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examination handbook
January 2009
CPHQ Examination
Program Administered by the
Healthcare Quality Certification Board of
the National Association for Healthcare Quality
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
CPHQ T H E MA R K O F DI S TIN C TION IN H EA LT H C A R E Q U A L IT Y
Statement of Nondiscrimination
The certification examination is offered to all eligible candidates,
regardless of age, gender, race, religion, national origin, marital
status or disability. Neither the HQCB nor AMP discriminates on
the basis of age, gender, race, religion, national origin, marital
status or disability.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
g e n e r a l i n f o r m at i o n
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
CPHQ pr o g r a m o v e rv i e w
Definition of the Quality Each successful candidate will receive a certificate that is suitable
for framing, identification card, CPHQ pin and recertification
Management Professional information approximately 6-8 weeks after completing the
The practice of quality management occurs in all healthcare
examination.
settings, is performed by professionals with diverse clinical and
non-clinical educational and experience backgrounds, and
involves the knowledge, skills and abilities needed to perform Recertification
the tasks significant to practice in the CPHQ examination content Following successful completion of the certification examination,
outline. (Refer to the Examination Content Outline found later in the CPHQ is required to maintain certification by fulfilling
this Handbook.) continuing education (CE) requirements, which are reviewed and
established by the HQCB annually. The current requirements
include obtaining and maintaining documentation of thirty (30)
A Certified Professional in CE hours over the two-year recertification cycle and payment of
Healthcare Quality (CPHQ) is ... a recertification fee. All continuing education must relate to areas
covered in the most current examination content outline. Current
an individual who has passed the HQCB’s accredited,
employment in the quality management field is not required
international examination, demonstrating competent
to maintain active CPHQ status. The process for obtaining
knowledge, skill and understanding of program development
recertification is described in the Recertification Handbook, which
and management, quality improvement concepts,
is provided to each CPHQ upon initial certification and at the
coordination of survey processes, communication and
beginning of each subsequent recertification cycle.
education techniques, and departmental management.
Eligibility Requirements
The examining board’s goal is to produce examinations that test In 2003, the Board of Directors of the Healthcare Quality
generic concepts that can be applied to any healthcare setting Certification Board (HQCB) voted to eliminate the minimum
globally. Candidates who pass the CPHQ examination must education and experience criteria previously required to apply
also understand how all of these important elements of quality for and take the CPHQ examination. The decision, effective 1
management, case/care/disease/utilization management and January 2004, removes all subjective barriers to certification.
risk management, as well as data management and general With this change, all candidates have complete access to the
management skills integrate together to produce an effective examination process. Those who aspire to excel and demonstrate
and efficient system to monitor and improve care. their competency in the field of healthcare quality management
will now have an equal chance to do so and achieve certification.
Certification
To become certified, each quality management professional After years of extensive experience in testing research and
must pass the CPHQ examination. The examination is available development and after observing the extraordinarily diverse
in computer-based format at Assessment Centers in the United backgrounds of exceptional candidates who have been successful
States and multiple international locations. Certified professionals on the examination and as CPHQs, the Board is confident that the
carefully crafted international CPHQ examination will differentiate
are entitled to use the designation “CPHQ” after their names.
Certification in quality management is effective on the date between candidates who are able to demonstrate competence
you pass the examination. The credential is valid from that and those who are not. It is with this confidence that the Board
date through a two-year period which begins on the 1st day of celebrates the elimination of barriers such as minimum education
January of the year following the date you pass the examination. and/or experience requirements that are not objectively linked to
Candidates who do not achieve a passing score or whose cycle success on the examination and effectiveness as a healthcare
of eligibility has expired must submit a new application and be quality professional.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
However, with elimination of the previous minimum education About the Examination
and experience requirements, each candidate must take time The international quality management certification examination
to assess and judge his/her own readiness to apply to take is the only fully accredited, standardized measurement of the
the CPHQ examination, particularly if you have not worked in knowledge, skills and abilities expected of competent quality
the field for at least two years. A careful review of all available management professionals. The examination is available in
information about the tasks covered in the CPHQ examination a computerized format on a daily basis at AMP Assessment
content outline, the sample examination questions, reference list centers.
and any other available data is essential before you make the
decision to apply for the examination. The certification examination is an objective, multiple-choice
examination consisting of 140 questions. 125 of these questions
The Examination Committee develops and writes the examination are used in computing the score, as discussed later in this
to test the knowledge, skills and abilities of effective quality Handbook. The HQCB uses the following percentage guidelines
management professionals who have been performing a in selecting the three types of questions that appear on each
majority of the tasks on the examination outline for two examination: 32% recall, 53% application, and 15% analysis.
years. The examination does not test at the entry level and is Recall questions test the candidate’s knowledge of specific facts
not appropriate for entry-level candidates. If you are new to and concepts. Application questions require the candidate to
healthcare quality management, have worked in the field less interpret or apply information to a situation. Analysis questions test
than two years or your experience as a quality manager was the candidate’s ability to evaluate, problem solve or integrate a
not specifically related to healthcare, the HQCB cautions variety of information and/or judgment into a meaningful whole.
that you may not be ready to attempt the examination. Refer to
the content outline later in this Handbook for detailed content
information and other tools to assess your readiness.
Pretest Questions on the Examination
In addition to the 125 scored questions, CPHQ examinations also
include an additional 15 pretest questions. You will be asked to
answer these questions, however, they will not be included in the
scored examination result. Pretest questions will be disbursed
within the examination, and you will not be able to determine
which of the questions are being pretested and which will be
included in your score. This is necessary to assure that candidates
answer pretest questions in the same manner as they do scored
questions. This allows the question to be validated as accurate
and appropriate before it is included as a measure of candidate
competency.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
CPHQ T H E C P H Q EXAMINATION
To apply for a computerized examination using the application who arrive at the assessment center later than 15
included in this handbook or downloaded from www.cphq.org: minutes from the scheduled appointment time will not be
admitted. Unscheduled candidates (walk-ins) will not be
1. Complete the paper application and mail it with the
admitted to the assessment center.
appropriate fee to: AMP, 18000 W. 105th Street, Olathe, KS
66061-7543. Note: Examinations will not be offered on the following
holidays.
