This article systematically examines the significance, practical challenges, and optimization strategies for drug clinical trial management in public hospitals. As the primary institutions conducting drug clinical trials, public hospitals play a critical role in safeguarding participants' rights, maintaining data integrity and traceability, ensuring trial compliance, and achieving broad coverage of the target population. However, current management practices still face multiple challenges, including operational inefficiency, shortages of specialized professionals with high attrition rates, lagging informatization levels, and inadequate quality control systems. To address these issues, the article proposes strategies to enhance the quality and efficiency of clinical trial management comprehensively. These include optimizing management models and processes, strengthening the development of specialized talent pools, advancing digital and informatization transformation, refining quality control systems, and expanding diversified collaborations. Such measures will promote clinical trials in public hospitals towards more scientific, standardized, and efficient practices.