Holly Leslie, vice president of services at Ledger Run, explains why site selectivity is not yet universal, but increasingly driven by larger, more sophisticated sites that are demanding stronger remuneration policies and greater leverage in sponsor relationships.
In a video interview with Applied Clinical Trials at the 2026 SCOPE Summit, Holly Leslie, vice president of services at Ledger Run, explained that while site selectivity is not yet universal, momentum is clearly building—particularly among larger, more sophisticated sites. Leslie outlined how payment practices, including holdbacks, inconsistent remuneration, and the operational burden created by AI-driven data queries, are becoming key decision factors for sites. She warned that unless sponsors apply the same rigor to payment performance that they do to patient recruitment, sites will increasingly leverage their power to shift work toward sponsors that offer transparency, consistency, and fair compensation.
Editor's note: This transcript is a lightly edited rendering of the original audio/video content. It may contain errors, informal language, or omissions as spoken in the original recording.
ACT: What are your takeaways from the session you participated in on sites being more selective with who they work with?
Leslie: I think the key takeaway is that it’s not quite as pervasive yet as some people would believe, but it’s coming. The larger, more sophisticated sites are making additional demands, such as being paid for data queries and asking for better remuneration policies and processes. Smaller sites, through events like this and through webinars, are learning that they have a lot more power in the dynamic than they actually thought. If this is left unaddressed, it’s going to cause a huge impact in the next 18 to 36 months.