2. The application is processed, and a confirmation notice of
eligibility is sent to the candidate within approximately 10 New Year’s Day
business days. If a confirmation notice is not received within Martin Luther King Day
three weeks, contact the AMP Candidate Services Department
Presidents’ Day
at 888-519-9901. A candidate’s eligibility and acceptance of
Good Friday
the application is valid for 90 days.
Memorial Day
A candidate who fails to schedule an appointment for
Independence Day (July 4)
examination within the 90-day eligibility period must submit a
Labor Day
complete application and examination fee to reschedule an
examination appointment. Columbus Day
Veterans’ Day
3. The confirmation notice contains a web address and toll-
Thanksgiving Day (and the following Friday)
free telephone number for the candidate to contact AMP.
Appointments can be scheduled online 24 hours a day, Christmas Eve Day
seven days a week at www.goAMP.com. The toll-free line Christmas Day
is answered from 7:00 a.m. to 9:00 p.m. (Central Time) New Year’s Eve Day
Monday through Thursday, 7:00 a.m. to 7:00 p.m. on Friday
and 8:30 a.m. to 5:00 p.m. on Saturday. The candidate
must be prepared to confirm a date and location for testing
and to provide her/his Social Security number as a unique
identification number. The examinations are administered by
appointment only Monday through Friday at 9:00 a.m. and
1:30 p.m. Individuals are scheduled on a first-come, first-
served basis. Refer to the following chart.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
International Examination Services On the Day of Your Examination
HQCB and AMP are making available international computerized On the day of your examination appointment, report to the
examinations. For information regarding the availability of assessment center no later than your scheduled testing
international computerized Assessment Centers please visit time. Once you enter the office, look for the sign indicating “AMP
the AMP website at www.goAMP.com. AMP is continuing to Assessment Center Check-In”. A candidate who arrives more than
expand its international locations and more locations are being 15 minutes after the scheduled testing time will not be admitted.
added throughout the year. If you are an international candidate
you will need to submit a completed application form and the Required Candidate Identification
application fee. If you do not have a Social Security number or To gain admission to the assessment center, you must present
social insurance number, a unique identifying number will be two forms of identification, one of which must be a current, legal
assigned to you when your application is processed. All other identification bearing your photograph and signature. Acceptable
rules and regulations regarding the computerized examination forms of legal identification include a driver’s license, government
apply to international examination candidates. All examinations identity card, military identification card or passport. Credit cards,
will be given in computerized format only. International candidates employment badges, student ID cards or club membership cards
will not receive instant score reports. Results will be sent within are NOT acceptable for the legal identification, although they
3-5 business days after completion of the examination to the may be used as the second form of identification. The second
candidate’s address of record. identification must be current and must verify your signature and
name. Any type of identification that verifies your signature and
Assessment Center Locations
name may be used as the second form of identification. Both
AMP Assessment Centers are typically located in H&R Block
forms of identification must be current. Temporary identification
offices. Detailed maps and directions are available on AMP’s
cards are NOT acceptable. You will also be required to sign a
website www.goAMP.com.
roster for verification of identity.
candidate’s time. If rescheduling is needed, the candidate must to a testing carrel. You will be instructed on the computer screen
call AMP at 888-519-9901 at least two business days prior to to enter your social security number. Candidates without a U.S.
the original scheduled examination session. (See table that social security number will be assigned a unique test identification
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
CPHQ R U L E S F O R C OM P U TE R I Z ED TE S TING
Examination Restrictions
• No personal belongings will be allowed in the Assessment Timed Examination
Center. Pencils will be provided during check-in. Following the practice examination, the actual examination will
begin. Before beginning, instructions for taking the examination
• The candidate will be provided with scratch paper to use during
are provided on-screen.
the examination, which must be returned to the supervisor
at the completion of testing, or the candidate will not receive
The computer monitors the time spent on the examination. The
a score report. No documents or notes of any kind may be
candidate will have three hours to complete the examination. The
removed from the examination room.
examination will terminate if testing exceeds the time allowed.
• No questions concerning the content of the examination may Click on the “Time” box in the lower right portion of the screen
be asked during the examination. or select the Time key to monitor testing time. A digital clock
• Eating, drinking or smoking will not be permitted in the indicates the time remaining to complete the examination. The
Assessment Center. Time feature may be turned off during the examination.
• The candidate may take a break during the examination, but will
not be allowed additional time to make up for time lost during
breaks.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
Only one examination question is presented at a time. The Candidate Comments
question number appears in the lower right portion of the screen. During the examination, online comments may be provided for
Choices of answers to the examination questions are identified as any question by clicking on the button displaying an exclamation
A, B, C, or D. The candidate must indicate his/her choice by either point (!) to the left of the Time button. This opens a dialogue box
typing in the letter in the response box in the lower left portion of where comments may be entered. Comments will be reviewed, but
the computer screen or clicking on the option using the mouse. individual responses will not be provided.
