CPHQ Exam Practice

CPHQ Exam Practice Quiz
Congratulations - you have completed CPHQ Exam Practice Quiz.
All the questions in the quiz along with their answers are shown below. Your answers are
bolded. The correct answers have a green tick while the incorrect ones have a red cross.
Question 1 of 105
The benefits of studying a process include all of the following EXCEPT
1. arriving at a common understanding.

2. eliminating errors.
3. eliminating inconsistencies.
4. highlighting obvious problems.
Answer: B
Benefits of studying a process include the following:
 Arriving at a common understanding. When Team Members work through the

recommended strategies, they gain a common understanding of the process, start using
the same terminology, and don't waste time pulling in different directions.
 Eliminating inconsistencies. When comparing how various people associated with the
process carry out their work, inconsistencies will surface. Many of these can be traced to
a lack of documentation and inadequate training about the best way to run the process.
Quality and productivity often increase dramatically once employees who do the same
job start sharing and using a "best-known way" to do their work.
 Highlighting obvious problems. Looking closely at a process almost always highlights
glaring problems that have gone unnoticed but can be easily fixed. This is particularly
true of administrative processes.
Studying a process does not directly lead to the elimination of errors.
Content Category: Performance Measurement and Improvement

Cognitive level required for a response: Recall
Tasks on the CPHQ exam content outline to which the question is linked: Coordinate or
participate in quality improvement projects
Question 2 of 105
The second sponge count at the end of a hernia repair operation on an obese patient was
incorrect. This was confirmed by repeat sponge counts, and the surgeon eventually located and
retrieved the missing sponge. The patient's recovery was uneventful.
The healthcare professional should
1. conduct root cause analysis.

2. perform failure mode and effects analysis.
3. continue to monitor incident reports of inaccurate sponge counts from the Operating
Room.
4. recommend retraining of Operating Room staff to better track surgical instruments and
sponges during surgical procedures.
Answer: A
This question consists of two parts. Firstly, to answer the question correctly, you need to
recognize that the incident in the Operating Room is a sentinel event. As discussed in my article
on sentinel events, this incident meets the definition of a sentinel event because there was a
significant risk that the sponge (a foreign body) was retained in the patient. Secondly, you are
expected to know that any sentinel event requires a thorough and credible root cause analysis.
Content Category: Patient Safety

Cognitive level required for a response: Analysis
Tasks on the CPHQ exam content outline to which the question is linked: Perform or
coordinate risk management
Question 3 of 105
A point prevalence survey in 2010 showed that the overall prevalence proportion of healthcare-
associated infections in a hospital system was 7.3%. In 1990, the prevalence proportion was
8.1%. A hypothesis test for the difference between the two prevalence proportions gave a P-
value of 0.029.
Which of the following is the most accurate interpretation of the results?
1. The prevalence of healthcare-associated infections in 2010 is significantly lower than that

in 1990.
2. The prevalence of healthcare-associated infections in 2010 is lower than that in 1990, but
there is a small chance that, in reality, there was no difference in the prevalences.
3. The prevalence of healthcare-associated infections in 2010 is higher than that in 1990 but
there is a moderate chance that, in reality, there was no difference in the prevalences.
4. The prevalence of healthcare-associated infections in 2010 is slightly lower than that in
1990.
Answer: B
The prevalence of healthcare-associated infections is lower in 2010 than in 1990. Therefore, the
third answer option (C ) should be eliminated. The final answer option (D) is ambiguous -the
term "slight" carries no meaning in statistics or in healthcare quality. Some candidates might
have chosen the first answer option because the P-value was lower than 0.05. However, the level
of significance for the hypothesis test was not stated. It could have been 0.01 (in which case it
would not have been a "significant result") or 0.10 (in which case it would have been
significant). The most accurate interpretation of the result is this: the prevalence of healthcare-
associated infections in 2010 is lower than that in 1990, but there is a small (2.9% probability)
that the result would have been observed, due to chance, if there was in truth no difference
between the two prevalences. The correct answer for this question is B.
Content Category: Information Management

Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the question is linked: Use the results of
statistical techniques to evaluate data (e.g. t-test, regression)
Question 4 of 105
Which of the following is most effective in communicating instructions to patients before their
discharge from hospital?
1. In addition to clear verbal instructions, the caregiver conveys all instructions in written
form.
2. The caregiver gives verbal instructions on more than one occasion before the patient's
discharge from hospital.
3. The caregiver communicates the same instructions to a member of the patient's family.
4. The caregiver communicates instructions to the patient and then asks the patient to
explain what he/she has just been informed to do.
Answer: D
Each of the four communication strategies above could be applied. However, "teach back"
(answer option D) is probably the most effective technique to communicate instructions to
patients. According to the Agency for Healthcare Research and Quality (2001) report Making
Health Care Safer, "Asking that patients recall and restate what they have been told" is one of 11
top patient safety practices based on strength of scientific evidence.

Tasks on the CPHQ exam content outline to which the question is linked: Facilitate
evaluation or selection of evidence-based practice guidelines (e.g. for standing orders or as
guidelines for physician ordering practice)
Question 5 of 105
Among the following factors, competency assessment of staff is LEAST influenced by data
related to
1. productivity.
2. feedback from patients, families, and staff.
3. performance improvement findings relative to performance standards in the job
description.
4. knowledge of administrative policies and procedures.
Answer: D
The first three answer options support staff competency assessment. Whilst knowledge of
administrative policies and procedures may be required for some jobs, the other factors are
stronger in evaluating an employee's competency and skill gaps.

Tasks on the CPHQ exam content outline to which the question is linked: Incorporate
performance improvement into the employee performance appraisal system
Question 6 of 105
The senior leaders of a managed care organization have consulted a healthcare quality
professional on the purchase of a clinical data management software system to support
performance improvement.
Which of the following is the most important issue in identifying the system requirements?
1. Users' need for customized graphs and tables.

2. The number of existing computer terminals.
3. The organization's goals for the data management system.
4. Integration with existing information systems.
Answer: C
All the answer choices play a part in identifying the system requirements but the primary issue,
at least at the beginning of the software selection process, is identifying the goals and objectives
of the new data management system.

Tasks on the CPHQ exam content outline to which the question is linked: Assist with the
evaluation of computer software applications
Question 7 of 105
A team in a healthcare facility is working on a project to improve access to primary care. The
average length of time to the "third next available" appointment was chosen as an outcome
measure. Which of the following is the most appropriate balancing measure?
1. Number of new patient visits.

2. Percentage of patients satisfied with phone access.
3. Individual panel size.
4. Office visit cycle time.
Answer: B
For this project, the number of new patient visits and individual panel size (i.e. number of unique
patients for which a physician is responsible) are process measures. Office visit cycle time, i.e.
the length of time that a patient spends at an office visit, is possibly another outcome measure for
this project.
A "balancing measure" is one used to make sure that any changes introduced during the project
to improve one part of the system are not causing new problems in other parts of the same
system. In this case, by reducing the time to the "third next available" appointment, staff could
possibly be stretched too thin and their response to telephone calls may become less satisfactory.
As another example, if you were involved in a project to prevent venous thromboembolism

(clots) after pelvic surgery, you might select, as balancing measures, the incidence of bleeding
episodes and heparin-induced thrombocytopenia (low platelet count).

development or selection of process and outcome measures
Question 8 of 105
A licensed independent practitioner with admitting privilege at a hospital must
1. be a fully licensed physician.

2. be eligible for medical staff membership.
3. be a member of the medical staff.
4. have completed proctoring for any clinical privileges previously requested.
Answer: C
A licensed independent practitioner with admitting privilege MUST be a member of the medical
staff. In some organizations, the medical staff may include professionals other than medical
doctors (MD, MBBS, DO, etc.). Examples of the latter are dentists, clinical psychologists, and
podiatrists. Therefore, the first answer option (A) is not the best answer. Eligibility for medical
staff membership implies that the individual has not yet been appointed. Proctoring is usually
required for a predefined period after the initial appointment. In many organizations, completion
of proctoring is not required for admitting privilege.

Tasks on the CPHQ exam content outline to which the question is linked: Participate in the
credentialing and privileging process
Question 9 of 105
In your capacity as the Director of Quality and Patient Safety at a 1600-bed tertiary referral
center, you are consulted to assist in the development of a balanced scorecard.
In selecting measures for the scorecard, the "perspectives" commonly used include all of the
following EXCEPT
1. Financial.
2. External Business Processes.
3. Customer.
4. Learning and Growth.
Answer: B
The 4 classic "perspectives" of the balanced score card are: "Financial", "Customer", "Internal
Business Processes", and "Learning and Growth". See this article on the Balanced Scorecard
Framework for more information.
Content Category: Management and Leadership

Tasks on the CPHQ exam content outline to which the question is linked: Develop and use
performance measures (e.g. balanced scorecards, dashboards, core measures)
Question 10 of 105
To assess their job satisfaction, 32 nurses on a Med-Surg ward were given a self-administered
questionnaire. One of the items on the questionnaire was a self-rating of job satisfaction on a
Likert scale (1 = Very Dissatisfied, 10 = Very Satisfied).
What is the healthcare quality professional's interpretation of the results from the graph above?
1. There is a strong linear positive association between job satisfaction and years of
employment.
2. There is a moderate linear positive association between job satisfaction and years of
employment.
3. There is a strong linear negative association between job satisfaction and years of
employment.
4. There is a moderate linear negative association between job satisfaction and years of
employment.
Answer: D
The scatter plot (one of the 7 Basic Tools of Quality) describes the association between two
variables. This is a summary of scatter plots, which also explains the correct answer.

