The CLEAR Exchange: promoting evidence-based regulation

The CLEAR Exchange is an online collaboration focused on exchanging evaluation data related to regulatory and practice policy from a variety of regulatory sources. As regulators strive to make their decisions evidence-based, sharing evaluation data on questions and projects large and small will be a tremendous benefit to all.

The goals of the CLEAR Exchange are to:
  • share outcomes and learnings within and across regulatory organizations on topics of key importance.
  • support best practice evaluation processes that serve to increase regulatory efficiency and effectiveness.
  • promote rigor in policy making that inspires public confidence.
  • support and further evidence-informed policy decision-making.
This real-time sharing and networking across the regulatory community offers numerous benefits:
  • understanding who has done what and the lessons learned
  • exploring what data exists in an area
  • determining what research activities and processes do not bear repeating
  • discovering who might be interested in partnering in evaluation work to increase cost efficiency and provide additional wisdom from the outcome
Do you have research or evaluation data that you'd like to share?  Click here
We welcome research and evaluation of all types to increase and support evidence-informed regulation.  Examples of material for submission might be: a research study on peer assessment; the use of a governance evaluation survey; a sunset review; a survey of members' opinions on a new rule; a submission to government on a policy matter.  The aim is to capture smaller unpublished studies, evaluation reports, background discussion papers, and other data that, if shared, are helpful to others as questions and discussions are repeated at board tables around the globe.

CLEAR Glossary of Regulatory Terminology

CLEAR invites you to explore the categories and submissions via the links below.   As the Exchange continues to grow, categories will be added as appropriate.

* denotes a project generated by a regulatory entity


American Institutes for Research. Examination of Cosmetology Licensing Issues. Washington, D.C.: AIR, 2016, Licensing_Issues_Abridged_2016_0912.pdf.

* Learning from Experience: Improving the Process of Internationally Educated Nurses' Applications for Registration (LFE)

* Student fitness to practise and student registration: A literature review

Besancon, Rockey and van Zanten. Regulation of Health Professions: Disparate Worldwide Approaches are a Challenge to Harmonisation. World Medical Journal vol.58, Nr 4 September 2012.

Bureau of Labor Statistics. The De-Licensing of Occupations in the United States. Washington, D.C.: May 2015,

Carpenter, Dick M., et al. License to Work: A National Study of Burdens from Occupational Licensing. Arlington, Va.: Institute for Justice, 2012,

Cox, Carolyn, and Susan Foster. The Costs and Benefits of Occupational Regulation. Washington, D.C.: Federal Trade Commission. 1990,

Fetsch, E. “No bars: Unlocking the economic power of the formerly incarcerated.” Kansas City, Mo.: Ewing Marion Kauffman Foundation, 2016,

Flanders, W., and C. Roth. Fencing out opportunity: The effect of licensing regulations on employment. Milwaukee, Wis.: Wisconsin Institute for Law &Liberty, FOO2-FINAL-v3.pdf.

Fontinelle, A.; D. Mitchell, D.; and T. Snyder. Unnatural rights in the natural state: Occupational licensing in Arkansas. Conway, Ark.: Arkansas Center for Research in Economics, University of Central Arkansas, 2016, http://

Furth, Salim. Understanding the Data on Occupational Licensing. Washington, D.C.: The Heritage Foundation, Sept. 28, 2016,

Gius, M. Waiting to work: The effects of occupational licensing on wages and employment. Hartford, Conn.: Yankee Institute for Public Policy, 2016, YI_CCW_OccupationalLicensing_Study_webhh-1.pdf.

Hall, J.C., and S.B. Pokharel. "Barber licensure and the supply of barber shops: Evidence from U.S. states." Cato Journal 36, no. 3: 647-657,

Jones, A, Kelly, D, Brown, T.  Whistle-blowing in health and social care.  A narrative review of the literature.  Report commissioned by the Older People's Commissioner for Wales. Cardiff University 2013.   

Kleiner, M.M. Guild-ridden labor markets: The curious case of occupational licensing. Kalamazoo, Mich.: W.E. Upjohn Institute for Employment Research, 2015a, cgi?article=1254&context=up_press.

