Summary: This narrative review is useful to research staff involved in pragmatic clinical trials because it frames trial delivery as an operational management problem, emphasizing concrete mechanisms for execution: explicit role delineation and accountability across sites and departments, milestone-based timelines, and routine monitoring to identify and address slippage early. It also synthesizes common sources of failure that persist despite sound protocols, variable recruitment performance, coordination demands in multicenter implementation, and extended ethics and regulatory processes and outlines where dedicated trial management functions add measurable value through structured communication, issue escalation, documentation control, and consistent site support, including evidence that centralized coordination can improve start-up timelines and participant accrual in multicenter studies.

Summary: This task mapping example functions as a task management tool by breaking a complex activity into defined goals, timelines, resources, and assigned roles. It supports planning, delegation, and monitoring by outlining dependencies, checkpoints, and expectations needed to complete the task efficiently and on schedule.  

Summary: This paper presents a project-management review of the Canadian multicenter CYCLE pilot randomized trial of early in-bed cycling for mechanically ventilated ICU patients, using trial documents and process metrics to examine initiation, planning, execution, and monitoring phases across seven ICUs. Start-up was lengthy (median 185 days from ethics submission and 162 days from contract submission to first enrolment), and intervention delivery required substantial training and retraining due to staffing turnover. During recruitment, many patients were screened and eligibility was common, but enrolment remained limited largely because specialized physiotherapist availability constrained randomization and contributed to lost recruitment time. The authors conclude that trials involving complex, clinician-delivered interventions require proactive staffing and contingency planning, structured internal communication, and routine monitoring of process measures to identify barriers early and maintain site performance.