To change an answer, enter a different option by pressing the A,
B, C, or D key or by clicking on the option using the mouse. The
candidate may change his/her answer as many times as he/she
Failing to Schedule and
wishes during the examination time limit. Report for an Examination
A candidate who does not schedule an examination within the
90-day eligibility period forfeits the application and all fees
paid to take the examination. Lack of availability of a requested
examination date and/or Assessment Center late in the 90-day
eligibility period is not an accepted justification to waive the
processing fee. A complete application and examination fee are
required to reapply for the examination.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
CPHQ GENE R A L IN F O R MATION
Fees for the CPHQ examination are shown in the table that an administration, your examination will restart where you left off
All Examinations: $440 $370 of the opportunity to take the examination solely by reason of
that disability. AMP will provide reasonable accommodations for
The special member fee applies to current or new National candidates with disabilities. Wheelchair access is available at all
Association for Healthcare Quality (NAHQ) members or members established Assessment Centers. A candidate with a disability
of a non-U.S. national society NAHQ affiliate. The special member may request special accommodations and arrangements to take
fee does not apply to members of U.S. state NAHQ-affiliate the examination on the regularly scheduled examination date
associations unless they are also members of NAHQ. Candidates at established Assessment Centers. Such requests must be
who wish to join NAHQ must send the separate membership made in writing to AMP at the time of application. Verification of
application and dues directly to NAHQ, not to the HQCB. disability and statement of the specific assistance necessary must
Contact NAHQ at 800-966-9392 or visit www.nahq.org. be included. Please use the Request for Special Examination
Accommodations and Documentation of Disability-Related Needs
Fees may be paid by credit card, personal check, or money forms included in this handbook. Assessment Center personnel
order for the total amount, payable to HQCB. Checks drawn on will be prepared to accommodate requested needs.
non-United States banks must state “Payable in U.S. Dollars”.
Please write your name on the face of your check. An additional Scores Canceled by HQCB or AMP
$25 charge will be added for any returned checks or rejected HQCB and AMP are responsible for the integrity of the scores they
credit cards to cover additional handling fees and service charges report. On occasion, occurrences, such as computer malfunction
imposed by the bank or credit card company. Your canceled or misconduct by a candidate, may cause a score to be suspect.
check or credit card receipt serve to document payment for the HQCB and AMP are committed to rectifying such discrepancies
examination. as expeditiously as possible. HQCB may void examination results
if, upon investigation, violation of its regulations is discovered.
Inclement Weather or Emergency
In the event of inclement weather or unforeseen emergencies Disciplinary Policy
on the day of an examination, HQCB and AMP will determine The HQCB shall undertake sanctions against applicants,
whether circumstances warrant the cancellation, and subsequent candidates or individuals already awarded the CPHQ designation
rescheduling, of an examination. The examination will usually not only in relation to failure to meet Board requirements for initial
be rescheduled if the proctor is able to open the Assessment certification or recertification. The HQCB certification program is a
Center. voluntary process, not required by law for employment in the field.
Monitoring and evaluating actual job performance is beyond the
Candidates may visit AMP’s website at www.goAMP.com prior scope of the HQCB.
to the examination to determine if AMP has been advised that
any Assessment Centers are closed. Every attempt is made
to administer examinations as scheduled; however, should an
examination be canceled at an Assessment Center, all scheduled
candidates will receive notification following the examination
regarding a rescheduled examination date or reapplication
procedures.
10 C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
Applications may be refused, candidates may be barred from If You Pass the Examination
future examinations, or candidates or individuals already certified If you pass the HQCB examination, you are entitled to use the
may be sanctioned, including revocation of the CPHQ designation, designation Certified Professional in Healthcare Quality and
for the following reasons: registered acronym “CPHQ”, with your name on letterheads,
1. attesting to false information on the application or on business cards, and all forms of address. Certification is for
recertification documents or during the random audit individuals only. The CPHQ designation may not be used to imply
procedure that an organization, association, or private firm is certified.
Passing scores may vary slightly for each version of the Verification of CPHQ Status
examination. To ensure fairness to all candidates, a process of Information on the current certification status of an individual will
statistical equating is used. This involves selecting an appropriate be provided to the public upon request. Employers who request
mix of individual questions for each version of the examination verification of CPHQ status must provide the individual’s name
that meet the content distribution requirements of the examination and social security number to assure correct identification in the
content blueprint. Because each question has been pretested, CPHQ database. Annually, a listing of successful candidates will
a difficulty level can be assigned. The process then considers be published in the program newsletter and on the CPHQ website
the difficulty level of each question selected for each version of (www.cphq.org).
the examination, attempting to match the difficulty level of each
version as closely as possible. To assure fairness, slight variations
in difficulty level are addressed by adjusting the passing score up
or down, depending on the overall difficulty level statistics for the
group of scored questions that appear on a particular version of
the examination.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k 11
CPHQ GENE R A L IN F O R MATION
12 C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
7. Journal for Healthcare Quality published by the National International Terminology Crosswalk
Association for Healthcare Quality (NAHQ), 4700 W. Candidates are encouraged to review the terms listed on pages
Lake Avenue, Glenview, IL 60025-1485, 800-966-9392, 13-14 which could be found on a CPHQ examination. This list
international 847-375-4720, FAX 847-375-6320, includes healthcare quality terms and words that may have
www.nahq.org. different meanings in different countries. For purposes of the
8. Managing Performance Measurement Data in Health Care, CPHQ examination, they are considered to have the same or
published by Joint Commission Resources, One Renaissance equivalency meaning in the context of individual examination
Blvd., Oakbrook Terrace, IL 60181, 630-792-5800, Library of questions.
Congress Catalog Card No. 00-110892, International Standard
Book No. 0-86688-693-1, www.jcrinc.com. A translation of these terms from English to Arabic, Spanish
9. Statistics by Martin Sternstein, PhD, Barron’s EZ-101 Study and Traditional Chinese can be viewed and printed from the
Keys, published by Barron’s Educational Series, Inc., www.cphq.org website by clicking on “International.” The
250 Wireless Blvd., Hauppauge, NY 11788, Library of translation is provided as an aid to candidates for whom English
Congress Catalog Card No. 94-4069, International Standard is not their primary language. These candidates may find it helpful
Book No. 0-8120-1869-9. to familiarize themselves with the list and translation prior to taking
the examination.