Laird, M.; A. Moore; and S. Staley. Occupational licensing in Florida: Unnecessary licenses are killing jobs (Policy Brief No. 131). Los Angeles, Calif.: Reason Foundation, 2016, florida.pdf.

Levin, Mark. Testimony before the Senate Business & Commerce Committee Regarding Interim Charge Concerning Occupational Licensing. Austin, Texas: Texas Public Policy Foundation, April 10, 2012, https://www.

Little Hoover Commission. Jobs for Californians: Strategies to ease occupational licensing barriers (Report #234). Sacramento, Calif.: Little Hoover Commission, 2016,

Natividad Rodriguez, Michelle, and Beth Avery. Unlicensed and Untapped: Removing Barriers to Occupational Licenses for People with Criminal Records. Washington, D.C.: National Employment Law Project, April 2016,

Paeth, Scott R.  The Responsibility to Lie and the Obligation to Report.  Bonhoeffer's "What Does It Mean to Tell the Truth?" and the Ethics of Whistleblowing.  Journal of Business Ethics (2013) 112:559-566.

Pham, Nam D., and Anil Sarda. The Value of Cosmetology Licensing to the Health, Safety and Economy of America. Washington, D.C.: NDP Analytics, December 2014,

Nunn, Ryan. Occupational Licensing and American Workers. Washington, D.C.: The Brookings Institution, 2016,

Reforming Occupational Licensing Policies. Washington, D.C.: The Hamilton Project, Brookings Institution, 2015,

Skorup, J. This isn't working: How Michigan's licensing laws hurt workers and consumers. Midland, Mich.: Mackinac Center for Public Policy, 2017,

Slivinski, S. Bootstraps tangled in red tape: How state occupational licensing hinders low-income entrepreneurship (Policy Report No. 272). Phoenix, Ariz.: Goldwater Institute, 2015, https://goldwater-media.

Turning shackles into bootstraps: Why occupational licensing reform is the missing piece of criminal justice reform (Policy Report No. 2016-01). Tempe, Ariz.: Center for the Study of Economic Liberty, Arizona State University, 2016,

Snyder, T. J. The effects of Arkansas' occupational licensure regulations. Conway, Ark.: Arkansas Center for Research in Economics, University of Central Arkansas, 2016, Arkansas-Occupational-Licensure-Regulations-by-Dr.-Thomas-Snyder.pdf.

Summers, Adam B. Occupational Licensing: Ranking the States and Exploring Alternatives. Los Angeles: Reason Foundation, 2007,


"The Future of Occupational Licensing Reform." The Regulatory Review Jan. 30, 2017, https://www.


Bismark, MM, Spittal, MJ, Gurrin, LC, Ward, M, Studdert, DM. Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia.  Quality and Safety in Healthcare Published Online First: 10 April 2013.

Elkin, KJ, Spittal, MJ, Elkin, DJ, Studdert, DM. Doctors disciplined for professional misconduct in Australia and New Zealand, 2000-2009 MJA, Volume 194 Number 9, 2 May 2011.

Elkin, K, Spittal, MJ, Elkin, D, Studdert, DM.  Removal of doctors from practice for professional misconduct in Australia and New Zealand.  BMJ Quality and Safety 2012;21:1027-1033. (10.1136/bmjqs-2012-000941) .

Meleyal L. Reframing Conduct: A critical analysis of the statutory requirement for registration of the Social Work Workforce. 2011.   

Papadakis, MA, Hodgson, CS, Teherani, A, Kohatsu, MD. Unprofessional behaviour in medical school is associated with subsequent disciplinary action by a state medical board.  Academic Medicine, 79 (2004), 244-249.  

Papadakis, MA, Arnold, GK, Blank, LL, et al.  Performance during internal medicine residency training and subsequent disciplinary actgion by state licensing boards.  Annals of Internal Medicine, 148 (2008), 869-876.

Teherani, A, Hodgson, CS, Banach, M, Papadakis, MA.  Domains of Unprofessional Behavior During Medical School Associated with Future Disciplinary Action by a State Medical Board.  Academic Medicine, Vol. 80, No. 10.  October 2005 Supplement.

