Table 3.

Advantages and learnings of NH services from BPCRN and Pedmed-NL.

Topic	Advantages	Learnings	Future perspectives	Stakeholders to overcome pitfalls
Streamlined processes	High quality and speed of service	Multiple checkpoints in verifying delivered data on recruitment and site capabilities ensure the precision and quality in trial estimates based on current and historical knowledge.	Showcasing the improvement/advantages due to NH facilitation (through metrics), which resulted in potential cost reduction and lower trial failure rate for the sponsor.	NH, sponsors
	Continuous communication and information between Central SPoC, NH and site.	More flexible/ad hoc capacity within NH needed. Adaptable to the learning curve of collaboration with sponsors.	Standardization of communication process within a NH and multidisciplinary teams. Early inclusion of a NH to connect with the potential sites.	NH, trial sites
Improved feasibility-related data quality	More transparent and reliable data due to standardized process, e.g., CFS.	The NH creates time-efficient and quality completion on site level (Figure 1).	Centralization of all trial requests, from site level as well as from the sponsor level.	NH, sponsor, trial sites
	Potential for having trial-specific peer-to-peer explanation of the trial.	Enhancing knowledge per protocol at NH provides valuable in-depth understanding, and the inclusion of and enchancing the inclusion of sites.	Investment into protocol knowledge was relevant when being consulted for multiple phases of the trial or multiple trials within the same indication.	NH, trial sites
National-specific knowledge	Peer-to-peer personal connection and removal of language barrier.	Importance of maintaining knowledge of personnel on a national-level sustained growth and continuity.	Continuity of the NH team as well as local maintenance of site connection and site engagement.	NH
Site-specific improvement	Support of inexperienced sites	The time-intensive process of naïve site development requires dedicated trial budget	Building a community and interaction between different sites exchanging, including previously naive sites.	NH, trial sites
	Trial-specific advice in terms of trial implementation or recruitment optimization	NHs can advise and link sites to expertise of recruitment optimizations as well as review the sponsors recruitment plan for national adjustments.	Experience of NH broader selection of trials and recruitment analysis, reaching a standardized recruitment process with patient engagement.	NH, trial sites, sponsor
	A continuous and nationally adapted support system that can support the sites with for example budget support.	A NH ad hoc approach to site improvement navigation is time-intensive but ensures quality start-up and actual capability of a site.	Allowing a bottom-up approach with regard to engagement to the network and its activities/services. Budget support for both investigator-initiated and industry trials to allow reliable and sufficient budgets.	NH, trial sites
Access to a larger patient pool	By bringing multiple types of institutions together, a larger patient pool can be reached.	Diverse trials, such as those for rare diseases or medical devices, provide unique opportunities to access varied patient pools, needing different type of (quality) sites.	Early involvement of the network in the trial roll-out and network preparation. Progression of more naive sites and/or decentralized infrastructure for long-term follow-up.	Sponsor, NH
Peer-to-peer structure	Access to existing network and trust, improving speed and quality of communication.	Rebuilding connections every 2 years offers the opportunity to refresh relationships and stay updated with evolving needs and trends within the field and the respective network.	Including at least one senior pediatrician within the national hub and involving younger members in the network maintenance.	NN