10. The Memory Jogger, a Pocket Guide of Tools for Continuous
Improvement, Second Edition, published by GOAL/QPC,
The CPHQ Examination Committee uses this terminology
2 Manor Parkway, Salem, NH 03079, 800-643-4316,
crosswalk as a reference when reviewing and approving questions
international 603-893-1944, FAX 603-870-9122,
for the examination. They may decide to include both or several
www.goalqpc.com.
words that have a similar meaning in the context of an individual
11. The Memory Jogger Plus+ by Michael Brassard, 1989,
question, separated by a “slash” mark, to help candidates
First Edition, published by GOAL/QPC, 2 Manor Parkway,
understand the question and/or answer choices.
Salem, NH 03079, 800-643-4316, international 603-893-1944,
FAX 603-870-9122, www.goalqpc.com.
Terminology Crosswalk of Terms
12. The Team Handbook: How To Use Teams To Improve Quality,
• administrator = leader or facility (hospital) director
Second Edition, by Peter R. Scholtes, published by Oriel
• aggregate = summarize (usually referring to data)
Incorporated, 3800 Regent St., PO Box 5445, Madison, WI
53705-0445, international 608-238-8134, www.goalqpc.com. • ambulatory care unit = outpatient care unit
• appointment = initial acceptance for membership in a
13. The Team Memory Jogger, A Pocket Guide for Team
healthcare service, such as a medical staff or medical group
Members, published by GOAL/QPC, 2 Manor Parkway,
Salem, NH 03079, 800-207-5813, international • behavioral health = behavioral/mental health
603-893-1944, FAX 603-870-9122, www.goalqpc.com. • capitation = capitated = predetermined or pre-negotiated fee
14. a study of journal articles, textbooks or other publications • case management = case/care/disease management
related to the examination content outline. • case mix = patient groupings
15. continuing education programs related to the examination • CEO = chief executive officer (CEO)
content outline. • charter = start = assign
16. self-study interviews with current CPHQs and/or colleagues • clinical pathways = clinical/critical pathways/guidelines
responsible for areas covered on the examination which may • compensable = payable
not now be within the scope of your work responsibilities. • CQI = continuous quality improvement (CQI)
• credentialing = initial evaluation of credentials or initial
credentialing process
• credentials = qualifications (e.g., licenses, certifications,
education, experience)
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k 13
CPHQ GENE R A L IN F O R MATION
• delinquency rate = non completion rate (usually referring to Sample Examination Questions
medical records)
The following sample questions are illustrative of the type found
• deploy = implement = start = initiate on the CPHQ examination. The classification of each question,
• DRG = the diagnosis related group (a method of categorizing i.e., recall, application or analysis, is noted in the answer key
illnesses for purposes of payment or statistical analysis) for information. (Refer to the “Additional Sample Questions”
• ED = emergency department (ED) reproduced later in this Handbook for additional examples of
• equipment = device = supplies CPHQ examination test questions.)
• FTE = full time equivalent = full time employee
1. Which of the following processes is most cost-effective
• generic screening = concurrent screening
in preventing unnecessary resource consumption in the
• governing body = board of directors = board of trustees hospital?
• H&P = history and physical
A. effective preadmission screening
• healthcare organization = healthcare entity
B. accurate DRG assignment at admission
• HMO = health maintenance organization C. second opinions for all surgeries
• legal standard = requirement of law D. preadmission insurance benefit denials
• LOS = length of stay (LOS)
• managed care setting = a facility with managed care contracts 2. A social service department regularly monitors the number of
• “Meals on Wheels” = meals in home inappropriate referrals, the timeliness of discharge planning,
• member = patient, in the context of a managed care program and the number of days of discharge delays. What additional
monitor should be added to evaluate the appropriateness of
• modality = type of service
social service interventions?
• pathway = pathway/guideline
• performance improvement = quality improvement A. inadequacy of documentation in progress notes
B. attainment of social service goals
• proctor = mentor = coach = supervise = observe
C. timeliness of referrals to social services
• providers/practitioners = physicians or other licensed
D. number of social service referrals from nursing
independent practitioners
• quality council = steering council = QM committee
3. The primary purpose of a management information system
• reappointment = renewal of membership in a healthcare is to
service, such as a medical staff or medical group
A. provide data for quality assessment.
• reappraisal = re-evaluate competency = periodic competency
B. computerize operations for greater effectiveness.
review
C. guarantee better coordination of organizational change.
• recredentialing = periodic re-evaluation and renewing of
D. provide information that facilitates management
credentials
decisions.
• senior management = directors = administrators
• sentinel event = sentinel/unexpected event 4. Which part of a job description should be used in a
• severity = mental or physical dependency = acuity criteria-based performance evaluation?
