[Why health services research projects may fail in practice - Insights from experts using the example of RECUR, a...

The "Registry for Recurrent Stone Diseases of the Upper Urinary Tract" (RECUR) was developed as a prospective long-term study. The aim was to link clinical data from hospital information systems (HIS) with self-report data from patients. The aim was to sustainably minimize resource requirements through digital and automated processes. However, numerous formal, legal, and logistical factors led to considerable delays in the implementation of the necessary digital infrastructure. This caused a significant delay in the start of recruitment. In addition, recruitment itself fell far short of the projected figures so that the registry had to be closed, partly because further funding could no longer be guaranteed. This paper describes the obstacles, supporting measures and reasons for the inability to achieve the targets, in particular the inadequate recruitment.

To evaluate the recruitment process, seven guided expert interviews were conducted in the autumn of 2024 at the Freiburg site with healthcare professionals recruiting for RECUR (doctors and a ward secretary). Interview transcripts served as the basis for the qualitative summarizing content analysis according to Mayring. This involved sorting and summarizing the data material on the basis of case- and topic-related summaries.

The following reasons for insufficient recruitment of participants were identified: (1) Physicians faced increasing workloads, particularly due to administrative tasks, making even minor additional duties a low priority. (2) There was no intrinsic benefit perceived by those responsible for recruitment. (3) On the patient side, challenges included language and cognitive barriers, lack of technical affinity and equipment, as well as information overload. Opportunities for optimization include centralizing responsibilities, providing additional staffing resources, automating and digitalizing processes, and implementing incentive systems for staff.

Everyday hospital life is characterized by a high level of organizational and administrative effort combined with limited personnel and time resources. Such conditions considerably limit the implementation of care research studies. In the RECUR use case, recruitment was hampered by limited cognitive, technological, and linguistic competences as well as little recognizable intrinsic benefit for both staff and patients. Future research projects should incorporate these findings to improve design and recruitment.