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members at all, but much rather as suppliers contracted to deliver valid patients (or conversely, customers who need to be influenced). Almost instant communications are already bringing people into close and regular contact, often without ever meeting, and it is amazingly quick and easy (and inexpensive) to send an E-mail message anywhere in the world. This will never obviate the need for site visits (you have to go there to see for yourself), but, in between such visits, contacts can be far more frequent. Those with any experience as clinical research associates will understand the frustration of trying to contact a busy consultant by telephone, but with E-mail the parties do not have to talk in real timetheir mail is waiting to be read whenever they are ready. A sense of involvement will be far more easily achieved with a dedicated (and secure) Internet web site for the study, which can contain the very latest information and can be interactive. |
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What we are creating here is a kind of virtual team territory, which the project can call its own. For projects carried out entirely on one geographical site, a physical meeting place is a traditional team building method, but for multicenter and multinational clinical projects, we have had to make do with regional meetings held fairly infrequently because of cost and time constraints. Video conferencing may have a place, but the cost and complication are still high. Although Internet technology does not yet have the capacity to make real-time video practical, cheap text-and voice-based conferencing are already hereand you can exchange graphics and video clips while you talk. |
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In Fig. 11, the study site is shown as one of the external elements with which the project team has to interactnot even one of the outer (parttime) team members. Surely performance is going to be far better if study sites can be brought much closer to the inner team. With virtual team territory, we may be a step nearer this goal. |
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5.
Changing Attitudes in Health Care |
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In most developed countries, the current major changes in providing health care involve a more market-oriented model. Hospitals and primary care organizations are extending their market concept to include clinical trials as a source of extra revenue. Again, the New World nations have grasped the initiative, and we have already discussed here how the clinical function can organize itself to provide much better value to those commissioning clinical research. In the U.K., the National Health Service is breaking out of its institutional straightjacket, and a number of the new hospital trusts are considering formal organizations and partnerships to manage their research activities. The NHS now has a national Director of Trials, indicating |
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