Tasks on the CPHQ exam content outline to which the question is linked: Use basic
statistical techniques to describe data (e.g. mean, standard deviation)
Question 11 of 105
The number of productive hours worked by nursing staff with direct patient care responsibilities
per patient day is a
1. structural measure.
2. process measure.
3. outcome measure.
4. composite measure.
Answer: A
Structural measures reflect the conditions in which providers care for patients. Process measures
show the degree to which evidence-based steps in care processes are followed. Outcome
measures look at the results of care. Composite measures combine the result of multiple
performance measures to provide a more comprehensive picture of quality care. You might like
to read our article on assessing the quality of care.

Question 12 of 105
In your capacity as the Director of Quality at an 800-bed multidisciplinary hospital, you are
consulted on how best to reduce complication rates while reducing length of stay and cutting
overall costs for total hip replacement.
Provided none of the following has already been attempted, the best option is
1. to identify the causes for the unacceptable complication rates, high lengths of stay and
rising costs related to total hip replacement.
2. a clinical pathway.
3. to analyse the data and confirm that total hip replacement is associated with unreasonable
rates of complications, and higher-than-expected lengths of stay and costs.
4. to review, and revise if necessary, all existing policies and procedures for total hip
replacement.
Answer: B
There is no indication that the complication rates, length or stay or overall costs are unacceptable
or above the average. Therefore, answer options A and C are not appropriate. Between the other
two choices, B is the better answer. Merely reviewing policies and procedures rarely improves
the outcomes considered in this question. See our article on clinical pathways for an explanation.

development of clinical/critical pathways or guidelines
Question 13 of 105
The senior leaders of a hospital are prioritizing performance improvement initiatives for the
coming year.
Which of the following tools will be most useful for this purpose?
1. Pareto chart
2. Cause-and-effect diagram
3. Affinity diagram
4. Stratification
Answer: A
The most useful tool would likely be a Pareto chart. A cause-and-effect diagram is useful for
identifying possible causes of a problem. An affinity diagram is useful for brainstorming and
therefore not relevant in this situation. Stratification is unlikely to be appropriate in this scenario.

establishment of priorities for process improvement activities
Question 14 of 105
Which of the following graphs is most appropriate in displaying the root causes of adverse
events that have occurred in a hospital system over the past 10 years?
1. Histogram
2. Frequency polygon
3. Line chart
4. Bar chart
Answer: D
Root causes are qualitative data. Therefore, a correct way to summarize them is by using a bar
chart. Another acceptable way of displaying the data would be via a pie chart (but a bar chart is
preferable). A line chart, histogram or frequency polygon may be used for quantitative data. See
our article on graphing frequency distributions for more details. Page 46 of Improving America’s
Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2007 illustrates how
bar charts can effectively display data on root causes of sentinel events.

Tasks on the CPHQ exam content outline to which the question is linked: Compile and write
performance improvement reports
Question 15 of 105
A series of poor surgical outcomes at a small community hospital led to an investigation which
eventually found that the vast majority of recent failed surgeries were conducted by only one
surgeon. The "surgeon" was subsequently discovered to have forged his medical qualifications
and had been impersonating a doctor for the previous 8 months. He is currently awaiting trial on
charges in connection with the surgeries he performed at the hospital.
The primary role of the healthcare quality professional in this case is
1. to assist in the criminal prosecution of the alleged perpetrator.

2. to identify other licensed independent practitioners whose qualifications had been forged.
3. to facilitate a review of the credentialing and privileging process.
4. to review policies and procedures related to surgical procedures so that patient safety may
be improved.
Answer: C
The healthcare quality professional's primary role in such a case is to help improve processes. A
credentials committee is usually responsible for reviewing the qualifications of medical staff
applicants/members, not the healthcare quality professional. A review of policies and procedures
related to surgery is unlikely to prevent unqualified practitioners from operating in the future.

Tasks on the CPHQ exam content outline to which the question is linked: Integrate patient
safety concepts within the organization
Question 16 of 105
The chart below shows the overall inpatient mortality at a hospital.
Based on the data, the healthcare quality professional should
1. report that overall inpatient mortality has improved and the improvement is statistically
significant.
2. conclude that inpatient mortality has increased overall.
3. conduct drill-down analysis.
4. continue to monitor inpatient mortality.
Answer: D
As explained in our article on using run charts, identification of special cause variation - both
good and bad - follows the criteria listed. In this case, there is no clear run/shift, trend or pattern
in the run chart. In the absence of evidence of special cause variation, it is best to continue
tracking the measure. The actions in the other answer options are not appropriate without any
further information. However, if the next data point is below the median line, I would call it a
run/shift and therefore try to understand why this has occurred. It is possible that something
significant occurred around or before January 2010 to account for the start of this run, e.g.
change of management, introduction of strategic improvement initiatives, etc.

Tasks on the CPHQ exam content outline to which the question is linked: Use or coordinate
the use of statistical process control components (e.g. common and special cause variation,
random variation, trend analysis)
Question 17 of 105
The senior leaders of a hospital system were interested to learn whether inpatient deaths were
associated with after hours admission. Therefore, a random sample of patients who had died in
hospital and a representative group of patients who did not die were selected. Subsequently, the
times of their hospital admission were analysed.
Which of the following measures is most appropriate to determine whether there is an

association between inpatient mortality and after hours admission?
1. Rate ratio
2. Odds ratio
3. Risk ratio
4. Risk incidence
Answer: B
This is an example of a case-control study. As discussed in our article on overview of study

design, we start by identifying individual cases of the outcome of interest. We then identify a
representative group of individuals who do not have the outcome. These individuals act as
controls. We then compare cases and controls to assess whether there were any differences in
their past exposure to one or more possible risk factors. The most appropriate measure of effect
for case-control studies is the odds ratio.
Tasks on the CPHQ exam content outline to which the question is linked: Use
epidemiological theory in data collection and analysis
Question 18 of 105
Which of the following sampling methods should a healthcare quality professional use to obtain
the most precise estimate of the prevalence of pressure ulcers in a 900-bed multi-disciplinary
tertiary care facility?
1. Simple random sampling

2. Systematic sampling
3. Stratified simple random sampling
4. Multi-stage sampling
Answer: C
For this heterogeneous hospital population, the most precise estimate of pressure ulcer
prevalence will be obtained by stratified simple random sampling (unless the sample is very
large). See our article on complex sampling methods for more information.

Question 19 of 105
In examining the association between inpatient mortality and after hours admission, the
healthcare quality professional was interested to find out whether the distance between patients'
place of residence and the hospital might be a confounding variable.
Which of the following methods can she use to determine whether the association between
inpatient mortality and after hours admission was confounded?
1. ANOVA
2. Stratification
3. Chi-squared test
4. Student's t-test
Answer: B
This article on confounding explains the use of stratification to control for confounding.
Question 20 of 105
One of the aims in the treatment of severe community-acquired pneumonia is to maintain an

oxygen saturation of >94% (or 88 - 92% in patients with chronic obstructive airway disease).
Ensuring adequate oxygenation for this condition is a
1. process and outcome measure.

2. structure measure.
3. process measure.
4. outcome measure.
Answer: C
Please refer to our article on structure, process and outcomes for an explanation of the answer.

Question 21 of 105
Senior leaders of an organization can promote quality by
1. executive walkarounds.
2. micromanagement to demonstrate a hands-on approach.
3. encouraging staff to set their own expectations so that they can meet them.
4. focusing on the financial position, reputation and lay management of the hospital.
Answer: A
Senior leaders can improve quality, especially patient safety, by executive walkarounds.
Micromanagement is generally frowned upon. Leaders should set expectations for staff.
Traditionally, senior leaders focused on finance, reputation and lay (non-clinical) management
but modern quality management requires their active participation.

assessment and development of the organization’s quality culture
Question 22 of 105
The chart below shows the rate of Cesarean Sections in a hospital.
The healthcare quality professional should
1. continue monitoring the monthly rates of Cesarean Sections.

2. recommend a Cesarean Section audit by peer review.
3. review the policies and procedures for Cesarean Section.
4. review the antenatal care of women who had Cesarean Sections.
Answer: B
There is a rise in the rate of Cesarean Sections and the final 7 consecutive data points form a
run/shift. A rise in the Cesarean Section rate is not desirable and should be investigated. The
healthcare quality professional is not responsible for determining whether the procedure was
medically indicated - this is done by peer review. Reviewing policies and procedures alone rarely
helps in situations like this. Antenatal care may be a contributing factor - this is evaluated during
peer review.

Tasks on the CPHQ exam content outline to which the question is linked: Interpret outcome
data
Question 23 of 105
A randomized controlled trial was conducted to assess the effectiveness of a multimedia patient
education program designed to help prevent falls in a hospital. The following results were
obtained:
What is the rate ratio?
1. 2.3
2. 1.3
3. 0.77
4. -2.3
Answer: C
The rate ratio is the ratio of the incidence rate in the exposed (intervention) population to the
incidence rate in the unexposed (control) population. In this case, the rate ratio = 7.5/9.8 = 0.77. See
our article on difference and ratio measures for more information.

Tasks on the CPHQ exam content outline to which the question is linked:
Aggregate/summarize data for analysis
Question 24 of 105
In participative management,
1. the leader attempts to sell his/her decisions to the group.

2. the leader makes decisions and announces them to the group with minimal participation
from group members.
3. few decisions are made.
4. the leader presents a tentative decision, elicits suggestions from group members, and then
makes the final decision.
Answer: D
See this brief description on participatory management style for an explanation of the answer.