• sues = takes legal action against
A. salary grade
• third party payor = payer = insurance company B. duties and responsibilities
• transcriptionist = secretary = typist C. working conditions
• unit = unit/ward/floor D. qualifications
• workers compensation = injured workers
• “written off” = erased = waived (usually referring to a financial
obligation)
14 C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
5. Which of the following are hardware components that would 9. The following represents two samples of five hospitals’
be included in a computerized management information hysterectomy rates per 1,000 women aged 40-60 years
system? of age:
Standard
A. binary and decimal coding
Rates Mean Deviation
B. flow chart and program
C. instructions and data Sample A 3, 5, 7, 8, 5 5.6 1.8
D. printer and random access memory Sample B 4, 5, 6, 7, 5 5.4 1.1
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k 15
CPHQ e x a m i n at i o n c o n t e n t o u t l i n e
The content validity of the CPHQ examination is based on an 15. Link performance improvement activities with
international practice analysis which surveyed QM professionals strategic goals
on the tasks they perform. Each question on the examination is 16. Demonstrate financial benefits of a quality program
linked directly to one of the tasks listed below. In other words, 17. Facilitate change within the organization
each question is designed to test if the candidate possesses the B. Operational
knowledge necessary to perform the task and/or has the ability to 1. Facilitate establishment of a performance
apply it to a job situation. improvement oversight group (e.g., Quality Council,
Steering Council, QM Committee)
Each of the tasks below was rated as significant to practice by 2. Identify the need for a performance improvement
QM professionals who responded to the survey. One decision rule team or teams
used by the International Practice Analysis Committee required 3. Identify the appropriate team structure (e.g., cross
that a task be significant to practice in the major types and sizes functional, self-directed)
of healthcare facilities, including those employed in managed 4. Identify champions (e.g., process owners, quality,
care. Thus the examination content is valid for this segment of QM patient safety)
professionals as well as those employed in hospital, clinic, home 5. Monitor the activities of consultants (e.g., quality and
care, behavioral/mental health or other care settings. patient safety)
6. Assist in developing objective performance
The following list of tasks is those which form the content outline measures/indicators
of the CPHQ examination and to which the examination questions
7. Contribute to development and revision of a written
are linked:
plan for a risk management program
8. Contribute to development and revision of a written
1. Management and Leadership (28 items or 22%)
plan for a case/care/disease/utilization management
A. Strategic
program
1. Facilitate development of leadership values and
9. Coordinate survey processes (i.e., accreditation,
commitment
licensure, or equivalent)
2. Facilitate assessment and development of the
10. Participate in cost analysis
organization’s quality culture
11. Participate in developing and managing a budget for
3. Participate in organization-wide strategic planning
a department
4. Identify internal customer/supplier relationships
5. Identify external customer/supplier relationships 2. Information Management (30 items or 24%)
6. Participate in developing an organizational vision A. Design and Data Collection
statement 1. Maintain confidentiality of performance improvement
7. Participate in developing an organizational mission activities, records, and reports
statement 2. Organize information for committee meetings
8. Develop goals and objectives (e.g., agendas, reports, minutes)
9. Develop and use performance measures (e.g., 3. Assess customer needs/expectations (e.g., surveys,
balanced scorecards, dashboards, core measures) focus groups, teams)
10. Determine lines of authority/accountability 4. Perform or coordinate data inventory listing activities
11. Evaluate applicability of performance improvement (i.e., what is available from which sources?)
models (e.g., FOCUS, PDCA, Six Sigma) 5. Perform or coordinate data definition activities
12. Evaluate applicability of national/international 6. Perform or coordinate data collection methodology
excellence/quality models 7. Assist with the evaluation of computer software
13. Facilitate evaluation and/or selection of appropriate applications
voluntary accreditation process(es) 8. Evaluate computerized systems for data collection
14. Develop a performance improvement plan and analysis
16 C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
9. Implement computerized systems for data collection 3. Facilitate development or selection of process and
and analysis outcome measures
10. Use epidemiological theory in data collection and 4. Facilitate evaluation or selection of evidence-based
analysis practice guidelines (e.g., for standing orders or as
11. Collect qualitative and quantitative data guidelines for physician ordering practice)
12. Aggregate/summarize data for analysis 5. Participate in the development of clinical/critical
B. Measurement pathways or guidelines
1. Use or coordinate the use of process analysis tools 6. Aid in evaluating the feasibility to apply for external
to display data (e.g., fishbone, Pareto chart, run quality awards (e.g., Malcolm Baldrige, Magnet)
chart, scattergram, control chart) B. Implementation
2. Use basic statistical techniques to describe data 1. Coordinate the performance improvement process
(e.g., mean, standard deviation) 2. Lead performance improvement teams
3. Use or coordinate the use of statistical process 3. Facilitate performance improvement teams
control components (e.g., common and special 4. Participate on performance improvement teams
cause variation, random variation, trend analysis) 5. Participate in the credentialing and privileging
4. Use the results of statistical techniques to evaluate process
data (e.g., t-test, regression) 6. Coordinate or participate in quality improvement
C. Analysis projects
1. Use comparative data to measure or analyze 7. Participate in the process of:
performance a. medication usage review
2. Interpret benchmarking data b. medical record review
3. Interpret incident/occurrence reports c. infection control processes
4. Interpret outcome data d. peer review
5. Interpret data to support decision making e. service specific review (e.g., pathology,
D. Communication radiology, pharmacy, nursing)
1. Interact with medical staff and support personnel f. patient advocacy (e.g., patient rights, ethics)
regarding individual patient management issues 8. Perform or coordinate risk management:
2. Promote organizational values and commitment a. risk prevention
among staff b. risk identification
3. Compile and write performance improvement reports c. mortality review
4. Integrate quality concepts within the organization d. failure mode and effects analysis
5. Coordinate the dissemination of performance e. collaborate with quality department
improvement information within the organization 9. Perform or coordinate risk management: risk
6. Ensure accuracy in public reporting activities (e.g., prevention
organizational transparency, website content) C. Education and Training
7. Facilitate communication with accrediting and 1. Develop organizational performance improvement
regulatory bodies training (e.g., quality, patient safety)
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k 17
CPHQ e x a m i n at i o n c o n t e n t o u t l i n e
18 C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
a d d i t i o n a l s a m pl e qu e s t i o n s w i t h p e rf o r m a n c e d e ta i l
The following ten questions have been removed from active use from the Certified Professional for Healthcare Quality (CPHQ)
examination item pool that is established, maintained and owned by the Healthcare Quality Certification Board (HQCB) of the National
Association for Healthcare Quality (NAHQ). The purpose of releasing these questions is to provide information that could assist
prospective candidates to prepare for the examination and to further their understanding of the examination process.
In releasing these questions, the HQCB has attempted to provide examples that represent a range of content and difficulty that would be
typical of an actual examination. However, HQCB emphasizes that this small number of sample questions does not provide a complete
depiction of the overall diversity that candidates should expect to encounter on an actual examination form.