Zhong, E. H., & Thomas, M. B. (2012). Association between job history and practice error: An analysis of disciplinary cases. Journal of Nursing Regulation, 2(4), 16-18. (Article available through subscription or purchase.)     

Continuing Competence

* Continuing fitness to practise - Towards an evidence-based approach to revalidation

*Evaluation Report: Effectiveness on the potential of a new online portal tool, which was designed to support veterinarians throughout the Continuing Professional Development (CPD) Cycle

* Measuring Post-Licensure Competence with Simulation: The Nursing Performance Profile  

Weinberg, D. B., Cooney-Miner, D., & Perloff, J. N. (2012). Analyzing the relationship between nursing education and patient outcomes. Journal of Nursing Regulation, 3(2), 4-10.   

Friedman, Andrew L 2012.  Continuing Professional Development - Lifelong learning of millions. Routledge, December 2012.  

Legal Action Center. After Prison: Roadblocks to Reentry. New York, N.Y.: LAC, 2009,

National Blueprint for Reentry. New York, N.Y.: LAC, 2008, National_Blueprint_For_Reentry_08.pdf.

Phipps, Noyce, Walshe, Parker and Ashcroft. Risk Assessment in Pharmacy Practice, (Final Report Version 2). University of Manchester, December 2010.  

Reid, J & Bromiley, M.  Clinical human factors: the need to speak up to improve patient safety.  Nursing Standard 26, 35, 35-40.  2012.  

Shojania, Kaveh G & Dixon-Woods, M. 'Bad apples': time to redefine as a type of systems problem? BMJ Quality and Safety Online First 6 June 2013 (10.1136/bmjqs-2013-002138

Spendlove, Z.  Regulatory Reform: Revalidation as professional crisis or critique and change opportunity for midwifery? British Journal of Midwifery, Vol.21, Iss.6, 06 Jun 2013, pp.417-421.  

Standards and Ethics

* Professionalism in healthcare professionals

Carthey, J, Walker, S, Deelchand, Vincent, C, Griffiths, WH.  Breaking the rules: understanding non-compliance with policies and guidelines.  BMJ 2011; 343:d5283.

Cole, AP, Block, L, Wu AW. On higher ground: ethical reasoning and its relationship with error disclosure.  BMJ Quality and Safety 2013; 22; 580-585.

Gallagher, A. Whistleblowing: what influences nurses on whether to report poor practice? Nursing Times 106(4), 2010, pp.22-25.

IPSOS MORI Social Research Institute: Understanding Society. How do we change behaviour? Make it simple. April 2013.   

Jones, A, Kelly, D, Brown, T.  Whistle-blowing in health and social care.  A narrative review of the literature.  Report commissioned by the Older People's Commissioner for Wales. Cardiff University 2013.   

Meyers, Roberta; Ray P. McClain; and Lewis Maltby. Best Practice Standards: The Proper Use of Criminal Records in Hiring. New York, N.Y.: The Lawyers' Committee for Civil Rights Under the Law, The Legal Action Center, and National Workrights Institute, 2013, Proper-Use-of-Criminal-Records-in-Hiring.pdf.

Moorhead, R, Hinchly, V, Parker, C, Kershaw, D, Holm, S.  Designing Ethics Indicators for Legal Services Provision.  Legal Services Board September 2012.    

Paterson, Ron. The Good Doctor - What Patients Want.  Auckland University Press, 2012.

Standards for Hiring People with Criminal Records. New York, N.Y.: LAC, Accessed April 2017, https://lac. org/toolkits/standards/standards.htm.

Thierer, A., et al. How the internet, the sharing economy, and reputational feedback mechanisms solve the "lemons problem" (Mercatus Working Paper). Arlington, Va.: Mercatus Center, George Mason University, 2015,

Governance and Oversight

Baldwin R, Cave M & Lodge M. Understanding Regulation: Theory, Strategy and Practice (Second Edition). Oxford University Press, October 2011.   

