Study staff was encouraged to avoid a narrow view of their job or role in the study. Inclusivity of staff is an integral aspect of the study design. The principal investigators led the study but sought the opinion of every staff member when solutions to challenges were being developed. Hierarchical decision making was avoided as much as possible. Suggestions from staff members are solicited on most aspects of the study. Staff learned to exhibit a high level of flexibility to accommodate changes in protocols and scheduling because they were empowered to take initiative in developing plans to address problems as they occurred not retrospectively.
