Separate referral volume, consent conversion, screen failure, randomization/enrollment, and retention instead of arguing about one enrollment number.
Problem Play
Slow Recruitment
Start with protocol feasibility review, site feedback, screen-failure breakdown, stakeholder map, risk register, and governance decision memo.
What to do first
Ask site strategy, CRO operations, patient engagement, and biostatistics to review the top three barriers and the evidence behind each assumption.
Escalate if the forecast threatens LPI, diversity, endpoint evaluability, or requires protocol, budget, vendor, or site-mix change.
Expected output
Leave the first review with a named owner, dated action, evidence source, escalation threshold, and closure proof. If the issue affects participant protection, endpoint credibility, safety reporting, protocol compliance, critical path, budget authority, vendor scope, or inspection evidence, prepare a decision-ready escalation rather than a status update.