Batalova, Jeanne; Michael Fix; and James D. Bachmeier. Untapped Talent: The Cost of Brain Waste Among Highly Skilled Immigrants in the U.S. Washington, D.C.: Migration Policy Institute, New American Economy, and World Education Services, 2016,

Bergson-Shilcock, Amanda, and James Witte. Steps to Success: Integrating Immigrant Professionals in the U.S. New York, N.Y.: World Education Services, 2015,

Black, J.  Calling Regulators to Account: Challenges, Capacities and Prospects.  LSE Law, Society, and Economy Working Papers 15/2012.

Carpenter, D. M., and L. McGrath. “The balance between public protection and the right to earn a living” (resource brief). Lexington, Ky.: Council on Licensure, Enforcement and Regulation, 2014,

Etienne, J. The Impact of Regulatory Policy on Individual Behaviour: A Goal Framing Theory Approach. Centre for analysis of Risk and Regulation, Discussion paper no. 59, January 2010.

Gross, Jeffrey. Rx for Strengthening Massachusetts' Economy and Healthcare System. Report prepared for the Commonwealth of Massachusetts' Governor's Advisory Council for Refugees and Immigrants. Boston: Governors' Advisory Council for Refugees and Immigrants, 2014, gac_task_force_report-final-12.18.14.pdf.

Humphris, Amy; Morris M. Kleiner; and Maria Koumenta. "How Does Government Regulate Occupations in the United Kingdom and United States? Issues and Policy Implications." In Employment in the Lean Years: Policy and Prospects for the Next Decade, edited by David Marsden, ADD PAGE NUMBERS. Oxford: Oxford University Press, 2011.

Kleiner, Morris M., and Alan B. Krueger. Analyzing the Extent and Influence of Occupational Licensing on the Labor Market. Bonn, Germany: Institute for Labor Economics, 2011,

Kulhmann, Ellen & Saks, Mike (Eds).  Rethinking professional governance.  International directions in healthcare.  The Policy Press 2008.  

Marshall, Will, ed. Unleashing Innovation and Growth: A Progressive Alternative to Populism. Washington, D.C.: Progressive Policy Institute, 2016, Unleashing-Innovation-and-Growth_A-Progressive-Alternative-to-Populism.pdf.

McGivern, G. & Fischer, M. Reactivity and reactions to Regulatory Transparency in Medicine, Psychotherapy and Counselling.  Social Science & Medicine, 74 (3) 286-96, 2012.

McGivern, G et al. The Visible and Invisible Performance Effects of Transparency in Medical Professional Regulation: Full Research Report.  2009.

Mellor, William, and Dick M. Carpenter. Bottleneckers: Gaming the Government for Power and Private Profit. New York, N.Y.: Encounter Books, 2016.

National Governors Association Center for Best Practices. Veterans' Licensing and Certification Demonstration: A Summary of State Experiences, Preliminary Findings and Cost Estimates, a report prepared for the U.S. Department of Labor. Washington, D.C.: NGA, September 2015, Demonstration_Final%20Report_9_28_v2.pdf.

Panel on the Integration of Immigrants into American Society. The Integration of Immigrants into American Society. Washington, D.C.: The National Academies Press, 2015, uploads/2016/10/NatAcSci-Integration-of-Immigrants-in-US-2015-Report.pdf.

Quick, O. A scoping study on the effects of health professional regulation on those regulated.  Final report submitted to the Council for Healthcare Regulatory Excellence. May 2011.   

Shimberg, Benjamin, and Doug Roederer. Questions a Legislator Should Ask. Lexington, Ky.: Council on Licensure, Enforcement and Regulation, 1994.

Short, Stephanie D & McDonald, Fiona (Eds).  Health Workforce Governance. Improved Access, Good Regulatory Practice, Safer Patients.  Ashgate May 2012.    

Spendlove, Z.  Regulatory Reform: Revalidation as professional crisis or critique and change opportunity for midwifery? British Journal of Midwifery, Vol.21, Iss.6, 06 Jun 2013, pp.417-421.  

Stages of Occupational Regulation. Kalamazoo, Mich.: W.E. Upjohn Institute for Employment Research, 2013.

