Clinical trial protocols become overly complex because teams copy and paste from previous studies, accumulating unnecessary data points and criteria. Merck advocates for "protocol lean design," which starts from the core research question and rigorously challenges every data collection point to reduce site and patient burden.

Oshkosh's CVC team is a hybrid, not siloed in one department. It includes members from corporate development, a venture lead in a tech hub (Bay Area), and a counterpart in an engineering business unit. This structure ensures that strategic goals, technological feasibility, and market deal flow are constantly aligned.

When integrating acquired biotechs, Merck prioritizes retaining key talent and preserving ongoing science. The strategy involves immediate face-to-face engagement to reduce anxiety, followed by a pragmatic assessment of which processes must be standardized versus which can remain to avoid disrupting critical trials, a practice they call avoiding 'mercification'.

To avoid a broken handoff, embed key business and integration experts into the core deal team from the start. These members view diligence through an integration lens, validating synergy assumptions and timelines in real-time. This prevents post-signing surprises and ensures the deal model is operationally achievable, creating a seamless transition from deal-making to execution.

For smaller biotechs, the key to a successful CRO relationship is treating them as a genuine partner. This requires moving beyond a transactional, fear-based dynamic to one of open communication and mutual respect. Biotechs should actively solicit CRO feedback, as they possess valuable cross-industry insights and can identify sponsor-side behaviors that need to change.

Clinical trial sites are increasingly leveraging their power to demand protocol modernization from sponsors. Merck changed its internal processes to allow non-physician sub-investigators only after a site refused to participate without that flexibility. This shows that operational change can be driven from the ground up by partners, not just top-down by sponsors.

Unlike the common model of a separate, consultant-heavy value creation team, Premira integrates specialists like ex-operators directly into its sector teams. This ensures deep industry expertise is applied to drive top-line growth, not just cost-cutting.

A process where the deal team hands off a signed transaction to a separate integration team is flawed. State Street integrates business and integration experts into the deal team from the start. This ensures diligence is informed by integration realities, timelines are realistic, and synergy assumptions in the deal model are achievable.

For certain acquisitions like Poker, IFS deliberately avoids full integration to retain the target's agile, entrepreneurial culture. Instead, they use product connectors and provide access to parent company resources, allowing the startup to maintain its dynamism while leveraging scale.