Abstract: This article systematically examines the significance, practical challenges, and optimization strategies for managing drug clinical trials in public hospitals. As the primary entities conducting drug clinical trials, public hospitals play a pivotal role in safeguarding participants’ rights, maintaining data integrity and traceability, ensuring trial compliance, and achieving broad participant coverage. However, current management practices still face multiple challenges, including operational inefficiency, shortages and attrition of specialised personnel, lagging information technology levels, and inadequate quality control systems. To address these issues, the article proposes strategies to comprehensively enhance the quality and efficiency of clinical trial management. These include optimising management models and processes, strengthening the development of specialised talent pools, advancing information technology and digital transformation, refining quality control systems, and expanding multi-stakeholder collaborations. Such measures will propel clinical trials in public hospitals towards more scientific, standardised, and efficient practices.