CPHQ Exam Practice Quiz (December 2012)

Congratulations—you have completed CPHQ Exam Practice

Quiz (December 2012).

All the questions in the quiz along with their Answers are
shown below.

Question 1 of 26
Which of the following statements BEST describes a process
in statistical control?

A. A process in which there is no evidence of special

causes on a control chart.
B. A process in which there are no points beyond the
control limits on a control chart.
C. A process in which the points fall within 2 standard
deviations of the middle line on a control chart.
D. A process in which the points fall within 3 standard
deviations of the middle line on a control chart.
Answer: A
Statistical control is the condition describing a process from
which all special causes have been removed, evidenced on a
control chart by:

 The absence of points beyond the control limits; and

 The absence of non-random patterns or trends within
the control limits on a control chart.
The control limits on a control chart is determined
statistically and may be 2 or 3 standard deviations (or some
other number of standard deviations) from the mean.

Content Category: Information Management

Cognitive level required for a response: Recall
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 2 of 26
A run is

A. a pattern in a Run Chart that has a series of continually

rising or falling consecutive points.
B. a pattern in a Run Chart within which a number of
consecutive points lie on the same side of the median.
C. a pattern in a Run Chart that consists of 14 consecutive
points alternating up and down.
D. all of the above.
Answer: B
A run is a pattern in a Run Chart or Control Chart within
which a number of points line up on only one side of the
central/middle line.

Content Category: Information Management

Cognitive level required for a response: Recall
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 3 of 26
Which of the following tools/techniques is most appropriate
for collecting data on typing mistakes in real time in a
Medical Transcription Department?

A. Check sheet
B. Observation
C. Questionnaires
D. Medical record review
Answer: A
A check sheet is a form that may be used to collect data on
defects in real time where the data are generated. It is
particularly well suited to collecting data on typing mistakes
in real time.

Neither direct observation nor questionnaires are

appropriate for collecting data on typing mistakes.

Medical record review will not be a practical way of

collecting data on typing mistakes in real time.

Content Category: Information Management

Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Perform or coordinate data collection
methodology (e.g. qualitative, quantitative)
Question 4 of 26
Which of the following tools is LEAST helpful to an
improvement team trying to write a problem statement?

A. Brainstorming
B. Run Chart
C. Pie Chart
D. Check Sheet
Answer: A
Brainstorming, though helpful for other tasks, is unlikely to
be useful for arriving at a statement that describes the
problem in terms of what it is specifically, where it occurs,
when it happens, and its extent.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Participate on performance/quality
improvement teams (i.e. as a coordinator or team
member/leader/facilitator)
Question 5 of 26
Which of the following tools is LEAST useful for developing
a complete picture of all the possible causes of a problem?

A. Brainstorming
B. Check Sheet
C. Cause-and-Effect Diagram
D. Histogram
Answer: D
Tools/Techniques that can help a team develop a list of all
the possible causes of a problem include:

 Brainstorming
 Cause-and-Effect Diagram
 Check Sheet
A histogram displays the frequency distribution of a dataset.
It is not primarily used for problem identification.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Participate on performance/quality
improvement teams (i.e. as a coordinator or team
member/leader/facilitator)
Question 6 of 26
An acute care facility is planning to implement an
Electronic Health Record (EHR) system but staff are
resisting this change. Which aspect of the new system
should the leaders address/emphasize first in order to build
support for EHR among the staff?
 A. Lack of training
B. Improved patient safety
C. Greater efficiency
D. Federal EHR financial incentives and penalties
Answer: A
The literature suggests that reducing or eliminating a
“restraining force” (cf. Force Field Analysis), e.g. lack of
training (in EHR use), is more effective in facilitating
change than focusing on a “driving force,” e.g. financial
penalties that the facility will face if it does not implement
an EHR
Content Category: Performance/Quality Measurement and
Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Coordinate or participate in quality
improvement projects
Question 7 of 26
Which of the following tools will an improvement team find
most useful when deciding which problem in the radiology
process in an Emergency Department to address first?

A. Pie Chart
B. Nominal Group Technique
C. Force Field Analysis
D. Histogram
Answer: B
The tools/techniques usually used to help a team decide
which problem will be addressed first include:

 Flowchart
 Check Sheet
 Pareto Chart
 Brainstorming
  Nominal Group Technique
Content Category: Performance/Quality Measurement and
Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Facilitate development of
performance/quality improvement action plans and
projects
Question 8 of 26
Which of the following charts is most appropriate for
displaying the results of a survey of staff perception of the
overall level of customer service (e.g. Excellent/Very
Good/Average/Below Average/Poor) provided in a
hospital?