Tasks on the CPHQ exam content outline to which the question is linked: Facilitate change
within the organization
Question 25 of 105
The Process Management area of the Baldrige Health Care Criteria for Performance Excellence
addresses each of the following EXCEPT
1. healthcare processes.
2. support processes.
3. operational planning.
4. strategic planning.
Answer: D
The Process Management category includes healthcare processes, support processes and
operational planning, but not specifically strategic planning (though the latter is somewhat
related to the first three areas).

Tasks on the CPHQ exam content outline to which the question is linked: Aid in evaluating
the feasibility to apply for external quality awards (e.g. Malcolm Baldrige, Magnet)
Question 26 of 105
A healthcare quality professional examined the relationship between the rate of adverse patient
occurrences and duration of overall medical practice among physicians in a hospital. In the
analysis, the computed value of r was 0.8139.
The healthcare quality professional concluded that there is a
1. moderate positive relationship between the rate of adverse patient occurrences and
duration of medical practice.
2. strong positive relationship between the rate of adverse patient occurrences and duration
of medical practice.
3. moderate negative relationship between the rate of adverse patient occurrences and
duration of medical practice.
4. strong negative relationship between the rate of adverse patient occurrences and duration
of medical practice.
Answer: B
The letter r stands for the correlation coefficient. A value of 0.8 or above is generally considered
strong and a positive value indicates a positive relationship. See our article on scatter plots and
correlation for more details.

Tasks on the CPHQ exam content outline to which the question is linked: Use the results of
statistical techniques to evaluate data (e.g. t-test, regression)
Question 27 of 105
Clinical decision support software is an example of
1. external memory.
2. a server.
3. artificial intelligence.
4. mass storage.
Answer: C
You should be familiar with some common terms used in computerized systems as they are
necessary for evaluating such systems and using them. See this brief description of Clinical
Decision Support.

Tasks on the CPHQ exam content outline to which the question is linked: Evaluate
computerized systems for data collection and analysis
Question 28 of 105
The main purpose of performance improvement in healthcare is to
1. improve patient outcomes.

2. enhance patient and family satisfaction.
3. improve processes of care.
4. meet accreditation standards.
Answer: A
A general definition of performance improvement is "a planned, systematic, organizationwide

approach to the monitoring, analysis, and improvement of organization performance, thereby
continually improving the quality of patient care and services provided and the likelihood of
desired patient outcomes."

Tasks on the CPHQ exam content outline to which the question is linked: Develop a
performance improvement plan
Question 29 of 105
For a patient with insulin-dependent diabetes mellitus, which of the following programs is the
most appropriate to administer?
1. Disease management
2. Utilization management
3. Demand management
4. Risk management
Answer: A
Disease management is defined as "a system of coordinated health care interventions and
communications for populations with conditions in which patient self-care efforts are significant.
It is the process of reducing healthcare costs and/or improving quality of life for individuals by
preventing or minimizing the effects of a disease, usually a chronic condition, through
integrative care."
Utilization management is concerned with "the planning, organizing, directing, and controlling
of the healthcare product in a cost-effective manner while maintaining quality of patient care and
contributing to the overall goals of the institution."
Demand management involves the use of decision and behaviour support systems to
appropriately influence individual patients' decisions about whether, when, where, and how to
access medical services.
Risk management is a formal attempt to control liability, prevent financial loss, and protect the
financial assets of the organization. Note that in the CPHQ Exam Candidate Handbook's
"Terminology Crosswalk of Terms", case management = case/care/disease management.

Tasks on the CPHQ exam content outline to which the question is linked: Contribute to
development and revision of a written plan for a case/care/disease/utilization management
program
Question 30 of 105
Impressed by what he saw at a healthcare conference, the Chief Executive Officer decided to
adopt Lean Six Sigma as the hospital's new approach to process improvement.
If the desired results are not achieved, which of the following is the most likely reason for this?
1. Lack of understanding of Lean Six Sigma.

2. Lack of top management support.
3. Projects not linked to organizational goals and objectives.
4. Inadequate focus on behavioural change to support process change.
Answer: B
All of the above contribute to failure of quality improvement initiatives. However, the
commonest problem is lack of senior management support. It's common for a senior member of
staff liking the idea of introducing something they had heard about but not understanding what it
takes to achieve success. This often leads to disillusionment later and subsequent failure of
projects. All improvement requires investment in resources - time, people, skills development,
money, etc. - and leaders need to be aware of this before committing to new methods.

development of leadership values and commitment
Question 31 of 105
The prevalence of pressure ulcers in an acute-care facility is 18.3%. The healthcare quality
professional obtained information that the prevalence of pressure ulcers across 420 acute care
hospitals in the state was 14.8%. For the purpose of improvement in her hospital, the latter figure
(14.8%) is best regarded as
1. a benchmark.
2. a goal.
3. a comparison.
4. an estimate.
Answer: C
The figure of 14.8% is an "average" of the measure across the hospitals. It's not a "benchmark",
which relates to best practice. The figure may be a "goal" and is certainly an "estimate" but the
BEST description is a "comparison".

Tasks on the CPHQ exam content outline to which the question is linked: Use comparative
data to measure or analyze performance
Question 32 of 105
The Body Mass Index (a measure of body fat) was measured in a group of women attending a
primary care clinic. The graph below summarizes the results.
Which of the following measures best summarizes the data?
1. Mean
2. Mode
3. Median
4. Range
Answer: C
The relative frequency distribution is skewed (to the right). The median is the most appropriate
summary measure for skewed distributions. Read our article on measures of location for more
details.

Question 33 of 105
Which of the following is NOT a key concept of Total Quality Management?
1. Waste elimination
2. Customer focus
3. Process centered
4. Continual improvement
Answer: A
See this resource on Total Quality Management for more information.

Tasks on the CPHQ exam content outline to which the question is linked: Develop
organizational performance improvement training (e.g. quality, patient safety)
Question 34 of 105
Which of the following is the first step in implementing lean management effectively in a
hospital?
1. Create an organizational culture that is receptive to lean thinking.

2. Distinguish between value-added steps from non-value-added steps in any given process.
3. Eliminate waste.
4. Identify key processes for kaizen projects.
Answer: A
The first step in successful lean implementation in an organization is senior leadership creating
an organizational culture that is receptive to lean thinking.

Question 35 of 105
When a healthcare quality professional plotted data on patients' age in a frequency histogram,
she found a negatively skewed distribution. Therefore,
1. the median is greater than the mean and the mode is greater than the median.
2. the mean is greater than the median and the median is greater than the mode.
3. the mode is greater than the mean and the median is greater than the mode.
4. the mean is greater than the mode and the mode is greater than the median.
Answer: A
For a negatively skewed distribution, the mode is greater than the median, which is, in turn,
greater than the mean. Below are illustrations of the relative values of the mean, median and
mode for both negatively skewed and positively skewed distributions.
Question 36 of 105
Which of the following is the most likely cause of medication errors in an acute care facility?
1. Illegible physician handwriting.

2. Systems failure.
3. Careless nurses.
4. Look-alike, sound-alike drugs.
Answer: B
Medication errors, like other patient safety incidents, are thought to be due to systems failure.
James Reason's Swiss cheese model of system accidents is discussed in the following article:
http://www.bmj.com/content/320/7237/768.full
The other answer options give factors that contribute to medication errors but "systems failure" is
the best answer.

Question 37 of 105
Which of the following tools is most useful in identifying ways to shorten nurses' walking time
from one activity to another in a hospital ward?
1. Pareto chart
2. Ishikawa diagram
3. Spaghetti diagram
4. Control chart
Answer: C
A Pareto chart is used to identify the most frequent or impactful problems or causes of problems.
An Ishikawa diagram, or cause-and-effect diagram, is a tool for identifying and organizing the
possible causes of a problem.
"The spaghetti diagram is a tool to help you establish the optimum layout for a department or
ward based on observations of the distances travelled by patients, staff or products, e.g. x-rays.
Spaghetti diagrams expose inefficient layouts and identify large distances travelled between key
steps."
A control chart is a time plot that indicates the rage of variation built into the system.
Of these four tools, a spaghetti diagram would be the most useful in this case. The spaghetti
diagram is often used with other tools and techniques, e.g. process mapping. Below is an
example of a spaghetti diagram.
the use of process analysis tools to display data (e.g. fishbone, Pareto chart, run chart,
scattergram, control chart)
Question 38 of 105
A healthcare quality professional can best display the distribution of 48 data points on waiting
times in an ambulatory care clinic using a
1. stem-and-leaf plot.
2. bar chart.
3. scatter diagram.
4. run chart.
Answer: A
A stem-and-leaf plot, or stem-plot, is a tool for presenting quantitative data in a graphical format.
Like a histogram, it provides information on the shape of a distribution. A bar chart, scatter
diagram, and run chart are not appropriate in presenting the distribution of data points.

