Table 1.

Practice Recruitment Process Lessons and Strategies

Lesson	Strategies
More complex study interventions required more recruiting efforts with more stakeholders at more levels, at the clinic, in the system, and across roles. Building on past relationships helped with initial and on-going recruitment conversations, yet those alone were insufficient. There were often multiple contacts and visits to practices that included a wide range of stakeholders: lead clinicians (on the system and individual practice levels), office managers, system “c-suite” leaders, health information technology leads, care management or health coaching leads, and others. This also meant identifying how the project aligns with multiple roles and interests in a practice. We were not surprised to find reluctance among busy practice staff and clinicians; however, there were clear signs in some practices that the staff members who were likely to implement much of the study had not been included in discussions or they were overtly opposed to doing anything related to the study. We realized we would have to re-sell the project to them. In large and small practices, team communication was ineffective at either letting staff and clinicians know the details of the project or how it might work. Our practice facilitators often fulfilled that role.	Build on existing relationships from participation in past PBRN studies, experience with clinicians through residency training, or ongoing contact through other professional activities.
	Help with the communication effort (in systems and in larger practices), which will likely take multiple attempts with staff and clinicians. Ask who will be the actual implementers. Address their concerns and connect the project to their role. Find individuals who are interested in the study (often nurses and managers, or someone new to the practice who can more easily adopt new tasks). Build alliances with them. Among the different practice roles and stakeholders, listen for what individual interests are for patient care or practice improve and align your study message with those. Allow for minor adaptations at the practice-level to accommodate different approaches and to align with critical practice workflows, staffing, and resources. Track those adaptations to guide future projects.
Recruitment was a process that took longer than expected with unplanned turnover of key contacts. Recruitment does not end when a leader says, “Yes, we'll do it.” You still need to win over individual administrators, staff, and clinicians. After system-level buy-in, there may be a need to continue to work on practice-level staff and clinician buy-in. The lag times from initial agreement, to randomization, and then to study launch can mean turnover and changing of priorities. In several instances, a key person who was identified as a champion or key contact left the practice. We had to actively seek out a new champion or contact to carry the project forward.	Be ready for multiple contacts with established relationships.
	Re-engage with leadership, especially when weeks pass between a “yes” and actually getting into the practice to launch a study. Use the recruitment process to identify and troubleshoot likely implementation challenges before launching in practices. Identify a “back-up” champion because turnover can happen from “yes” to “go live,” even in practices that have been relatively stable.