Following each question is the correct response (key), the cognitive level (Cog) required for a response, the linkage to the current test
content outline (TCO), and a description of other relevant question characteristics and notes about the history of the question, where
applicable. Additional information about the CPHQ examination and certification program is available from a variety of other sources.
These sources include but are not limited to: other sections in this Handbook, the HQCB worldwide website (www.cphq.org), the
HQCB-sponsored item writing workshop (“Secrets of Competency Testing: Writing Questions for the CPHQ Examination”) presented at
the annual NAHQ conference or in co-sponsorship with NAHQ-affiliated state associations, and course work offered by NAHQ or other
educational providers independently from and without endorsement by the HQCB.
#1. The primary benefit of adopting a countrywide or global uniform set of discharge data is to
A. facilitate computerization of data.
B. validate data being collected from other sources.
C. facilitate collection of comparable health information.
D. assist medical records personnel in collecting internal data.
Key: C Cog: Application
TCO: II.A.7 – Perform or coordinate data collection methodology.
This question was used many years ago in a somewhat different form. When administered, the stem (question portion) referred
specifically to the Uniform Hospital Discharge Data Set (UHDDS), which is not currently considered to be relevant content. When
the question was used, approximately 78% of the candidates provided a correct response, with approximately 7% choosing each
of the distracters (or wrong answers A, B, and D).
#2. In order to perform a task for which one is held accountable, there must be an equal balance between responsibility and
A. authority.
B. education.
C. delegation.
D. specialization.
Key: A Cog: Application
TCO: I.A.9. – Determine lines of authority/accountability.
This question appeared on examination forms several years ago, but could still test relevant content. It was a fairly easy question,
in that approximately 85% of the candidates provided a correct response. Option B was chosen by approximately 10% of the
candidates, and options C and D were selected less frequently.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k 19
CPHQ ADDITIONA L S AM P L E Q U E S TION S W IT H P E R F O R MAN C E DETAI L
#3. A patient was in the operating room when a piece of a surgical instrument broke off and was left in the patient’s body. The patient
was readmitted for removal of the foreign object. Which of the following would most likely apply in this situation?
A. res ipsa loquitur
B. contributory negligence
C. contractual liability
D. tort liability
Key: A Cog: Application
TCO: IV.B.9b. – Perform or coordinate risk management (risk identification).
This question was considered to be of moderate difficulty, as approximately 75% of the candidates have responded correctly.
Among the distracters, option C has been the least attractive (2%); option B has been selected by about 13% and option D has
been selected by about 10%. The discrimination index (rpb, or point-biserial correlation) was quite acceptable, i.e., the average
raw score of candidates selecting the correct response was approximately seven points higher than the average score of those
selecting an incorrect response.
#4. Which of the following types of budgets itemizes the major equipment to be purchased in the next year?
A. capital
B. variable
C. operating
D. zero-based
Key: A Cog: Recall
TCO: I.B.10. – Participate in preparing and managing operating budgets.
This question has not been used on an examination form as it is shown here. The stem (question portion) of this version was
revised, but the previous version of this question performed quite effectively. It was about average in difficulty and had a good
discrimination index.
#5. A quality manager needs to assign a staff member to assist a medical director in the development of a quality program for a newly
established service. Which of the following staff members is most appropriate for this project?
A. a newly hired staff member who has demonstrated competence and has time to complete the task
B. a knowledgeable staff member who works best on defined tasks
C. a motivated staff member who is actively seeking promotion
D. a competent staff member who has good interpersonal skills
Key: D Cog: Analysis
TCO: I.A.11. – Develop a performance improvement plan.
This question was moderately difficult (68% correct) when it was administered several years ago. The most attractive distracter
was option B, and options A and C were selected by a small percentage of candidates.
20 C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
#6. A surgeon’s wound infection rate is 32%. Further examination of which of the following data will provide the most useful information
in determining the cause of this surgeon’s infection rate?
A. mortality rate
B. facility infection rate
C. use of prophylactic antibiotics
D. type of anesthesia used
Key: C Cog: Application
TCO: IV.B.7g. – Participate in peer review.
This question has been used on several examination forms, with consistently good performance characteristics. On average,
approximately 70% of the candidates have responded correctly, with most of the incorrect responses on option B. The average
raw score of respondents selecting the correct answer has been consistently around six points higher than those selecting an
incorrect response, resulting in rpb values around .30.
#7. The separate services of Pharmacy and Nursing are having difficulty developing an action plan for medication errors. Pharmacy
Services states that Nursing Services causes the majority of the problems related to errors, while Nursing Services states the
opposite. The quality professional’s role in resolving this problem is to
A. provide them with directives on how to solve the problem.
B. facilitate discussion between the groups to enable them to assume ownership of their portions of the problem.
C. assign the task to an uninvolved manager.
D. refer the problem to the facilitywide quality council.
Key: B Cog: Application
TCO: III.A.4. – Facilitate change within the organization.
An question very similar to the one shown above was last used on an examination form in 1991, when approximately 82% of the
candidates provided a correct response. The question was modified as shown, but has not been used in this format. One reason
the question is no longer active is that a flaw was noted in this version of the question that could provide an unfair advantage to
test wise candidates, namely, the length of the correct response. Questions with such flaws are not approved for use on a current
examination form.
#8. Which of the following is most likely to be a benefit of concurrent ambulatory surgical case review?
A. decreased medical record review at discharge
B. an increase in the number of cases failing screening criteria
C. an increase in reviewer competence
D. decreased employee turnover
Key: A Cog: Application
TCO: II.A.7. – Perform or coordinate data collection methodology.
This question has been used on several examination forms, as recently as 1996, with consistently good performance
characteristics. On average, approximately 75% of the candidates have responded correctly, with approximately 16% of
the incorrect responses on option B, 8% on C, and 1% on D. The average raw score of respondents selecting the correct answer
has been consistently around seven points higher than those selecting an incorrect response.