Question 39 of 105
In team decision making, consensus means
1. a unanimous vote.
2. everyone getting what they want.
3. everyone finally comes around to the "right" opinion.
4. everyone understands the decision and can explain why it is best.
Answer: D
Consensus decision making is a search for the best decision through the exploration of the best of
everyone's thinking. As more ideas are addressed and more potential problems are discussed, a
synthesis of ideas takes place and the final decision is often better than any single idea presented
at the beginning.
Consensus does NOT mean:
 A unanimous vote
 Everyone getting what they want
 Everyone finally comes around to the "right" opinion
 Reaching a compromise
Consensus means:
 Everyone understands the decision and can explain why it's best
 Everyone can live with the decision

performance improvement teams
Question 40 of 105
A 37 year old woman who underwent mechanical aortic valve replacement was discharged on
warfarin (coumadin). The target International Normalized Ratio (INR) was 3.0–3.5. She
developed a severe pneumonia two weeks later and was readmitted to hospital, at which time her
INR was found to be 8.3.
Upon receiving a report on the elevated INR, the healthcare quality professional should first
1. inform the reporting staff member that cases of elevated INR levels need not be reported.
2. conduct root cause analysis.
3. check if the patient received predischarge medication counseling.
4. continue monitoring reports of elevated INR levels.
Answer: C
This patient's elevated INR was most likely related to her pneumonia or the medications used to
treat it before her readmission. However, a high INR is a potentially fatal and preventable
condition - it should be reported. Root cause analysis (RCA) is not appropriate in this case -
conducting RCA on all cases of elevated INR levels would not make the best use of available
resources. It is probably useful to determine whether the patient received the necessary
counseling about her discharge medications, including warfarin. This could uncover
opportunities for improvement in the predischarge medication counseling process. Data on
elevated INR levels should be collected and aggregated. However, between answer options C
and D, C is the better answer.

Question 41 of 105
Common causes of process variation refer to causes of variation that
1. are one-time occurrences.

2. occur over long periods of time and that are persistent.
3. are extrinsic to the process.
4. are more easily identified.
Answer: B
"Common causes" are chronic and persistent. Answer options A, C, and D are features of
"special causes".

Question 42 of 105
Cross-sectional studies
1. can be used to study causation.

2. measure incidence rate.
3. measure incidence risk.
4. can be conducted using a questionnaire survey.
Answer: D
For more information about cross-sectional studies, read our article on study design.

Question 43 of 105
Concerning the surgical "time-out", which of the following statements is FALSE?
1. The surgical "time-out" reduces the risk of wrong-site surgery.

2. The surgical "time-out" reduces the risk of preventable surgical mistakes other than
wrong-site surgery.
3. The surgical "time-out" is a component of the World Health Organization (WHO) Safe
Surgery Checklist.
4. The surgical "time-out" requires involvement of the patient.
Answer: D
A "time-out" just before starting a surgical procedure, to ensure the correct patient, procedure
and body part, is part of The Joint Commission's Universal Protocol and is a requirement for one
of JCI's International Patient Safety Goals (Eliminate Wrong-site, Wrong-patient, Wrong-
procedure Surgery). The surgical "time-out" reduces the risk of wrong-site surgery and other
preventable surgical mistakes, and is a component of the WHO Safe Surgery Checklist. The
"time-out" should involve the entire operative team, but not necessarily the patient (who may be
under general anaesthesia when "time-out" is performed").

safety goals into organizational activities (e.g. Joint Commission, JCI, NQF, IHI)
Question 44 of 105
Leaders of a multi-hospital system are trying to prioritize the services to introduce in the coming
year based on their impact on the community. These leaders, who work geographically apart, can
arrive at a group consensus without meeting face to face by
1. the nominal group technique.

2. the Delphi technique.
3. brainstorming.
4. a focus group.
Answer: B
Among the four answer options (in their original iterations), only the Delphi technique does not
require face-to-face meetings.
Content Category: Performance Measurement & Improvement

Tasks on the CPHQ exam content outline to which the question is linked: Lead performance
improvement teams
Question 45 of 105
Following a serious adverse event, a hospital decided to pursue a negotiated settlement. Which of
the following would most likely apply in this situation?
1. Tort liability
2. Contributory negligence
3. Contractual liability
4. Res ipsa loquitur
Answer: C
Tort liability is a sort of insurance coverage that takes effect when a court determines that
damage (in some form or other) was caused by negligence on the part of the defendant. In this
case, tort liability does not apply as it was an out-of-court settlement, i.e. it did not involve the
courts. There is no information in the question that suggests contributory negligence. Contractual
liability for negligent treatment is likely to be applicable in this case - when a patient is admitted
for care, he/she and the hospital enter into a contractual relationship. Res ipsa loquitor is not
relevant in this case.

Question 46 of 105
A hospital purchases additional malpractice insurance and general tort liability insurance prior to
introducing a pediatric heart surgery program. This is an example of
1. risk transfer.
2. risk avoidance.
3. risk reduction.
4. risk retention.
Answer: A
Risk transfer, or risk sharing, means transferring the burden of loss (or the benefit of gain) from a
risk to another party (which, in this case, is an insurer). Risk avoidance means not conducting the
activity that carries the risk. Risk reduction involves reducing the severity of the loss and/or the
likelihood of the loss occurring. Risk retention means accepting the loss, or benefit of gain, from
a risk when it occurs.

Question 47 of 105
The Chief Executive Officer of an acute care facility wishes to know the difference between
Total Quality Management (TQM) and Six Sigma.
The healthcare quality professional should inform him that
1. TQM can be implemented on its own while the benefits of Six Sigma can only be
realized when it is combined with Lean methods.
2. TQM loosely monitors progress toward goals whereas Six Sigma ensures that investment
in quality produces the expected return.
3. TQM focuses on compliance with performance standards. Six Sigma focuses on world
class performance.
4. TQM is a management philosophy whereas Six Sigma is a tool to reduce variation in a
product or process.
Answer: D
Only answer option D provides a true statement.
Six Sigma has been used successfully without Lean methods by numerous organizations.
TQM does not "loosely" monitor progress toward goals.
One of the basic principles of TQM is continuous improvement. Contrary to popular belief,
"compliance" is not a feature of TQM.

applicability of performance improvement models (e.g. FOCUS, PDCA, Six Sigma)
Question 48 of 105
The following table shows the risk-adjusted Acute Myocardial Infarction (AMI) inpatient
mortality for 10 different hospitals in 2009:
What is the benchmark risk-adjusted AMI inpatient mortality?
1. 4.7%
2. 8.2%
3. 8.5%
4. 10.4%
Answer: A
Benchmarking is based on identifying best practices. In this case, the benchmark is the lowest
AMI inpatient mortality rate, i.e. 4.7%.

Tasks on the CPHQ exam content outline to which the question is linked: Interpret
benchmarking data
Question 49 of 105
A hospitalized patient died shortly after being administered with medication intended for another
patient. Which of the following tools is most appropriate for facilitating root cause analysis?
1. Barrier analysis
2. Prioritization matrix
3. Pie chart
4. Pareto chart
Answer: A
Root cause analysis following an adverse event is commonly facilitated by a fishbone diagram,
also known as a cause-and-effect diagram or Ishikawa diagram. However, this is not one of the
answer options.
Barrier analysis is suitable for use in root cause analysis.
A prioritization matrix is often used by teams to get consensus about an issue.
Pie charts display categorical data.

Pareto charts help to identify the most frequent or impactful problems or causes of problems but
are not generally employed during root cause analysis.

coordinate risk management—root cause analysis
Question 50 of 105
In the second half of 2008, the inpatient fall rate at Hospital X was above 15 falls per 1000
patient-days. A multidisciplinary team commenced an initiative to lower the rate of inpatient
falls in February 2009. The historical average in the 10 years before 2008 was 6.6 falls per 1000
patient-days and the target for this initiative was 5.0 falls per 1000 patient-days. The results of
this improvement work are shown in the graph below.
Which of the following is the most appropriate next step?
1. Stop monitoring patient falls.

2. Continue monitoring patient falls.
3. Continue the initiative to reduce the rate of patient falls further.
4. Lower the target.
Answer: B
Patient falls are reportable events in a hospital and should therefore be tracked by the event
reporting system. Patient falls in Hospital X should continue to be monitored - this is the best
answer. It is unlikely that the improvement team can reduce the inpatient fall rate any further,
having achieved improvement beyond the target and well below the historical average. Lowering
the target, likewise, is unlikely to be beneficial.
Tasks on the CPHQ exam content outline to which the question is linked: Integrate results of
data analysis into the performance improvement process
Question 51 of 105
The dimension of quality/performance that is addressed by introducing a rapid response team in

a hospital is
1. continuity of care.
2. efficiency.
3. effectiveness.
4. prevention and early detection.
Answer: D
A rapid response team, also known as a medical emergency team, "is a team of clinicians who
bring critical care expertise to the bedside". Their primary purpose is to identify unstable patients
and those patients likely to suffer cardiac or respiratory arrest, and prevent their unnecessary
deaths.
Continuity of care refers to the degree to which healthcare is delivered in a coordinated and
seamless manner from one service to another.
Efficiency refers to the amount of resources required to achieve a desired result.
Effectiveness is "the degree to which a desired outcome is reached".
Prevention and early detection means the degree to which interventions promote health and
prevent disease. The most appropriate answer is D.

coordinate risk management: risk prevention
Question 52 of 105
In analyzing data, the healthcare quality professional can minimize the risk of interpreting noise
as if it were a signal AND minimize the risk of failing to detect a signal when it is present by
using a
1. run chart.
2. control chart.
3. specifying a target.
4. comparing data to average values.
Answer: B
Both the run chart and control chart describe or define the "voice of the process", whereas
specifications (answer options C and D) define the "voice of the customer".
The distinction between signals and noise is the foundation for every meaningful analysis of
data. It also defines two mistakes which can be made when attempting to analyze data. The first
mistake is that of interpreting random variation as a meaningful departure from the past—
interpreting noise as if it were a signal. The second mistake consists of not recognizing when a
change has occurred in a process—failing to detect a signal when it is present. This mistake is
most often found in conjunction with the specification approach to analysis. The underlying
process changes, but the values are still within the specification limits, so no one notices.
Clearly, one may avoid the first mistake by never reacting to any value as if it were a signal, but
this would guarantee many mistakes of the second kind. Likewise, one may avoid the second
type of mistake by reacting to every point as if it were a signal, but this guarantees many
mistakes of the first kind.
The control chart approach strikes a balance between the two errors. The use of control limits to
filter out the noise will minimize the occurrence of both types of errors.