UK Commission for Employment and Skills. A review of occupational regulation and its impact. London, October 2011.   

Van Tol, J.  Summary analysis of the risk-regulation reflex: entrenched beliefs and six possible avenues for solutions.  2011.  


Regulatory Models and Frameworks

* Comparison of Telehealth Models

Bilton D and Cayton H.  Finding the right touch: extending the right-touch regulation approach to the accreditation of voluntary registers.  British Journal of Guidance and Counselling, Volume 41, Number 1, 1 February 2013, pp14-23.

College of Registered Nurses of British Columbia. Underlying Philosophies and Trends Affecting Professional Regulation.  February 2012.  

Hemphill, T.A., and D.M. Carpenter. "Occupations: A hierarchy of regulatory options." Regulation 39, no. 3): 20-24,

Huising, R & Silbey, SS.  Governing the gap: Forging safe science through relational regulation Regulation & Governance (2011) 5, 14-42.

Indiana Professional Licensing Agency. SEA 421 Report: Establishing a process for self-certification registration: A playbook for future occupational regulation in Indiana. Indianapolis, Ind.: Indiana Professional Licensing Agency, 2014,

Johnson, E., et al. Occupational licensing and women entrepreneurs in Missouri: A report to the Women's Foundation (IPP Research Report). Columbia: University of Missouri, Institute of Public Policy, 2016, https:// OL+and+Women+Entrepreneurs+in+MO+-+Final+11.14.16.pdf

Johnstone, S, Sarre, R. Regulation: Enforcement and Compliance. Research and Public Policy Series paper 57, Canberra: Australian Institute of Criminology, 2004.  

McGivern, G, Fischer, M, Ferlie, E, Exworthy,M. Statutory Regulation and the Future of Professional Practice in Psychotherapy and Counselling: Evidence from the Field . October 2009.

McGivern, G. & Fischer, M. Medical Regulation, spectacular transparency & the blame business. Journal of Health Organisation and Management 26 (2010): 597-610.  

Sparrow, Malcolm K.  The Regulatory Craft: Controlling Risks, Solving Problems and Managing Compliance.  Brookings Press, Washington DC, 2000.

Spira, LF & Page, M.  Regulation by disclosure: the case of internal control. July 2009.  

U.S. Department of Defense, "Allow Private Sector Employers to Offer Hiring Preference to Veterans." Arlington, Va.: DOD, 2017, OPI2.pdf.

"Private Sector Veteran Hiring Protection Best Practices." Arlington, Va.: DOD, 2016, http://download.

U.S. Department of Defense and U.S. Department of the Treasury. Supporting Our Families: Best Practices for Streamlining Occupational Licenses Across State Lines. Washington, D.C.: DOD, 2012, http://archive.defense. gov/home/pdf/Occupational_Licensing_and_Military_Spouses_Report_vFINAL.PDF

U.S. Department of Treasury Office of Economic Policy, Council of Economic Advisers and U.S. Department of Labor. Occupational Licensing: A Framework for Policymakers. Washington, D.C.: U.S. Department of Treasury and U.S. Department of Labor, 2015, report_final_nonembargo.pdf.

Walshe, K and Boyd A. Designing regulation: a review. Centre for Public Policy and Management, Manchester Business School. April 2007.   

Waring, J, Dixon-Woods, M, Yeung, K.  Modernising medical regulation: where are we now?  Journal of Health Organisation and Management, Vol. 24, Iss: 6 pp. 540-555. 2010.

Wilson, Bryan. How Many More Skilled Workers Do We Need? Using Supply and Demand Reports for State Workforce Planning. Washington, D.C.: National Skills Coalition and State Workforce and Education Alignment Project, June 2014,


Sherman, Amy; Becky Klein-Collins; and Iris Palmer. College Productivity Resource Guide for State Leaders: State Policy Approaches to Support Prior Learning Assessment. Chicago, Ill., and Washington, D.C.: Council for Adult and Experiential Learning and HCM Strategists, 2012, uploads/2013/09/cp_resource_guide_final_0-copy.pdf.

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