Operations

The Real Bottleneck in OTP Operations (And Why Staffing Alone Won't Fix It)

Ask almost any opioid treatment program leader what's keeping them up at night and you'll hear the same answer: staffing.

Not enough nurses or pharmacists to fill the openings. Long-time staff are retiring. New nurses won't stay in the job. The cost of contract staff is not sustainable.

Workforce shortages are real. But focusing on staffing alone often leads programs to make expensive decisions that are not actually solving the underlying constraint. And the programs that miss this may continue to burn through budget, burn out staff, and not serve their communities in their fullest capacity.

The truth is this: staffing is not the bottleneck. It's workflow, specifically dose preparation.

Where Capacity Actually Breaks Down

Most OTPs don't struggle because their clinicians aren't working hard enough. They struggle because the system they're operating in has hard, non-negotiable limits.

Think about a typical dosing window, each day:

• Hundreds of doses must be pumped, labeled, and sealed accurately
• Each dose must be verified
• Inventory must be reconciled
• Patients must be observed
• Safety checks must happen, every time

All of this occurs in a narrow window of time, often just a few hours each morning, and all of it is governed by clinical, regulatory, and safety requirements that can't be rushed.

Why "Just Hire More Nurses" Fails

This is the uncomfortable part that many leaders already feel but rarely say out loud. Hiring more nurses:

• Is not actually possible for some clinics
• Takes time and is expensive
• Increases payroll immediately and often requires sign-on bonuses
• Requires training, onboarding, and supervision
• Often has marginal gains in efficiency and patient experience
• Doesn't protect against errors during peak volume

In fact, in some high-volume settings, adding more people into a tightly constrained workflow can increase risk, not reduce it.

The result? Staff still feel underwater. Leaders still feel capped. Patients still wait.

The Structural Constraint That OTPs Don't Need to Accept Anymore

Dose preparation and verification are:

• Time-intensive
• Repetitive
• High-stakes
• Required to be perfect, every time

They sit at the intersection of safety and scale. And because they're manual in most programs, they become the natural choke point as census grows or clinics work to expand take-home medications for patients.

This is why programs can have:

• Strong clinicians
• Engaged leadership
• Full schedules

...and still be unable to expand.

Seeing the System Instead of Blaming the Staff

This isn't a people problem. It's a systems problem.

When capacity is constrained by a manual, safety-critical process, the answer isn't to push humans harder, it's to redesign the workflow so humans are focused where judgment and care matter most.

That means asking different questions:

• Where are we spending licensed time on repetitive tasks?
• What steps are required for safety, and which are required only because the process is manual?
• What limits throughput regardless of how many staff we add?

Programs that grow sustainably tend to answer these questions early. Programs that don't often end up cycling through staff, stretching hours, or freezing intake, all without solving the root issue.

What Increasing Capacity Actually Looks Like

When OTPs successfully increase capacity with limited staff, it's usually because they've addressed throughput directly by:

• Reducing manual preparation time through automation
• Implementing workflow changes (usually a hybrid of real-time and advanced dose prep)
• Standardizing verification processes
• Smoothing peak dosing volume
• Protecting staff from constant interruption during safety-critical steps

Staffing matters deeply. And when these changes are put in place, clinics can expand hours with the same staff, reduce patient wait times, enhance clinical programs, and reduce nurse burnout and staffing churn.

Why This Matters Right Now

Demand for care is rising. Expectations around access are changing. The nursing shortage is not getting any better. Rural expansion, satellite models, and new care settings are all on the table.

If programs don't address the real bottleneck, expansion becomes theoretical and in some cases, there is a daily worry about how to keep the clinic open.

Access and safety aren't opposing goals. But scaling safety requires more than people. It requires infrastructure that's built for the work.

Sam Wilson

CEO