Question 53 of 105
From a quality perspective, which of the following is the BEST way to control costs in
healthcare?
1. Identifying and eliminating waste.

2. Organization-wide budget cuts.
3. Temporary hiring freeze.
4. Improving customer satisfaction.
Answer: A
Past approaches to controlling costs in healthcare have included across-the-board budget cuts,
hiring/salary freezes, and even laying off of staff. However, from a quality perspective, the best
way to cut costs is by identifying and eliminating muda (waste), of which there is plenty.
Improving customer satisfaction will not directly lead to reduced costs.
Tasks on the CPHQ exam content outline to which the question is linked: Demonstrate
financial benefits of a quality program
Question 54 of 105
The odds ratio of an outcome
1. is the ratio of the number of cases to the number of non-cases in a defined population and
time period.
2. provides an approximate estimate of the risk ratio when the outcome of interest is rare.
3. is used in case-control studies only.
4. compares the number of cases in a population exposed to a suspected risk factor with the
number of cases in a population not exposed.
Answer: B
The odds ratio of an outcome compares the odds of having a particular outcome (not the number
of cases) in a population exposed to a suspected risk factor with the odds in a population not
exposed. When the outcome of interest is rare, the odds ratio is approximately equal to the risk
ratio (the "rare disease assumption"). The odds ratio is also used in cross-sectional studies.

Question 55 of 105
Which of the following tools is most appropriate for investigating the relationship between two
characteristics?
1. Scatter plot
2. Cause-and-effect diagram
3. Failure modes and effects analysis
4. Pareto chart
Answer: A
Of the four answer options, a scatter diagram is the most appropriate tool to evaluate the
relationship between two variables. Cause-and-effect diagrams help to identify and organize the
possible causes of a problem in a structured format. Failure modes and effects and analysis is
used to anticipate possible process or product failures and the risks associated with these failures.
A Pareto chart is used to identify the most frequent or impactful problems or causes of problems.
Question 56 of 105
Updated guidelines to prevent falls in the elderly state that patients with no evidence or history of
gait problems or recurrent falls do not require a fall risk assessment. In this case, asking older
patients if they have fallen recently or if their gait is unsteady is a form of
1. surveillance.
2. screening.
3. diagnosis.
4. monitoring.
Answer: B
Surveillance, like monitoring, refers to an ongoing activity to detect changes in trends or

distribution of a disease or behaviours leading to an increased risk of a disease/outcome, with the
aim of facilitating disease/outcome control. The activity in this case is not ongoing (for any
particular individual) and therefore cannot be called surveillance or monitoring.
Screening is a method used to detect a disease/condition in individuals without overt signs or

symptoms of that disease or condition. In this case, the condition is an increased risk of falls.
Diagnosis is the "identification of the nature and cause of anything". In this case, the "diagnosis"
of increased falls risk has not yet been made; otherwise there would no longer be a need for
further fall risk assessment.

coordinate risk management: risk prevention
Question 57 of 105
In an improvement project to reduce the wait times in an Emergency Room, the time taken to be
assessed by a physician is
1. a process measure.
2. an outcome measure.
3. a structure measure.
4. not a suitable measure.
Answer: A
In reducing wait times in an Emergency Room, one of the key steps is to reduce the door-to-
physician time. It is, therefore, a process measure. It is not an outcome measure because
physician assessment is only one of the steps in the process that will lead to the final outcome -
discharge from the Emergency Room (to a bed in the hospital, home or other facility).

Question 58 of 105
Overall responsibility for an improvement project lies with the
1. Facilitator.
2. Sponsor.
3. Team Leader.
4. Team Members.
Answer: B
The Sponsor/Champion maintains overall responsibility, authority, and accountability for an

improvement project.

Tasks on the CPHQ exam content outline to which the question is linked: Identify
champions (e.g. process owners, quality, patient safety)
Question 59 of 105
In improvement work, a constraint is
1. a factor that will prevent the team from achieving its goal.
2. a factor that can be easily changed.
3. a factor that will limit the options the team can realistically consider.
4. a factor that is not easily changed but changing it will help the team's progress.
Answer: C
A constraint is an unchangeable factor that will limit the options the team can realistically
consider. Examples of real constraints are:
 Available budget
 Written or unwritten rules (sacred cows or taboos)
 Present technical ability of Team Members and other involved parties
 Factions, rivalries, or ongoing issues between individuals or groups

Question 60 of 105
A team was involved in an initiative to improve care for acute myocardial infarction (AMI) in an
acute care facility from January 2008 to September 2009. Some of the data collected are shown
in the two graphs below.
Upon reviewing the data in October 2009, the Director of Quality should recommend
1. closure of the initiative to improve AMI care.
2. further monitoring of the data.
3. a celebration of the team's achievement.
4. the data be reviewed.
Answer: D
From time to time, data might appear highly implausible, as in this case. The data suggest no
improvement in the early administration of aspirin from January 2008 - July 2009, and perhaps
some improvement in the AMI inpatient mortality rate from mid 2009. However, it is very
unlikely that the early administration of aspirin reached 100% for the last two (consecutive)
months, i.e. August and September 2009, so dramatically (i.e. relative to prior performance).
Likewise, it is highly improbable that the AMI inpatient mortality rate was zero for two
consecutive months, given the past data.
Such data warrant a review, preferably by an independent party. I recently came across similar
data in a hospital (not one of our clients) that was expecting its next JCI on-site survey in less
than a month! The latter could have explained the sudden and dramatic improvement in the data
(which was unlikely to reflect true performance).

Tasks on the CPHQ exam content outline to which the question is linked: Analyze/interpret
performance/productivity reports
Question 61 of 105
On a rheumatology ward of a hospital, a nurse accidentally administered 20 mg of methotrexate

to a patient instead of the prescribed 7.5mg. When interviewed later, the nurse explained that she
was accustomed to administering 20 mg of methotrexate to patients on the ward and that she was
extremely busy on the morning that she committed the error.
This is an example of a
1. slip.
2. lapse.
3. knowledge-based error.
4. rule-based error.
Answer: A
Slips relate to observable actions and are commonly associated with attentional or perceptual
failures. Lapses are internal events that generally involve failures of memory. Both slips and
lapses are errors in the performance of skill-based behaviours, typically when attention is
diverted. Knowledge-based errors occur when solving novel problems—this might occur in an
inexperienced or junior professional or someone with a "biased memory". Rule-based errors
occur when the wrong rule is applied for a given situation, e.g. choosing the wrong arm of a
clinical algorithm.

Question 62 of 105
According to the Law of Diffusion of Innovations, the highest rate of rise in innovation diffusion
occurs among the
1. innovators.
2. early adopters.
3. early majority.
4. late majority.
Answer: C
According to the Diffusion of Innovation theory, the adopter categories are:
 innovators
 early adopters
 early majority
 late majority
 laggards
The rates of adoption for innovations are determined by an individual’s adopter category. As
illustrated in the graph below, the rate of rise in innovation diffusion is highest among the early
majority (represented by the steepest part of the S-shaped cumulative frequency distribution
curve).
Question 63 of 105
A team is evaluating a new screening questionnaire to anticipate delayed discharge from hospital
following hip replacement surgery. The following table shows the results of using the tool:
What is the negative predictive value of the screening tool?
1. 0.33
2. 0.50
3. 0.66
4. 0.75
Answer: D
The negative predictive value (NPV) is the proportion of patients with a negative test result who
do not have the outcome of interest.
NPV = 60/(20 + 60) = 60/80= 0.75

Tasks on the CPHQ exam content outline to which the question is linked: Interpret outcome
data
Question 64 of 70
A healthcare professional has been consulted to evaluate the average monthly waiting time at an
orthopaedic clinic over the past 15 months. Which of the following charts indicate that waiting
time is NOT potentially "out of control"?
1. Chart A
2. Chart B
3. Chart C
4. Chart D
Answer: C
Applying Nelson Rules, only Chart C does not meet any of the 8 rules. Chart A has two out of
three points in a row that are more than 2 standard deviations from the mean in the same
direction. Chart B has fifteen points in a row all within 1 standard deviation of the mean on
either side of the mean. Chart D has nine points in a row on the same side of the mean.

Question 65 of 105
The Quality Manager of a hospital is using Nelson rules to determine whether the rate of sharps
injuries is out of control. After reviewing the data, she realizes that one "rule" is missing and
proceeds to include it in her analysis. In doing so, she increases the risk of a
1. Type I error
2. Type II error
3. Standard error
4. Sampling error
Answer: A
Nelson rules are used to determine if some measured variable is out of control. Selecting rules
once the data have been reviewed increases the risk of a “false positive”, i.e. concluding that
there is special-cause variation when in truth there is none. This is a Type I error. A Type II
error, in this context, occurs when one concludes there is no special-cause variation when in truth
it exists. "The standard error of a method of measurement or estimation is the standard deviation
of the sampling distribution associated with the estimation method." Sampling is not relevant in
this case.

Question 66 of 105
Which of the following is an example of a continuous variable?
1. Hospital admissions in year 2009.