C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k 21
CPHQ ADDITIONA L S AM P L E Q U E S TION S W IT H P E R F O R MAN C E DETAI L
This question has been used in this form only once, in 1994, when 81% of the candidates responded correctly. Among the
distracters, option C drew 10% of the responses, option A drew 7%, and option B drew 2%. On the 1994 administration,
the rpb was .26, which represents an appropriate level of discrimination.
#10. According to Joint Commission standards, the safety program must include all of the following EXCEPT
A. monthly safety committee meetings.
B. planned response to natural disasters.
C. orientation and continuing education on safety issues.
D. review of safety policies and procedures for all departments.
Key: A Cog: Recall
TCO: Questions that test a candidate’s knowledge of standards applicable to specific accrediting or licensing
bodies are no longer on the examination because they may not be applicable globally in all countries.
Because it assesses knowledge of standards specific to the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), this question is no longer applicable for the examination. The question has been selected to demonstrate an appropriate
use of a negatively-worded format. Most negatively-worded questions follow this format, using the word “except” at the end of
the stem, printed in all capital letters. The other general format of negatively-worded questions could include a statement such
as: “Which of the following is NOT . . . ?”. This question has been used on two different examination forms, most recently in 1994.
Approximately 86% of the candidates selected option A as the element that did not need to be included in a safety program;
option C was selected by only 1%, option B by 4%, and option D by 8% of the candidates.
22 C P H Q e x a m i n at i o n c a n d i d at e h a n d b o o k
HQCB Handbook, page 23
3. Social Security Number – Fill in your United States- 7. Educational level – Select the highest academic level you
issued social security number. This will be your confidential have completed from the list provided; enter that two-digit
examination identification number. Your social security code in the boxes provided.
number is required for us to verify CPHQ status for 8. Years of experience in healthcare quality management
employers. HQCB will assign a confidential examination – Select the category from the list provided to indicate
identification number for candidates who do not have a social the number of years of experience you have completed
security number. performing QM/CM/UM/RM activities, by the application
4. Preferred Mailing Address – Print one number or letter of deadline for the examination.
your street address in each box and leave a blank box for 9. Previous Examination date – If you have taken the
each space between words or numbers. This is the address examination before, enter the month and year of the
to which all examination information and post examination examination taken most recently.
materials will be mailed, including certificates and pins for
passing candidates. HQCB recommends candidates use 10. Fees – Indicate the correct member or non-member fee, in
their home address (not a business address) to assure mail is the box(s) provided. Add the amounts you have entered, if
forwarded if your address changes. needed, and fill in the appropriate total amount in the box.
City – Print the name of the city of your mailing address. 11. Licenses or Registrations – Check the appropriate box to
State/Province – Print the two-letter initials for your state or indicate any license(s) or registration(s) you currently hold.
province for your mailing address.
Apply online at www.goAMP.com or mail the completed application and appropriate fee
(checks payable to HQCB) or credit card information to:
AMP
18000 W. 105th Street
Olathe, KS 66061-7543
(Note: If sending by facsimile, do not mail the original as this may result in a duplicate entry and duplicate charge to your credit card. If
paying by check, you must mail your application and check; do NOT also send it by facsimile as this may result in a duplicate entry.)
HQCB Handbook, page 24
HQCB Handbook, page 25
APPLICATION FORM
The Certified Professional in Healthcare Quality (CPHQ) Examination
HEALTHCARE QUALITY CERTIFICATION BOARD
1. PRINT Last/Family
Name USE BLACK INK ONLY
FULL
NAME First Name
Middle Initial
2. Are you a member of NAHQ or a non-U.S. national quality society NAHQ-affiliate? (State, regional, local or non-affiliated national association
membership does not equal NAHQ membership.)
No (Non-member exam fee applies) Yes; NAHQ or affiliate member ID # ___________________________ or
Yes; new member; dues sent to NAHQ on _____________________ (date) (Member exam fee applies; call NAHQ at 800-966-9392 to join.)
3. SOCIAL – –
SECURITY NUMBER
Required to verify CPHQ status for U.S. employers) (AMP will assign ID number for candidates without SS #s)
4. PREFERRED Street
MAILING
ADDRESS City
Use of home State;
Province Zip/Postal Code –
address
recommended Country
Home
Work Phone – Phone –
Area/Country City Code Number Area/Country City Code Number
Code (If applicable) Code (If applicable)
Fax – – *E-mail
5. GENDER (optional)
Male Female
6. Primary place of employment: 8. Years of full-time and/or part time experience in healthcare quality,
(01) college or university (non-hospital case/care/disease/utilization and/or risk management activities:
(02) outpatient/specialty facility or clinic (01) fewer than two years
(03) consultant (02) two to five years
(03) more than five but not more than 10 years
(04) extended care facility
(04) more than 10 years
(05) hospital or medical center
(06) private review agency/third party payer/HMO/PPO/MMO/ 9. Have you previously taken the CPHQ examination?
insurance company Yes No If yes, most recent date:
(07) government agency (non-hospital) Month Year
13. Declaration
AGREEMENT OF AUTHORIZATION and CONFIDENTIALITY
I authorize the Healthcare Quality Certification Board (HQCB) to make whatever inquiries and investigations that it deems necessary to verify my credentials and
professional standing. Further, I understand that the HQCB will treat the contents of this application as well as all documents relating to certification as confidential,
except when required by legal compulsory process, with the following exception. If I successfully pass the examination and attain the CPHQ designation, I
authorize the HQCB to release my name and address to the National Association for Healthcare Quality and its affiliated organizations for the purpose of mailing me
association information. I also authorize HQCB to use information from my application and subsequent examination for the purpose of statistical analysis, provided
my personal identification with the information has been deleted. I understand that the initial certification period is two calendar years following successfully passing
the examination and agree to meet current requirements if I wish to maintain active certification status thereafter. I further understand that the governing body has
the authority to change requirements to attain and maintain certification from time to time.
