2026: From Experimentation To Operational Reality In Clinical Research

By Nick Spittal, COO, Velocity Clinical Research

As we move into 2026, the clinical research industry feels notably different from even 18 months ago. After a period of capital constraint, operational pressure, and recalibration, momentum is returning, unevenly. The organizations that thrive will be those that translate innovation into day-to-day execution, rather than treating it as a side project.

From where I sit, several shifts are set to define the year ahead.

AI Moves From Novelty To Infrastructure

In 2026, voice and chat-based AI for patient prescreening will no longer feel innovative but become routine.

The pace of improvement across these tools through 2025 was frenetic. We’ve seen rapid gains in accuracy, contextual understanding, and two-way conversational capability. What’s changing now is adoption. Patients are increasingly comfortable interacting with AI, and organizations are becoming more confident deploying it into patient-facing workflows. Velocity’s own initiatives have shown that patients are completing 94% of their interactions with AI, including AI-powered voice calls to carry out prescreening and then subsequent scheduling of appointments for those who qualify for a study; this is better than many human-to-human engagements.

From an operational perspective, AI-enabled prescreening and in-study support increase speed, consistency, and reach, enabling us to reallocate human effort. For example, teams now have more time to spend in direct conversation with participants and caregivers, improving service quality, compliance, and retention. In 2026, the question won’t be whether AI belongs in patient engagement, but how well it’s embedded into broader site operations to increase bandwidth and make the rest of the team more impactful.

The GLP-1 Conversation Broadens Beyond Headline Weight Loss

With multiple GLP-1s now approved and many more in the clinic, 2026 will mark a shift in how success is defined.

Percentage of body-weight loss has dominated the narrative to date. That won’t disappear but it won’t be sufficient on its own. We expect two important changes.

First, safety, tolerability, and side effect profiles will matter more. As payer coverage expands and patients gain the ability to switch between therapies, long-term users will be less willing to accept undesirable trade-offs. Products and study designs will need to look more closely at which weight is coming off; loss of muscle mass during a course of treatment, or replacement of muscle with fat after treatment, are undesirable outcomes. Individual fit will become central.

Second, the market will likely normalize a spectrum of therapeutic outcomes. Not every patient needs or wants to lose a third of their body weight. Drugs delivering 5%–10%, 10%–20%, and 20%+ reductions can all play meaningful roles, addressing different clinical and patient needs. From a research perspective, that opens the door to more nuanced endpoints and study designs.

A Widening Skills Divide Inside Organizations

Another dynamic we’re watching closely is the emergence of a split among knowledge workers.

On one side are digital- and AI-native professionals entering the workforce, who have grown up alongside rapid technological change. On the other are experienced, highly capable professionals who may struggle with the pace of transformation now underway.

History is full of similar transitions but the current acceleration feels different. The result will be significant demand for training and enablement tools that help experienced teams adapt. There will also, inevitably, be some attrition among those who choose not to make the shift.

For organizations, the imperative is clear: invest in upskilling, not replacement. The combination of domain expertise and modern tools is far more powerful than either alone.

Cost Pressure Reshapes R&D And Commercialization Paths

Policy and trade dynamics in the U.S. will increase costs of manufacturing while lowering reimbursement rates in the coming years. Over time, that pressure will flow into other areas of the value chain, with R&D and marketing increasingly in focus. Efficiency expectations will rise, and organizations will need to demonstrate clearer returns on development spend.

The knock-on effect will be a higher barrier to new entrants; advancing from a clinical stage biotech to a commercial stage company is set to become more difficult or virtually impossible. Building new U.S. manufacturing capacity will be expensive and slow, particularly as large pharma absorbs much of the available build-out capacity.

This environment favors scale. We expect increased acquisition activity, alongside more creative M&A models, potentially including pharma holding structures that bring multiple smaller assets together at the point of commercialization.

Renewed Interest In Site Networks And Ownership

Finally, after a relatively quiet period, 2026-27 will see renewed interest in clinical research sites as an asset class.

With trial starts rebounding and funding stabilizing, sites are back on the strategic agenda. To date, ownership has largely involved small to midsize private equity firms and a limited number of CROs. That may expand to include new large-scale entrants into the multisite clinical research corporation (MCRC) ownership space, whether from big-name life sciences private equity or new strategic buyers (think Amazon). History suggests that when confidence returns, capital follows.

The Year Execution Matters Most

Taken together, these trends point to a single theme: 2026 will reward execution.

AI, new therapeutics, evolving workforce dynamics, and capital shifts are all converging. The organizations that succeed won’t be those chasing every trend but those that integrate change into reliable, scalable operations, without losing sight of patients, quality, and long-term value.

That’s where the real work begins.

About The Author:

Nick Spittal joined the Velocity leadership team in 2023 with over two decades in clinical development and business operations roles at global CROs. As COO, Nick leads Velocity's project management, patient recruitment, and site operations, seeking to make clinical trials accessible to diverse groups worldwide. Prior to joining Velocity, Nick served as executive vice president and general manager of neuroscience at Syneos Health, where he spearheaded global operations and strategy for clinical trial execution and also served on the corporate council for diversity, equity, and inclusion. He has previously led project management, study start-up, vendor management, proposals, and marketing functions in life sciences companies, overseen numerous systems and technology implementations, and guided multiple post-merger integrations. Nick was a long-serving co-chair and member of the executive steering group for the PharmaTimes Clinical Researcher of the Year competition, and he is co-author on the book Rare Disease Drug Development: Clinical, Scientific, Patient, and Caregiver Perspectives, published in 2021.