2. Hepatitis carrier status of women attending an antenatal clinic.
3. Rates of adverse events as detected by the IHI Global Trigger Tool.
4. Customer satisfaction as measured on a five-point rating scale.
Answer: C
A continuous variable is "a variable that can take on any of a range of values", e.g. height,
weight, time.
The rate of adverse events is a continuous variable—it can take on almost any value, e.g. 40.1
adverse events/1000 patient-days, 40.2, 40.3,... 41.0, 41.1, etc.
The number of hospital admissions can take on a finite number of values, e.g. 1500, 1501, 1502,
etc. (and not 1500.1, 1500.2,... ), and is therefore a discrete variable.
Hepatitis carrier status is a binomial variable: carrier or non-carrier.
A 5-point rating scale is an example of a categorical variable because responses can take only
one of a finite number of values, e.g. Excellent, Good, Average, Below Average, Poor.

coordinate data definition activities
Question 67 of 105
Salaries are included in the
1. operating budget.
2. capital budget.
3. cash budget.
4. ongoing budget.
Answer: A
There are three kinds of budgets: operating budget, cash budget, and capital budget. Salaries are
included in the operating budget.

Tasks on the CPHQ exam content outline to which the question is linked: Participate in
developing and managing a budget for a department
Question 68 of 105
In strategic planning, critical success factors
1. define specific strategic end points toward which activity is directed to achieve the
organization's mission and vision.
2. define the organization's aspirations for the future.
3. are things that must be done for an organization to remain viable.
4. are things that must be accomplished for an organization to achieve its goals.
Answer: D
Answer option A describes the organization's goals. Answer option B describes the
organization's vision statement. Between options C and D, the latter is the better answer.

organization-wide strategic planning
Question 69 of 105
In 2009, Hospital A reported the following figures:
What is the incidence rate?
1. 7.1 deaths/1,000 admissions

2. 7.1 deaths/1,000 patient-days
3. 24.2 deaths/1,000 admissions
4. 24.2 deaths/1,000 patient-days
Answer: B
The incidence rate is the number of new cases per population in a given time period. In this case,
the denominator is the sum of the person-time of the "at-risk" population (number admissions ×
ALOS). Read our article "Measures of Occurrence".

Question 70 of 105
Which of the following are measures of dispersion?

1. Mean, mode, median
2. Correlation, regression, t-test
3. Distribution, analysis of variance, and dispersion factor
4. Range, standard deviation, variance
Answer: D
The range is the simplest measure of dispersion. The variance and standard deviation are
commonly used measures of dispersion.

statistical techniques to describe data
Question 71 of 105
"From a sample of 300 patients, the estimated rate of patient falls in Hospital A is 7.2 falls per
1,000 bed-days with a 95% confidence interval ranging from 6.75 to 7.65 falls per 1,000 bed-
days."
Which of the following statements about the confidence interval is correct?
1. The 95% confidence interval will contain the true overall patient fall rate in Hospital A
95% of the time.
2. We are 95% confident that the true overall patient fall rate in Hospital A lies within this
interval.
3. The 95% confidence interval is an interval containing 95% of the distribution of the
hospital's patient population.
4. The 95% confidence interval indicates the rate at which 95% of the patients in Hospital A
fall.
Answer: B
As discussed in our article on inference from a sample mean, the confidence interval is an
interval around the estimated mean which we can be confident contains the true population
mean. In this case, the population is all the patients in Hospital A.

Question 72 of 105
Which of the following bodies is ultimately responsible for credentialing in a hospital?

1. Chief Executive Officer
2. Chief Medical Officer
3. Governing Body
4. Credentialing Committee
Answer: D
In almost all healthcare organizations, particularly in the USA, a Credentialing Committee makes
the final decision(s) on credentialing.

credentialing and privileging process
Question 73 of 105
In a large tertiary hospital, 10.3% of a general surgeon's cases in the last 3 months were
associated with surgical site infections. The average surgical site infection rate for the other
general surgeon's was 4.8%. Working closely with the Chief Medical Officer, the healthcare
quality professional should
1. compare the hospital's overall surgical site infection rate with local and national data.
2. examine the surgeon's case-mix, risk-adjusted outcomes and practice patterns.
3. refer the surgeon's cases for peer review.
4. compare the surgeon's surgical site infection rate with that of surgeons in other
specialties.
Answer: B
The most appropriate course of action is to determine if the surgeon's SSI rate is consistent with
past practice and also if his cases in the last quarter carried an increased risk - more complex,
clean/clean-contaminated, co-existing diseases such as diabetes mellitus, etc. If the data indicate
an issue in the surgeon's practice, then his cases should be referred to a peer review body.
Comparing the hospital's data with local and national data will not help in this case. A
comparison between the surgeon's SSI rate and that of surgeons in other specialties is not
appropriate due to the likely difference in risk.

Question 74 of 105
Root cause analysis following a sentinel event will probably require a

1. flow chart.
2. Gantt chart.
3. force field analysis chart.
4. control chart.
Answer: A
All root cause analyses will need a thorough understanding of the actions/conditions/materials in
the process that led to the sentinel event. The best way to achieve this and to document the series
of steps is with a flow chart. The other answer choices are not appropriate: Gantt charts are used
in project management, a force field analysis chart may be used in group dynamics and action
research, and the control chart is a popular statistical tool.

coordinate risk management (root cause analysis)
Question 75 of 105
Compared with its previous version, the Procedure Coding System (PCS) of the tenth edition of
the International Classification of Diseases (ICD) standards describes procedures in greater detail
and thus improves
1. sensitivity.
2. specificity.
3. reliability.
4. precision.
Answer: B
For an explanation of the answer, read our article on statistics for diagnostic tests.

Tasks on the CPHQ exam content outline to which the question is linked: Interpret data to
support decision making
Question 76 of 105
In a facility which allows verbal/telephone orders, a nurse is asked to take a telephone order for
the sedative medication Zoplicone to help a patient with insomnia. The nurse should
1. ask the physician to write the order himself before she administers the medication as it is
not an emergency.
2. record the order word-for-word on the medication order sheet, read back the order and
get confirmation from the physician who gave the order.
3. ask another nurse to take the order.
4. record the order word-for-word on the order sheet, ask another nurse to verify it is
correct, and then administer the medication to the patient.
Answer: B
In general, the correct procedure for taking a verbal/telephone order is outlined in the second
answer choice (B). If the nurse has difficulty understanding the order, she should ask another
nurse to listen in as the first nurse takes the order, after which the second nurse should read it
back and sign the order as well. This was a National Patient Safety Goal of The Joint
Commission (USA) and is one of JCI's International Patient Safety Goals.

Tasks on the CPHQ exam content outline to which the question is linked: Integrate
accreditation and regulatory recommendations into the organization
Question 77 of 105
The rate of sharps injuries in Hospital X is shown in the chart below:
Which of the following steps should the healthcare quality professional take?
1. Educate the staff in Hospital X on sharps injuries prevention.

2. Review the policies and procedures for the handling of sharps injuries in Hospital X and
revise them if necessary.
3. Continue to monitor the rate of sharps injuries.
4. Conduct drill-down analysis of sharps injuries in Hospital X.
Answer: C
The chart above is a run chart, commonly used in healthcare organizations. Following the
"trending rules" described in our article on using run charts, no real trend is present. Therefore,
the most appropriate action is to continue monitoring sharps injuries in the hospital.

Question 78 of 105
Which of the following strategies is MOST effective in achieving widespread adoption of a new
electronic medical record system?
1. Convincing respected members of the medical staff to adopt the system.

2. Require all salaried staff to use the system first.
3. Institute financial penalties for not using the system.
4. Implementing the system in phases, starting with the most essential features.
Answer: A
Of the four answer options, widespread adoption of the new EMR system is most likely to occur
with its early use by respected members of the medical staff. Read our article on diffusion of
innovation for more tips on how to spread new technologies.

Question 79 of 105
In developing a patient safety training program, the healthcare quality professional must first
1. develop instructional objectives.

2. assess trainees' needs.
3. prepare training materials.
4. develop a pre- and post-test to assess knowledge of the subject.
Answer: B
The first step in most models for training development is an analysis of trainees' needs.
Tasks on the CPHQ exam content outline to which the question is linked: Develop
organizational performance improvement training (e.g. quality, patient safety)
Question 80 of 105
In your capacity as Director of Quality and Patient Safety, you are asked to develop a budget for
the quality management department. Because you anticipate growth of this department in the
coming year, you included the cost of new furniture and equipment, estimated at $5000.
Under which type of budget would your department's new furniture and equipment fall?
1. Operating Budget
2. Capital Budget
3. Fixed Budget
4. Master Budget
Answer: B
In general, furniture and equipment that cost more than $1000 - $2000 are classified under the
organization's Capital Budget. Costs of about $5000 in most healthcare organizations will be
treated as a capital budget expense.

developing and managing a budget for a department
Question 81 of 105
Concerning control charts, each of the following statements is true EXCEPT:
1. The standard error is calculated.

2. Control charts are used to evaluate whether or not a process is in a state of statistical
control.
3. The upper and lower control limits are drawn only at 3 standard errors from the center
line.
4. Control charts may be divided into zones.
Answer: C
Our article on control charts describes their key features. The control limits need not be drawn at
3 standard errors; they could (for example) be drawn at 2 standard errors from the center line.
Question 82 of 105
A suspicious death after surgery occurred in a prestigious hospital. Initial reports suggested that
post-operative nurses might have misread physician orders for intravenous fluids. Senior
management had concerns about litigation and adverse publicity.
In making rapid decisions, the Chief Executive Officer of the hospital should adopt a leadership
style that is
1. participatory.
2. consultative.
3. autocratic.
4. democratic.
Answer: C
This question describes a crisis. An autocratic leadership style is the most appropriate in crises.

