I came out of e-com­merce be­liev­ing en­roll­ment was a mar­ket­ing prob­lem. It is, for the first 20%. This is about the oth­er 80%.

I'm a founder who al­so hap­pens to be a rare dis­ease pa­tient, so I al­ways as­sumed pa­tient care and trust would be at the core of every re­cruit­ment cam­paign. Five years, 17 ther­a­peu­tic ar­eas, and dozens of tri­als lat­er, work­ing with every­one from two-per­son biotechs to five of the ten largest phar­ma­ceu­ti­cal com­pa­nies in the world, I'm still as­ton­ished by how of­ten we hear we're the on­ly ones ac­tu­al­ly do­ing it.

I start­ed in e-com­merce. The ap­par­el com­pa­ny my broth­er and I built taught us how to move peo­ple on­line bet­ter than al­most any­one, so when I first looked at re­cruit­ment I saw what any mar­keter sees: clicks, aware­ness, views, screen­er com­pletes. Fill the top of the fun­nel. That in­stinct was­n't wrong. It's step one of the job, and we do step one bet­ter than any­body in the world. But in e-com­merce the re­la­tion­ship ends at check­out.

In pa­tient re­cruit­ment, check­out is where it starts.

I have Star­gardt dis­ease. It slow­ly takes your cen­tral vi­sion. Years ago a late-phase study that might have treat­ed it shut down be­cause it could­n't find enough peo­ple. One of its sites was half a mile from my reti­na spe­cial­ist's of­fice. I drove past it while it was re­cruit­ing. I found out the tri­al had failed from a newslet­ter, and I was fu­ri­ous. Not at any­one in par­tic­u­lar. At the idea that a tri­al could spend years and hun­dreds of mil­lions of dol­lars and nev­er find the peo­ple it was for.

The thing that was ob­vi­ous to me as a pa­tient, long be­fore I un­der­stood it as a founder, is that I was nev­er go­ing to en­roll in a tri­al un­less some­body I trust­ed was hold­ing my hand through it. Some­body who picked up at nine at night. Some­body who knew my sched­ule, knew what my week looked like, and un­der­stood what I was scared of. And when I was fi­nal­ly ready to talk to a per­son, I need­ed to be able to do it right then.

So that's how we built the com­pa­ny. A caller reach­es a can­di­date an av­er­age of 87 sec­onds af­ter they sub­mit a screen­er and hands off live. Every­one who pass­es the phone screen gets a ded­i­cat­ed ad­vo­cate, the team I call Moth­er Goose, whose whole job is mak­ing a ner­vous per­son feel seen and get­ting them to the door. Leslie was a teacher for 30 years be­fore she joined us. That's who picks up at 9:47.

None of that is a fea­ture. It's what I would have need­ed.

The aha, for me, was­n't that this works. It was how few com­pa­nies were do­ing it.

Re­cruit­ment firms fall in­to two camps. One op­ti­mizes site data­bas­es and fea­si­bil­i­ty. The oth­er push­es as much vol­ume in­to the top of the fun­nel as the me­dia bud­get al­lows. Both live at the ends of the process, where the work can be au­to­mat­ed and vol­ume met­rics are easy to in­flate. No­body was in the mid­dle, treat­ing pa­tients like peo­ple in­stead of num­bers. That's the re­al­iza­tion Clin­i­cal En­roll­ment is built on, and it's why we've out­per­formed: we un­der­stand the first 20% bet­ter than any­one, and we know from the pa­tien­t's side of the phone what it ac­tu­al­ly takes to en­roll.

So why does­n't every­one do it? Be­cause it's cap­i­tal in­ten­sive, head­count in­ten­sive, and frankly hard.

Want an en­roll­ment time­line that holds? Talk to us.

Their job is mak­ing sure every­body in this process feels seen. The pa­tient feels seen, through the ad­vo­cate who an­swers at 9:47 at night. The site feels seen, through a site re­la­tions man­ag­er who knows co­or­di­na­tors are drown­ing, and that a re­fer­ral dropped in­to a shared in­box with a first name and a phone num­ber is one more thing on their plate. We send on­ly pa­tients who've passed eigh­teen ques­tions, with their med­ical records al­ready pulled and a face sheet on top. If a site can take one pa­tient a week, we send one pa­tient a week and make sure that pa­tient is per­fect. We know when the co­or­di­na­tor is on va­ca­tion in Ju­ly, and we hold the re­fer­ral un­til she's back. We want to be a site's best friend. And the Spon­sor feels seen through some­thing we had to build our­selves.

Every clin­i­cal op­er­a­tions lead gets asked that ques­tion, and it's al­ways both­ered me that the hon­est an­swer is usu­al­ly "we don't know." The Spon­sor, the site, and the re­cruit­ment part­ner are all work­ing on the same pa­tient from three dif­fer­ent si­los, look­ing at three dif­fer­ent sets of da­ta. How can three or­ga­ni­za­tions have an hon­est con­ver­sa­tion about a pa­tient when none of them are look­ing at the same in­for­ma­tion?

Every ref­er­ence ID in a fun­nel is a per­son who raised their hand for clin­i­cal re­search. A ran­dom­iza­tion does­n't hap­pen with­out each one of them, in­di­vid­u­al­ly, de­cid­ing to walk through a door. So we built Spon­sors a win­dow in­to every one of them. We call it the CE Script.

It shows every re­fer­ral we've ever de­liv­ered to every site on the tri­al: the date she was sent, the days since her last up­date, her cur­rent site sta­tus, and the time be­fore the site's next out­reach. Any pa­tient is se­lec­table, and from the plat­form a Spon­sor can email the site di­rect­ly, with our team copied, to clear what­ev­er's block­ing her. We call it rad­i­cal trans­paren­cy. Most ven­dors won't of­fer it, be­cause the same da­ta that helps you man­age a site al­so lets a Spon­sor au­dit the ven­dor. We're fine with that. Sites get the mir­ror im­age in TO­GO, our site plat­form, with the pa­tien­t's own words about why she wants to par­tic­i­pate, every screen­ing an­swer, and one tap to log what hap­pened.

What a Spon­sor sees: every re­fer­ral we've de­liv­ered, and where she stands right now.

Faith­ful minia­ture of The CE Script, Clin­i­cal En­roll­men­t's live Spon­sor plat­form. No re­al pa­tient da­ta shown.

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