A. Pareto Chart
B. Scatter Diagram
C. Histogram
D. Pie Chart
Answer: D
A Pie Chart or Bar Chart will be suitable for displaying the
frequency or relative frequency of the various responses,
e.g. Excellent/Very Good/Average/Below Average/Poor, in
this survey.

A Pareto Chart displays the relative importance of all the

problems or conditions in order to: choose the starting
point for problem solving, monitor success, or identify the
basic cause of a problem. It is not the ideal chart in this
case.

A Scatter Diagram is used to examine the

correlation/relationship between two continuous variables.
A Histogram is appropriate for examining the distribution
of continuous data (that is usually categorized).

Content Category: Information Management

Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Facilitate the use of process analysis
tools to display data (e.g. fishbone, Pareto chart, run chart,
scattergram, control chart)
Question 9 of 26
A process that is “in control” means that the process

A. is producing a product or service that is meeting the

specification.
B. is producing a product or service that is exceeding
expectations.
C. is monitored closely.
D. is consistent.
Answer: D
A process that is in “in control” only means that it is
consistent, i.e. it may be consistently good, consistently bad,
or consistently average. It does not mean that it is meeting
or exceeding specifications, customer needs, or customer
expectations.

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 or coordinate the use of statistical
process control components (e.g. common and special cause
variation, random variation, trend analysis)
Question 10 of 26
For the medication administration process, which of the
following staff have the greatest opportunity to reduce the
natural variation between the control limits on a Control
Chart?

A. Senior management
B. Medical staff
C. Nursing staff
D. Patients
Answer: A
Senior management, through support and action, has the
greatest opportunity to control/reduce common-cause
variation.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Participate on performance/quality
improvement teams (i.e. as a coordinator or team
member/leader/facilitator)
Question 11 of 26
Which of the following Prioritization Matrices should be
used when decisions are being made on critical strategy
issues?

A. The Consensus Criteria Method

B. The Combination Interrelationship Diagraph/Matrix
Method
C. The Full Analytical Criteria Method
D. Any of the above
Answer: C
The Prioritization Matrices listed above are not the same;
selection of which one to use depends on the complexity of
the issue and the time available to prioritize. The Full
Analytical Criteria Method is the most complex and
rigorous of the Prioritization Matrices, and should be used
when the decisions to be made are absolutely critical to the
organization.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Recall
Tasks on the CPHQ exam content outline to which the
Question is linked: Facilitate establishment of priorities
for performance/quality improvement activities
Question 12 of 26
Which of the following is an appropriate criterion when
using a Prioritization Matrix to select an Electronic Medical
Record (EMR) system?

A. Quick to implement
B. Availability of supporting hardware
C. Ease of data abstraction
D. Integration with existing billing system
Answer: A
At first glance, each of the Answer options may appear
appropriate. However, when using a Prioritization Matrix,
wording is important. Each criterion should reflect the
desired outcome. Only Answer option A states a desired
outcome. The other Answer options are neutral, e.g.
"Integration with existing billing system" could mean good
integration or poor integration.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Application 
Tasks on the CPHQ exam content outline to which the
Question is linked: Facilitate establishment of priorities
for performance/quality improvement activities
Question 13 of 26
Which of the following is LEAST useful when developing an
operational definition?

A. Involve team members

B. Critical review of the literature
C. Run trials
D. Determine what to observe and how to measure it
Answer: B
An operational definition describes what something is and
how it is measured. This definition is meant for use by
members of the improvement team. Each team must
discuss what quality characteristics or other quantities it
will be measuring, and decide how these will be measured.
The goal is to get a definition that all team members agree
on, and one that gives consistent results no matter who does
the measuring. The development of an operational
definition should involve all team members (because there
must be consensus), team members must know precisely
what to observe and how to measure it, and trials/tests
should be conducted so that inconsistent results can be
examined and definitions clarified.

A literature review may be helpful but the other steps

should take precedence.

Content Category: Information Management

Cognitive level required for a response: Recall
Tasks on the CPHQ exam content outline to which the
Question is linked: Perform or coordinate data definition
activities
Question 14 of 26
Where should the surgical "time out" for a total knee
replacement occur?

A. Med/Surg unit
 B. Preoperative holding area
C. Operating room
D. Post anesthesia care unit
Answer: C
The surgical "time out" should be conducted in the
surgery/procedure room.

Content Category: Patient Safety

Cognitive level required for a response: Recall
Tasks on the CPHQ exam content outline to which the
Question is linked: Integrate patient safety initiatives into
organizational activities
Question 15 of 26
Which of the following statements is TRUE about any
brainstorming session?

