Clinical research and innovation continue to play an important role in the advancement of evidence based clinical practice regardless of its complex multi-step processes and accordingly related challenges. Despite the adaption of technology and quality systems, site management organizations (SMOs) still face significant operational challenges to execute the studies effectively. SMOs administering various clinical trials in multiple clinical sites and operate with a vast number of clinical trial

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... staff. Therefore, the need for effective management strategies, well trained multi-skilled staff, teamwork, and collaboration of all sites are very crucial. This review article lists most of the SMOs operational challenges as well as potential innovative solutions needed to enhance their management process.