Question 83 of 105
A 35 year old man presented to the Emergency Room with diabetic ketoacidosis, a life-
threatening complication of diabetes mellitus. The patient's diabetes had been undiagnosed
previously. Discharge planning should begin
1. at the time of admission to the hospital.

2. after the patient's medical condition stabilizes and he is transferred from the Intensive
Care Unit to a medical ward.
3. after the physician writes the discharge planning order.
4. two days before the expected date of discharge.
Answer: A
In general, discharge planning should commence as soon as the patient is admitted.

Tasks on the CPHQ exam content outline to which the question is linked: Coordinate the
performance improvement process
Question 84 of 105
A patient with no prior history of major medical problems was admitted for an elective
cholecystectomy. On the second postoperative day, the patient started to experience pain at the
operative site and high fevers. Blood cultures were positive for Escherichia coli and other
investigations confirmed the presence of a surgical site infection. The patient died of
overwhelming septicaemia in the Intensive Care Unit 7 days after his operation.
From a quality standpoint, this case is best classified as a
1. clinical mishap.
2. adverse event.
3. never event.
4. sentinel event.
Answer: D
In general, The Joint Commission, JCI and many other agencies consider healthcare-associated
infection associated with a death or permanent disability as a sentinel event.
A healthcare-associated infection is an "adverse event" but the CPHQ exam requires you to
select the best answer choice. In this case, the best answer is "sentinel event."
This is not a case of medical or clinical mishap, which occurs when "injury or damage is caused
by mischance or accident, unexpected and undesigned".
The National Quality Forum's list of "Never Events" are grouped into six categories: surgical,
product or device, patient protection, care management, environmental, and criminal. The
incident described in this question does not meet the description of any of these "never events".

Question 85 of 105
The Emergency Department of Hospital X sees an average of 200 patients per month for the
management of acute chest pain. The department plans to conduct a retrospective chart review to
determine the compliance with a protocol for managing chest pain. In reviewing the charts of
patients seen in the department in Year 2009, an appropriate size of a randomly selected sample
is
1. 50.
2. 70.
3. 100.
4. 200.
Answer: B
The total number of cases for the year was 200 × 12 = 2400. As indicated by The Joint
Commission guidelines for sampling, the most appropriate sample size is 70. This number of
charts is sufficient to give the department staff the answer they are seeking. A smaller number
will not give adequate precision while a much larger number will be excessive and therefore
waste resources.

coordinate data collection methodology
Question 86 of 105
The senior management team of Hospital Z is reviewing data from several initiatives aimed at
improving the inpatient mortality rate from several conditions. The data is summarised in the
table below.
In order to prevent the highest possible number of deaths from these conditions, for which two
conditions should the hospital implement evidence-based care bundles (proven to reduce
mortality) in the coming year?
1. Acute Myocardial Infarction and Asthma.

2. Asthma and Surgical Site Infections.
3. Community-Acquired Pneumonia and Surgical Site Infections.
4. Ventilator-Associated Pneumonia and Surgical Site Infections.
Answer: C
To answer this question, several assumptions have to be made (as in many other decision-making
scenarios), e.g. all other factors that contribute to inpatient mortality remain the same. The
overall impact of the initiatives is measured by the product of the number of cases and the
magnitude of effect of the interventions. You should be aware that hospitals are implementing
bundles of care to improve survival outcomes for all the conditions above. The benchmark
figures can be assumed to be the best in the industry, which gives us the potential change in
effect. Note that this hospital outperformed the benchmark for two conditions - the hospital
should prioritise its improvement initiatives on other conditions to get the best return, which is
survival in this case. The table below shows you the calculations involved to derive the correct
answer.

establishment of priorities for process improvement activities
Question 87 of 105
A 45 year old patient died in the Surgical Intensive Care Unit overnight after receiving
medication intended for another patient. The Crisis Management Team is most effective if it is
chaired by the
1. Chief Executive Officer

2. Head of the Department of Intensive Care
3. Director of Quality & Patient Safety
4. Chief Pharmacist
Answer: A
The Crisis Management Team following a serious clinical adverse event is most effectively led
by the Chief Executive Officer. For more information, read the IHI White Paper on "Respectful
Management of Serious Clinical Adverse Events".

assessment and development of the organization’s patient safety culture
Question 88 of 105
The Board and Chief Executive Officer have renewed their commitment to improving quality in
Hospital X. Your primary role as the Director of Quality & Patient Safety should be
1. Data Consultant.
2. Team Leader.
3. Facilitator.
4. Quality Champion.
Answer: C
In the ideal situation, the healthcare quality professional facilitates performance improvement in
an organization by acting as a coach/internal consultant. The other roles listed above may also
apply but they should not be the primary responsibility of the healthcare quality professional.

Question 89 of 105
As the Director of Quality, you have recommended the engagement of an external healthcare
quality consultant to fill some gaps in knowledge and time.
In selecting an external consultant, which of the following has the LEAST impact on your
decision?
1. Reputation of the consulting firm.

2. Reputation of the consultant(s) in the consulting firm.
3. Recommendations of previous clients.
4. Budget.
Answer: A
When working with consultants, it is important to choose the right consultant for the job, i.e. one
who is able to deliver on time and on budget. In general, a reputable firm is desirable but you are
hiring the expertise of the firm, i.e. the people in the firm. You should seek recommendations
from previous clients. Your budget also plays a large part in whom you decide to engage.

Tasks on the CPHQ exam content outline to which the question is linked: Monitor the
activities of consultants (e.g. quality and patient safety)
Question 90 of 105
In implementing a care bundle for the management of acute myocardial infarction, the recording
of the extent to which smoking cessation counseling is provided is a measure of
1. structure.
2. process.
3. outcome.
4. process and outcome.
Answer: B
To learn more about structure, process and outcome measures, read our article on Assessing
Quality of Care: Structure, Process, and Outcome.

Question 91 of 105
Transparent communication with patients and families after a serious clinical adverse event
1. reduces patient satisfaction.

2. increases the risk of litigation.
3. improves patient satisfaction but increases the risk of medico-legal claims.
4. improves patient satisfaction and reduces the risk of medico-legal claims.
Answer: D
Recent research indicates that disclosure and apology (when appropriate) following serious
unanticipated clinical outcomes improve patient satisfaction and reduce the risk of medico-legal
claims.

Question 92 of 105
For which of the following scenarios would an uncontrolled before-and-after evaluation design
be most appropriate?
1. Evaluating the effectiveness of a one-day training course for nurses on infection
prevention and control.
2. Evaluating the effectiveness of a four-week educational program for nurses to prevent
back injury.
3. Evaluating the effectiveness of a training program for nurses to prevent patient slips and
falls after an unusually high rate of patient falls in the preceding 12 months.
4. Evaluating the effectiveness of an Acute Myocardial Infarction (AMI) care bundle in
reducing inpatient AMI mortality.
Answer: A
The before-and-after evaluation design, common in healthcare quality improvement work, is

exposed to several threats to (internal) validity. This design is most useful in demonstrating the
immediate impacts of short-term programs, such as a one-day training course, i.e. with a pre-test
and a post-test (provided the two are not identical and the answers to the post-test are not given
to the group during the training). Over a four-week program (answer option B), it is more likely
that other factors contribute to the outcome while the intervention of interest is administered, i.e.
threats to internal validity. Answer option C is not the best answer because the post-training
result may be affected by "reversion-to-the-mean". In other words, a period of higher-than-
average fall rates is likely to be followed by a period of lower rates. Therefore, we cannot be sure
if any observed improvement in the patient fall rate is due to the intervention or by other factors.
Likewise, the results of measuring the effectiveness of an AMI care bundle in reducing the AMI-
related death rate may be confounded. For this reason, it is often useful to compare your
organization's data with those of organizations in the same community.

effectiveness of performance improvement training
Question 93 of 105
The Model for Improvement, developed by Associates in Process Improvement,
1. is identical to the PDSA cycle.

2. may be applied in only a limited number of clinical areas.
3. may replace Lean Six Sigma that an organization is using.
4. is used to accelerate improvement.
Answer: D
The Model for Improvement consists of two parts:
 A "Thinking Part", and

 A "Doing" Part", which is the PDSA cycle.
This tool has been successfully applied in many different clinical settings to accelerate
improvement. However, it is not meant to replace existing improvement methodologies.
Read our article on the Model for Improvement for more information.

Question 94 of 105
After a comprehensive review of the benefits and risks, a hospital's Board of Directors decided to
cease the oncology service within the next 6 months. This is an example of
1. risk avoidance.
2. risk prevention.
3. risk shifting.
4. risk financing.
Answer: A
In the field of risk management, risk control includes risk avoidance, risk prevention and risk
shifting.

Question 95 of 105
A patient diagnosed with hepatocellular carcinoma is receiving a novel chemotherapeutic agent

based on promising preliminary data from clinical trials and the absence of other viable treatment
options. The dimension of quality for which the medication was chosen is its
1. efficacy.
2. effectiveness.
3. safety.
4. appropriateness.
Answer: A
Efficacy refers to the medicine's capacity to produce a desired effect.
Effectiveness is the degree to which the desired outcome is achieved.

Safety, in this context, refers to the extent to which the risks of taking the medication are
reduced.
Appropriateness refers to the degree to which the care provided is relevant to the patient's
clinical needs.

Question 96 of 105
As the Director of Quality & Patient Safety, you introduced the Institute for Healthcare
Improvement (IHI)) Global Trigger Tool for measuring adverse events about 2 months ago. You
now intend to present data collected using this tool to the hospital's Board of Directors, most of
whom are laypersons. Which of the following measures will you choose to present your
findings?
1. Adverse events per 1,000 patient-days

2. Adverse events per 100 admissions
3. Adverse events per 1,000 admissions
4. Percent of admissions with an adverse event
Answer: D
One of the most important responsibilities of a healthcare quality professional is to communicate

data to a variety of people. In this case, "percent of admissions with an adverse event" will be
most easily understood by laypersons. See Page 13 of the white paper on the IHI Global Trigger
Tool for Measuring Adverse Events for more information.

