Design, delivery and effectiveness of health practitioner regulation systems: an integrative review
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Abstract
BACKGROUND: Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions. METHODS: We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework. FINDINGS: This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners. CONCLUSION: We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.
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Previous reviews report the health practitioner regulation literature base to be diffuse, primarily descriptive, and insufficient for drawing strong conclusions about the effects of regulatory approaches, policies, and practices on patient safety, the health workforce, and health system outcomes.
“These authors report the literature base to be diffuse, primarily descriptive, and insufficient for drawing strong conclusions about the effects of various regulatory approaches, policies, and practices on patient safety, the health workforce, and health system outcomes [17,18].”
From Nursing regulation in Canada: Insights from a scoping review (2025) · cites this paper as [18]
Existing evidence about the design and outcomes of CCPs is mixed.
“Although mandatory continuing professional development is an approach that is used widely by professional regulators globally, existing evidence about the design and outcomes of CCPs is mixed [18,247–251].”
From Nursing regulation in Canada: Insights from a scoping review (2025) · cites this paper as [18]
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Nursing regulation in Canada: Insights from a scoping review
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“Although mandatory continuing professional development is an approach that is used widely by professional regulators globally, existing evidence about the design and outcomes of CCPs is mixed [18,247–251].”
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Performance measurement and evaluation of health practitioner regulation: A scoping review protocol
Chiu, P., Leslie, K., Jang, G., Adams, T. L., Thiessen, N., & Kung, J. Y. (2025) · PLOS ONE · doi:10.1371/journal.pone.0319507 · Cited by 5 · see citing works
Self-citationSusiku, E., Hewitt‐Taylor, J., & Akudjedu, T. N. (2025) · Radiography · doi:10.1016/j.radi.2025.102982 · Cited by 4 · see citing works
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Exploring the literature on racism and health practitioner regulation: a scoping review protocol
Chiu, P., Louie‐Poon, S., Leslie, K., & Kung, J. Y. C. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-084084 · Cited by 4 · see citing works
Self-citationPourazad, N., Samadbeik, M., Bastani, P., & Balasubramanian, M. (2025) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2025.106145 · Cited by 5 · see citing works
Developing a pan-Canadian nursing regulation research agenda
Chiu, P., Leslie, K., Myles, S., Ben-Ahmed, H. E., & Jang, G. (2025) · Journal of Nursing Regulation · doi:10.1016/j.jnr.2025.09.001 · Cited by 3 · see citing works
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Supporting Patient Involvement in U.S. Medical Education Through Changes in Accreditation
Tackett, S. A., Steinert, Y., Jackson, J. L., Adams, G. J., Reed, D. A., Whitehead, C. R., & Wright, S. M. (2024) · Teaching and Learning in Medicine · doi:10.1080/10401334.2024.2439850 · Cited by 3 · see citing works
Nursing regulation literature in Canada: protocol for a scoping review
Chiu, P., Leslie, K., & Kung, J. Y. (2024) · JMIR Research Protocols · doi:10.2196/56163 · Cited by 2 · see citing works
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Assessment of community health workforce governance in federal Nepal
Tikkanen, R. S., Pokhrel, S., Ghimire, U., Neupane, B., Closser, S., & Kumar, B. N. (2025) · Health Policy and Planning · doi:10.1093/heapol/czaf088 · Cited by 2 · see citing works
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Interventions that strengthen the care workforce: a realist synthesis review
Kelly, C., Dansereau, L., Jack, E. M., Pirzada, S., Oh, Y., Bhushan, P., Pelly, L., Linton, J., McCarthy, C. F., & Cometto, G. (2025) · Health Affairs Scholar · doi:10.1093/haschl/qxaf128 · Cited by 1 · see citing works
Health practitioner regulation and anti-racism: A scoping review
Chiu, P., Thiessen, N. J., Iduye, D., Louie‐Poon, S., Kung, J. Y. C., & Leslie, K. (2025) · SSM - Health Systems · doi:10.1016/j.ssmhs.2025.100108 · Cited by 1 · see citing works
Self-citationHealth conditions that impact fitness-to-practice in physicians: a scoping review
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Chiu, P., Alnoor, M., Shakeel, Z., & Leslie, K. (2026) · Journal of Nursing Regulation · doi:10.1016/j.jnr.2026.01.002
Self-citationAlshehri, S. A., Simmonds, L., Shafei, A., Indriyani, F., Al‐Hanawi, M. K., & Balasubramanian, M. (2026) · Human Resources for Health · doi:10.1186/s12960-026-01077-9
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Bounded Integration: The Regulation of Traditional and Complementary Medicine in Türkiye
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Global Health Inequality and Access to Care
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- Authors
- Leslie, K., Bourgeault, I. L., Carlton, A.-L., Balasubramanian, M., Mirshahi, R., Short, S. D., Carè, J., Cometto, G., & Lin, V.
- Affiliations
- Athabasca University (CA)
- University of Ottawa (CA)
- RMIT University (AU)
- The University of Sydney (AU)
- University of Technology Sydney (AU)
- World Health Organization (CH)
- University of Hong Kong (HK)
- Corresponding author
- Leslie, Kathleen
- ORCID
- Venue
- Human Resources for Health
- Published
- 2023-09-04
- Volume
- 21
- Issue
- 1
- Pages
- 72-72
- ISSN
- 1478-4491 (ISSN-L)
- PMC
- PMC10478314
- OpenAlex
- W4386423345
- Cited by
- 38
- References
- 252
- Citations by year
- 2026: 13 · 2025: 13 · 2024: 9 · 2023: 3
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Human Resources for Health (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- uO Research (University of Ottawa) (submittedVersion, public-domain)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- World Health Organization
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Occupational and Professional Licensing Regulation
- Health Sciences › Health Professions › Health Information Management › Healthcare Regulation
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Keywords
- health practitioner regulation, healthcare workers, statutory registration, risk-based regulation, continuing professional development, licensing examinations, mandatory reporting, remedial programme, patient safety, health workforce policy
- MeSH terms
- Accreditation, Government, Government Programs, Health Education, Humans, Databases, Factual
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