A. It is acceptable to criticize ideas.

B. Every person in a group must give an idea as their turn
arises.
C. Group members give ideas as they come to mind.
D. Every idea must be written on a flip chart or
blackboard.
Answer: D
The generally accepted guidelines about brainstorming
include:

 Never criticize ideas; and

 Write on a flip chart or blackboard every idea. Having
words visible to everyone at the same time avoids
misunderstandings and reminds others of new ideas.
Brainstorming can be conducted in one of two ways:
  Structured. In this method, every person in a group
must give an idea as their turn arises in the rotation or
pass until the next round.
 Unstructured. In this method, group members simply
give ideas as they come to mind.
Content Category: Performance/Quality Measurement and
Improvement
Cognitive level required for a response: Recall
Tasks on the CPHQ exam content outline to which the
Question is linked: Participate on performance/quality
improvement teams (i.e. as a coordinator or team
member/leader/facilitator)
Question 16 of 26
An acute care facility is planning to implement an
Electronic Health Record (EHR) system but staff are
resisting this change. Which aspect of the new system
should the leaders address/emphasize first in order to build
support for EHR among the staff?

A. Lack of training
B. Improved patient safety
C. Greater efficiency
D. Federal EHR financial incentives and penalties
Answer: A
The literature suggests that reducing or eliminating a
“restraining force” (cf. Force Field Analysis), e.g. lack of
training (in EHR use), is more effective in facilitating
change than focusing on a “driving force,” e.g. financial
penalties that the facility will face if it does not implement
an EHR
Content Category: Performance/Quality Measurement and
Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Coordinate or participate in quality
improvement projects
Question 17 of 26
An acute care facility has had recurrent spikes in
healthcare-associated infections over the past twelve years.
Which of the following tactics will contribute most to the
reduction of the infection rate in the future?

A. Hiring external consultants to provide expertise in

reducing the infection rate.
B. Setting up a committee to oversee the infection
prevention and control program.
C. Keeping good records of all activities aimed at
preventing infections.
D. Conducting a thorough review of current initiatives to
reduce the rate of infections.
Answer: C
In almost every organization, there are problems that get
repeatedly "solved." Somebody tries something once, it
doesn't do much good, so somebody else tries something
different the next time (with little idea of what has gone
before). With some luck, the problem will decrease or
disappear for a while, but it always returns because the
solutions tried are aimed at symptoms rather than causes of
the problem.

Without proper records, the organization will never be able

to tell which adjustments helped (and which didn't).
Therefore, it will not be able to duplicate any brief success
that it may have. Keeping and using good records of
everything tried on the process will provide valuable data
for future efforts.

Content Category: Performance/Quality 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 18 of 26
An improvement team has successfully completed a project
that reduced the rate of surgical site infections in patients
undergoing total hip replacement. Who among those
originally involved in the project, if any, is responsible for
monitoring the changes after the project?

A. Sponsor
B. Team leader
C. Team members
D. None of the above
Answer: A
After completion of an improvement project, the Sponsor
has the responsibility of monitoring the changes that were
made by the team.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Coordinate or participate in quality
improvement projects
Question 19 of 26
What is the primary reason why staff in the Emergency
Department should inform other departments about the
quality improvement initiatives conducted in their area?

A. To encourage staff in other parts of the organization to

improve quality.
B. To provide a benchmark for the rest of the
organization.
 C. To spread successful tests of change to other units.
D. To avoid inadvertently suboptimizing other areas of
the organization.
Answer: D
Depending on the nature of the quality improvement work,
there are several reasons why staff in one unit may wish to
keep others in the organization informed. However, in
general, the most important reason why other staff in the
organization should at least be aware of improvement
activities in your unit is to prevent those activities
(inadvertently) negatively impacting other parts of the
system. For instance, in trying to reduce waiting times in an
Emergency Department, patients may be pushed to other
areas, hence creating greater stress for staff in those areas if
the flow of patients is not coordinated.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Coordinate or participate in quality
improvement projects
Question 20 of 26
An organization-wide electronic medical record (EMR)
system was recently implemented in an acute care facility.
Nursing staff in the Intensive Care Unit (ICU) found the
electronic reports that were generated more difficult to read
than the previous paper-based ones. What should they do
first?

A. Report the issue to the EMR project team.

B. Attempt to find a solution in the ICU.
C. Wait to see if the EMR project team will provide an
organization-wide solution.
 D. Recommend that the ICU uses paper-based reports
only.
Answer: B
The issue in report generation is likely to affect other parts
of the organization other than the ICU, i.e. it is probably an
organization-wide issue. However, the ICU team should
first attempt to find a local solution in the immediate term,
and then seek assistance "upstream" for a longer term fix.
This is more practical than waiting for the EMR project
team to fix the problem (Answer options A and C) or
returning to paper-based reports only (Answer option D).