Tasks on the CPHQ exam content outline to which the question is linked: Coordinate the
dissemination of performance improvement information within the organization
Question 97 of 105
Healthcare workers should perform hand hygiene
1. before entering a patient's room.

2. before entering a patient's room and again immediately before touching a patient.
3. after touching a patient's bedside table.
4. after leaving a patient's room.
Answer: C
Every healthcare quality professional is expected to know common clinical processes. These
include processes in infection control and medication management. Not surprisingly, the CPHQ
exam will include some questions that appear to be "clinical" and not really related to quality
management. Answering such questions may be straightforward to those with plenty of clinical
experience but challenging for others.
The question above addresses the indications for the use of hand hygiene. Hand hygiene should
be performed:
 Immediately before touching a patient (close to the site of care to avoid recontamination)
or when entering a "patient zone", i.e. the patient and his/her immediate surroundings.
 Just after touching a patient and before touching any object located outside the patient
zone.
 After touching objects located in the vicinity of the patient. (Answer option C for the
question above.)
 Immediately before touching non-intact skin.
 Before manipulating invasive devices
 After contact with body fluids, mucous membranes, nonintact skin, or wound dressings—
even in the absence of visible soiling and even when gloves have been used.
This video on hand hygiene provides an excellent synopsis of hand hygiene.
Answer option C is the best answer.

process of infection control processes
Question 98 of 105
The performance improvement model adopted by any healthcare organization should include all
of the following, EXCEPT
1. a focus on prioritized areas.

2. the PDCA cycle.
3. use of statistical and analytical tools.
4. action for improvement.
Answer: B
The PDCA cycle is merely one of many different performance improvement models, and may
not be applicable in all healthcare organizations. The other characteristics listed are common to
all models.
applicability of performance improvement models (e.g. FOCUS, PDCA, Six Sigma)
Question 99 of 105
Effective quality management in healthcare requires leaders who are
1. well-respected clinicians.
2. department chairs.
3. committed to the organization's mission, vision and values.
4. members of the Quality Council.
Answer: C
Effective leaders in healthcare quality first and foremost demonstrate a commitment to the
mission, vision and values of the organization.
Content Category: Management and Leadership.

development of leadership values and commitment
Question 100 of 105
Which of the following is the most effective way to prevent accidental intravenous
administration of epidural bupivacaine (a local anaesthetic) due to epidural catheters being
inadvertently attached to intravenous lines?
1. Redesigning epidural catheters so that they cannot be attached to an intravenous line.

2. Regular reminders to doctors and nurses to be careful when administering epidural
bupivacaine.
3. Affixing stickers that state epidural catheters are for epidural use only.
4. Training of doctors and nurses.
Answer: A
Redesign of epidural catheters so that they cannot be attached to an intravenous line offers the
best chance of overcoming human error, therefore preventing accidental attachment of epidural
catheters to intravenous lines.

Question 101 of 105
Following a non-fatal overdose of intravenous heparin (a blood thinner) in a 43 year old man in a
cardiac care unit, which of the following is LEAST like to prevent the occurrence of a similar
event?
1. Requiring an additional member of the clinical team to check all intravenous

administrations of heparin.
2. Taking disciplinary action against any nurse found to have administered an incorrect dose
of medication.
3. Introducing a combined heparin order form and documentation tool.
4. Encouraging low molecular weight heparin (administered subcutaneously) in lieu of
intravenous heparin.
Answer: B
Answer options A, C, and D give methods that have the potential to reduce adverse events.
Answer option B offers an action that is common among hospitals but is erroneous for at least
two reasons—the practice of modern patient safety emphasizes a non-punitive (or just)
healthcare system and a focus on system (rather than individual) failures, among other things.

safety findings into governance and management activities (e.g. bylaws, administrative policies,
and procedures)
Question 102 of 105
Which of the following is a healthcare-associated infection?
1. A patient who was admitted for the treatment of acute myocardial infarction and who had
three positive urine cultures all isolating Pseudomonas aeruginosa. The patient did not
have an indwelling urinary catheter.
2. A patient who was admitted with fever and cough, and was diagnosed with severe
Pseudomonas aeruginosa pneumonia.
3. Cytomegalovirus infection in a newborn that was diagnosed 36 hours after birth.
4. A 65-year old man who was admitted for elective bowel surgery and developed shingles
48 hours after his operation.
Answer: A
Only the first answer option meets the criteria for a healthcare-associated infection, in particular
asymptomatic bacteriuria.
process of infection control processes
Question 103 of 105
A healthcare quality professional is conducting a study to examine the relationship between

cigarette smoking and unanticipated admission to the Intensive Care Unit (ICU). All patients
were categorised as being current smokers or non-smokers (the latter category included ex-
smokers). The patients were also categorised as having been admitted to the ICU unexpectedly
or not.
Assuming the expected value in any category is greater than 20, the most appropriate statistical
test is the
1. t-test
2. z-test
3. chi-squared test
4. eye-ball test
Answer: C
The chi-squared test is often used to conduct tests of hypothesis that involve data presented in a 2
× 2 contingency table.

Question 104 of 105
On which of the following is internal benchmarking most dependent?
1. Validity
2. Sensitivity
3. Reliability
4. Accuracy
Answer: C
Internal benchmarking is the process by which an organization compares performance of various

units and identifies best practices for dissemination within the organization.
In this case, validity and accuracy mean the same thing, i.e. the degree of closeness of a
measurement to the true (actual) value.
Sensitivity, in statistics, refers to the proportion of patients with the disease/condition detected by
a positive test.
In statistics, reliability is "the consistency of a set of measurements or of a measuring instrument,

often used to describe a test". The term is analogous to precision.
For internal benchmarking, reliability is important to derive meaningful conclusions due to the
need for comparison. On the other hand, validity, accuracy and sensitivity are all desirable but
not essential for internal benchmarking.

Tasks on the CPHQ exam content outline to which the question is linked: Assist in
developing objective performance measures/indicators
Question 105 of 105
A laissez-faire leadership style
1. is preferred in Total Quality Management (TQM).

2. involves the leader/manager providing regular feedback to let employees know how well
they are doing.
3. involves no decisions by the leader/manager.
4. involves the leader/manager presenting a tentative decision, receiving feedback from the
group, and then making the final decision.
Answer: C
In a laissez-faire style of leadership, no limits are set and no decisions are made by the
leader/manager.
Answer options A, B and D give false statements about a laissez-faire leadership style.

Tasks on the CPHQ exam content outline to which the question is linked: Identify the
appropriate team structure (e.g. cross functional, self-directed)

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CPHQ Exam Practice

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CPHQ Exam Practice Quiz

Congratulations - you have completed CPHQ Exam Practice Quiz.

The benefits of studying a process include all of the following EXCEPT

1. arriving at a common understanding.

Benefits of studying a process include the following:

 Arriving at a common understanding. When Team Members work through the

Studying a process does not directly lead to the elimination of errors.

Content Category: Performance Measurement and Improvement

The healthcare professional should

1. conduct root cause analysis.

Content Category: Patient Safety

Which of the following is the most accurate interpretation of the results?

1. The prevalence of healthcare-associated infections in 2010 is significantly lower than that

Content Category: Information Management

Content Category: Performance Measurement and Improvement

Content Category: Performance Measurement and Improvement

1. Users' need for customized graphs and tables.

Content Category: Information Management

1. Number of new patient visits.

As another example, if you were involved in a project to prevent venous thromboembolism

Content Category: Performance Measurement and Improvement

A licensed independent practitioner with admitting privilege at a hospital must

1. be a fully licensed physician.

Content Category: Performance Measurement and Improvement

Content Category: Management and Leadership

Content Category: Information Management

Content Category: Performance Measurement and Improvement

Content Category: Performance Measurement and Improvement

Content Category: Performance Measurement and Improvement

Content Category: Information Management

The primary role of the healthcare quality professional in this case is

1. to assist in the criminal prosecution of the alleged perpetrator.

Content Category: Patient Safety

The chart below shows the overall inpatient mortality at a hospital.

Based on the data, the healthcare quality professional should

Content Category: Information Management

Which of the following measures is most appropriate to determine whether there is an

This is an example of a case-control study. As discussed in our article on overview of study

1. Simple random sampling

Content Category: Information Management

One of the aims in the treatment of severe community-acquired pneumonia is to maintain an

1. process and outcome measure.

Content Category: Performance Measurement and Improvement

Senior leaders of an organization can promote quality by

Content Category: Management and Leadership

The chart below shows the rate of Cesarean Sections in a hospital.

The healthcare quality professional should

1. continue monitoring the monthly rates of Cesarean Sections.

Content Category: Patient Safety

Content Category: Information Management

1. the leader attempts to sell his/her decisions to the group.

Content Category: Management and Leadership

Content Category: Performance Measurement and Improvement

The healthcare quality professional concluded that there is a

Content Category: Information Management

Clinical decision support software is an example of

Content Category: Patient Safety

The main purpose of performance improvement in healthcare is to

1. improve patient outcomes.

A general definition of performance improvement is "a planned, systematic, organizationwide

Content Category: Management and Leadership

Content Category: Management and Leadership

1. Lack of understanding of Lean Six Sigma.

Content Category: Management and Leadership