The visible symptom is usually “enrollment is behind.”
That sentence compresses several different operating problems into one number. A study can have enough candidate supply and still miss plan because the next handoff is slow, the match is weak, or sites cannot act on the evidence they receive.
Start with the constraint, not the response.
Measure candidate-to-contact time, pre-screen conversion, screen-failure reasons, site response time, and the time from a completed milestone to the next owned action. These measures show whether the study needs more supply, better routing, or a more reliable workflow.
A simple decision sequence
First confirm that qualified candidates are entering the funnel. Then test whether eligibility evidence is available when the site needs it. Next examine whether ownership is explicit at every transition. Only after those checks should additional sites or recruitment spend become the default response.
Use the diagnostic with one active study.
The 7-Day Enrollment Recovery Map turns this sequence into a focused operating review. It gives the team a shared way to identify one constraint, assign the next handoff, and measure whether the intervention changes the path to randomization.