disciplined, because overruns are absorbed rather than addressed.
The reality is that most trials can be run faster and at higher quality with the same or even less budget if execution is optimized. That means stripping out delays, ensuring the right people are in the right roles, and designing patient pathways that work in real life, not just on paper.
It is also worth noting that even if more overall funding is not the answer, the timing of funding matters greatly. Too many small companies waste one to two years waiting to close the final €1–2 million of a Series A. Those years are irretrievable, and losing that time for such a relatively small sum is one of the most damaging inefficiencies in our ecosystem.
Want to talk? Contact me.
Peter M. Kovacs