Sites are Paying the Price for Complexity, and It’s Getting Steeper 

WCG’s annual Clinical Research Site Challenges Report finds trial complexity, staffing, and contract delays all rising as sites absorb more work without matching resources. 

CARY, NC – Nov. 4, 2026 – WCG, a global leader in providing solutions that measurably improve and accelerate clinical research, today announced the release of its Clinical Research Site Challenges Report, The Cost of Complexity, offering exclusive insights into the pressures facing clinical trial sites worldwide. Now in its fourth year, the global report deepens WCG and CenterWatch’s decades-long research into the clinical trial site experience, dating back to the launch of the biennial Global Site Relationship Survey in 1997. The survey-driven report examines how rising protocol complexity, growing trial volumes, and flat staffing are creating real costs for sites, and provides practical recommendations for sites, sponsors, and CROs to reduce them. 

Drawing on responses from more than 400 clinical research professionals across multiple site types, roles, and geographies, the 2026 Site Challenges Report finds that the top challenges sites face have become more difficult. Trial complexity remains the leading issue for the fourth year running, cited by 41% of sites, up from 35% in 2025. Site staffing (38%) and contract and budget delays (37%) also climbed year over year. 

“Sites are doing more work than ever. Their teams have not grown to match it,” said Sam Srivastava, chief executive officer, WCG. “This report shows exactly where the strain comes from. Most of it can be fixed before a study ever opens. That is work we can do together, and patients will feel the difference.” 

Key findings from this year’s report include: 

• Workloads are outpacing capacity. Two-thirds of sites describe their teams as overloaded or at risk of burnout, and fewer than a third say current workloads are sustainable. More than one in five sites now manage 150 or more active trials, the largest single group in this year’s survey. 

• Complexity starts with the protocol. 66% of sites rate protocol complexity a high source of overall trial complexity, up from 59% last year. Sponsor protocol design changes drive amendments at 78% of sites, and 55% of sites spend 20% or more of their start-up time on amendments. 

• Start-up stalls on shared work. More than half of sites need three months or longer to complete study start-up. The biggest contributors are budget development and negotiation (56%), sponsor and CRO engagement and responsiveness (43%), and CTA negotiation (38%); all work sponsors, CROs, and sites do together. 

• Site finances are under pressure. Nearly two-thirds of sites say current challenges have hurt their financial performance. Sites affected by NIH funding reductions have responded with hiring freezes and, in some cases, staff reductions. 

• AI is entering contracts faster than workflows. Only 16% of sites have implemented AI or automation, yet roughly 44% are already seeing AI-related clauses in their clinical trial agreements. Sites see the greatest potential in AI-assisted participant recruitment and matching (36%) and integrated systems that end duplicate data entry (35%). 

“This year’s report puts a number on something sites have been telling us for years: complexity has a cost, and sites are the ones paying it,” said Sandy Smith, senior vice president, Clinical Solutions & Strategic Partnering, WCG. “Much of that cost takes shape long before a study opens, in protocol design, feasibility, budgeting, and contracting. That means sponsors, CROs, and sites have a shared opportunity to address it. When we resolve complexity upfront, studies start sooner, site teams get time back for participants, and new therapies reach patients faster.” 

WCG’s full Clinical Research Site Challenges Report, The Cost of Complexity includes detailed findings and recommendations for sites, sponsors, and CROs, and can be accessed on WCG’s website at https://www.wcgclinical.com/insights/2026-clinical-research-site-challenges-report/. 

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