title: The synergy of the whole: building a global system for clinical trials to accelerate medicines development.
abstract: OBJECTIVE
  The pharmaceutical industry, once highly respected, productive, and profitable, is in the throes of major change driven by many forces, including economics, science, regulation, and ethics. A variety of initiatives and partnerships have been launched to improve efficiency and productivity but without significant effect because they have failed to consider the process as a system.
  
  
  METHODS
  Addressing the challenges facing this complex endeavor requires more than modifications of individual processes; it requires a fully integrated application of systems thinking and an understanding of the desired goals and complex interactions among essential components and stakeholders of the whole. A multistakeholder collaborative effort, led by the Alliance for Clinical Research Excellence and Safety (ACRES), a global nonprofit organization operating in the public interest, is now under way to build a shared global system for clinical research. Its systems approach focuses on the interconnection of stakeholders at critical points of interaction within 4 operational domains: site development and support, quality management, information technology, and safety. The ACRES initiatives, Site Accreditation and Standards, Product Safety Culture, Global Ethical Review and Regulatory Innovation, and Quality Assurance and Safety, focus on building and implementing systems solutions. Underpinning these initiatives is an open, shared, integrated technology (site and optics and quality informatics initiative).
  
  
  RESULTS
  We describe the rationale, challenges, progress, and successes of this effort to date and lessons learned. The complexity and fragmentation of the intensely proprietary ecosystem of drug development, challenging regulatory climate, and magnitude of the endeavor itself pose significant challenges, but the economic, social, and scientific rewards will more than justify the effort.
  
  
  CONCLUSIONS
  An effective alliance model requires a willingness of multiple stakeholders to work together to build a shared system within a noncompetitive space that will have major benefits for all, including better access to medicines, better health, and more productive lives.
authors.affiliation: Alliance for Clinical Research Excellence and Safety, One Broadway, 14th Floor, Cambridge, Massachusetts. Electronic address: gkoski@acresglobal.net.
authors.forename: Greg
authors.initials: G
authors.lastname: Koski
authors.affiliation: Alliance for Clinical Research Excellence and Safety, One Broadway, 14th Floor, Cambridge, Massachusetts.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Tobin
authors.affiliation: Alliance for Clinical Research Excellence and Safety, One Broadway, 14th Floor, Cambridge, Massachusetts.
authors.forename: Matthew
authors.initials: M
authors.lastname: Whalen
mesh_terms: D035843:Biomedical Research; D002986:Clinical Trials as Topic; D003299:Cooperative Behavior; D055808:Drug Discovery; D004345:Drug Industry / Q000458:organization & administration*; D006801:Humans; D009939:Organizations, Nonprofit
keywords: accreditation; alliance; clinical trials; information technology; standards; systems thinking