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  The aim is to capture smaller unpublished studies, evaluation reports, background discussion papers, and other data that, if shared, are helpful to others as questions and discussions are repeated at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


* 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.

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.   

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.


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.  

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.   

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.

Governance and Oversight

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

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

Committee on Standards in Public Life.  Standards matter. A review of best practice in promoting good behaviour in public life.  January 2013

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.

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

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.

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.   

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.  

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.  

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

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.  

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.



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