Beginning in the 1980s, the federal government encouraged institutional providers to collaborate with pharmaceutical companies, medical device manufacturers, and biotechnology ventures. The rationale underlying this public policy was that collaboration would accelerate the pace of innovation. More recently, the focus is on whether these collaborations create conflicts of interest that jeopardize the safety of subjects and the integrity of data. Various constituencies are calling for conflict of interest reform, while the demand for new diagnostic and therapeutic tools has never been greater. These competing messages have stakeholders questioning what to do. This article reviews recent developments in conflicts of interest reform and provides recommendations that institutions and industry can consider as they undertake to develop a scalable and flexible approach to enhancing their conflicts of interest infrastructure.