From Episodic Challenges to Structural Conditions in Clinical Research Clinical research sites remain indispensable as the operational backbone of the clinical trial ecosystem. They are where scientific hypotheses are translated into patient/participant interactions, data collection and regulatory compliance. Yet, as identified in a recent survey of over 600 clinical research sites, sites are operating within a system under sustained and intensifying strain. Many of the pressures documented in 2025 continue in 2026, reshaping what it means for a research site to remain viable, competitive and prepared for the future.