I have read and understand the information provided in the Candidate Handbook or on the cphq.org website. Under penalties of perjury, I declare that the
foregoing statements are true.
I understand that false information may be cause for denial or loss of the credential. I understand that I can be disqualified from taking or continuing to sit for an
examination or from receiving examination scores if the HQCB determines through either proctor observation or statistical analysis that I engaged in collaborative,
disruptive, or other prohibited behavior during the administration of the examination.
______________________________________________________________ ___________________________________
Candidate signature (Required) Date
Payment must be by credit card, check or money order payable in U.S. dollars to the “Healthcare Quality Certification Board”.
Please write your name on the face of the check. (HQCB/NAHQ tax ID #95-3062349)
No telephone or e-mail applications will be accepted. Completed forms may be sent by facsimile ONLY if paying by credit card.
Complete and mail this application with a check or credit card information to:
AMP/Examination Services
18000 W. 105th Street
Olathe, KS 66061-7543
913-895-4600
FAX 913-895-4650
HQCB Handbook, page 27
If you have a disability covered by the Americans with Disabilities Act, please complete this form and the Documentation of
Disability-Related Needs on the reverse side so your examination accommodations can be processed efficiently. The information you
provide and any documentation regarding your disability and your need for examination accommodations will be treated with strict
confidentiality.
Candidate Information
Social Security # __________ – _______ – ____________
__________________________________________________________________________________________________________
Name (Last, First, Middle Initial, Former Name)
__________________________________________________________________________________________________________
Mailing Address
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
City State Zip Code
__________________________________________________________________________________________________________
Daytime Telephone Number
Special Accommodations
I request special accommodations for the _____________________________________________________________________ examination.
______________________________________________________________________________________________
______________________________________________________________________________________________
Comments:____________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Return this form with your examination application and fee to:
Examination Services Department, AMP, 18000 W. 105th Street, Olathe, KS 66061-7543.
If you have questions, call the Examination Services Department at 913-895-4600.
HQCB Handbook, page 28
HQCB Examination
Please have this section completed by an appropriate professional (education professional, physician, psychologist, psychiatrist) to
ensure that AMP is able to provide the required examination accommodations.
Professional Documentation
I have known ___________________________________________________ since ______ / ______ / ______ in my capacity
Examination Candidate Date
_______________________________________________________________.
Professional Title
The candidate discussed with me the nature of the examination to be administered. It is my opinion that, because of this candidate’s
disability described below, he/she should be accommodated by providing the special arrangements listed on the reverse side.
Description of Disability:_________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Signed:_________________________________________________________________________ Title:_________________________________
Printed Name:______________________________________________________________________________________________
Address:___________________________________________________________________________________________________
__________________________________________________________________________________________________________
Telephone Number:_ ________________________________________________________________________________________
Return this form with your examination application and fee to:
Examination Services Department, AMP, 18000 W. 105th Street, Olathe, KS 66061-7543.
If you have questions, call the Examination Services Department at 913-895-4600.
HQCB Handbook, page 29
Directions: You may use this form to ask the testing agency, AMP, to send you a duplicate copy of your score report. This request
must be postmarked no later than 90 days after the examination administration. Proper fees and information must
be included with the request. Please print or type all information in the form below. Be sure to provide all information
and include the correct fee, or the request will be returned.
Fees: $25 US Dollars per copy. Please enclose a check or money order payable in US Dollars to AMP. Do not send cash.
Write your test identification number on the face of your payment.
Street_ _______________________________________________________________________________________________________________
Country_ _____________________________________________________________________________________________________________
E-mail________________________________________________________________________________________________________________
If the above information was different at the time you were tested, please write the original information below:
Street_ _______________________________________________________________________________________________________________
Country_ _____________________________________________________________________________________________________________
E-mail________________________________________________________________________________________________________________
I hereby request AMP to send a duplicate copy of my score report to the first address shown above.
You may use this form to request that HQCB enter a change of address, including e-mail address, into our database once you
have registered for the examination. To protect your confidential record and assure that no unauthorized person is able to alter your
record, we require that all address changes be submitted in writing and include your authorizing signature.
HQCB will forward your address change to the testing agency AMP. If you have questions, contact HQCB at 913-895-4609 or toll
free 800-346-4722 or e-mail: info@cphq.org.
Mail or fax your request to: Healthcare Quality Certification Board (HQCB)
P. O. Box 19604
Lenexa, KS 66285-9604, USA
Facsimile 913-895-4652
Print your NEW name and address (use of home address recommended):
Street_ _______________________________________________________________________________________________________________
Country_ _____________________________________________________________________________________________________________
E-mail________________________________________________________________________________________________________________
Street_ _______________________________________________________________________________________________________________
Country_ _____________________________________________________________________________________________________________
E-mail________________________________________________________________________________________________________________
I hereby authorize HQCB and AMP to change my address in the examination database as shown above.
Candidate signature Date
2009 Healthcare Quality Certification Board
and Examination Committee Roster
Joan Boldrey, RN, M.ED., MS, CPHQ, CLNC Paula J. Pillen, BFA, MPA, CFRE, LNHA
HQCB Past Chair Public Member
Clive, IA Omaha, NE
Phone: 515-633-1106 Phone: 402-572-0717
jboldrey@mchsi.com P2consulting@aol.com
Michael L. Greer, RN, MS, CPHQ, CMCN Thomas M. Smith, MA, RN, CPHQ
HQCB Secretary/Treasurer Immediate Past President, NAHQ
Brentwood, TN 37027 Mechanicsville, VA 23116
Phone : 615-565-1586 Phone: 202-331-5790
michael.greer@lpnt.net Thomas.smith2@hcahealthcare.com