Content Category: Performance/Quality 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 21 of 26
The monthly rate of laboratory errors at an acute care
facility is out of statistical process control for the first time
in more than four years. The organization's leaders have
decided that the variation in the laboratory error rate
should be reduced. What should be the improvement team's
next objective?

A. Continue monitoring the rate of laboratory errors.

B. Reduce sources of variation on measurement
processes.
C. Reduce sources of variation on the laboratory work
process.
D. Reengineer the laboratory work process.
Answer: B
Most candidates will recognize that there is a suggestion of
special cause variation because the process is not longer in
statistical control. A common response is to look for root
causes in the work process in an attempt to reduce the
variation and return the process to statistical control.
However, there are two potential sources of variation: the
measurement process and the work process. Reducing
measurement variation should come first because it
obscures the performance of a work process and masks the
effects of changes.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Coordinate or participate in quality
improvement projects
Question 22 of 26
A multidisciplinary team is using an Activity Network
Diagram to plan the setting up of a Hyperbaric Oxygen
Therapy Unit. What is the most important criterion for this
activity?

A. Good knowledge of the subtasks, their sequencing, and

duration.
B. Experience in the use of Activity Network Diagrams in
similar projects.
C. Involvement of clinical staff, including medical and
nursing staff.
D. A clear problem statement.
Answer: A
The most important criterion for the use of an Activity
Network Diagram is that team members are highly
knowledgeable of the subtasks, their sequencing, and
duration.
Content Category: Performance/Quality Measurement and
Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Coordinate or participate in quality
improvement projects
Question 23 of 26
When using a check sheet to measure the types of
medication errors that occur in a large acute care facility,
why is random sampling of all the patients in the facility not
appropriate?

A. The patient population is non-homogeneous.

B. The patient population is large.
C. The number of patients in the various units differs
significantly.
D. Check sheets should be used on the entire patient
population, and not a sample.
Answer: A
Check sheets are usually used on a sample, not the entire
population.

The patient population should be homogeneous (e.g. similar

in age, type of disease, level of care, etc.) in order for the
observations to be meaningful. If the population is not
homogeneous, then it must first be grouped/stratified, with
each group/stratum sampled individually.

Neither the size of the population nor the size of the sub-
populations (within the units) affects the validity of the
observations if a random sampling technique is used.

Content Category: Information Management

Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Perform or coordinate data collection
methodology (e.g. qualitative, quantitative)
Question 24 of 26
Assuming the measurement instrument is reliable, which of
the following ensures that measurements are almost
identical no matter who does the measuring?

A. One person taking all the measurements

B. An operational definition
C. Close supervision
D. Repeating the measurement for each observation
Answer: B
An operational definition describes what something is and
how it is measured. It helps to ensure that no matter who
does the measuring, the results are almost identical.

Having only one person take all the measurements is not

only impractical in most situations, but is also subject to
variation because the person may change his/her method of
measurement. The latter is more likely to occur in the
absence of an operational definition.

Close supervision may help but there is still ample

opportunity for inter-observer measurement variation if
there is no operational definition.

Repeated measurements for observations will have a

relatively small effect in reducing inter-observer
measurement variation.

Content Category: Information Management

Cognitive level required for a response: Recall
Tasks on the CPHQ exam content outline to which the
Question is linked: Perform or coordinate data definition
activities
Question 25 of 26
Which of the following activities is used to evaluate the
performance of an organization relative to its peers?

A. Gap analysis
B. SWOT analysis
C. Root cause analysis
D. Failure mode and effect analysis
Answer: B
A SWOT (Strengths, Weaknesses, Opportunities, and
Threats) analysis is commonly used in strategic planning to
evaluate the organization's internal and external
environment (including the organization's peers). A gap
analysis, on the other hand, is usually an internal
assessment done to identify performance deficiencies
relative to industry benchmarks.

Root cause analysis and failure mode and effect analysis, in

the context of healthcare, focus on the risks (and their
contributing factors) of the organization, as opposed to
those of its peers.

Content Category: Management and Leadership

Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Facilitate or participate in
organization-wide strategic planning
Question 26 of 26
An improvement team is trying to find a solution to the
rising rate of Methicillin-resistant Staphylococcus
aureus (MRSA) infections. It has identified several factors
that may be constraints.
What should the team do about these factors in the first
instance?
 A. Attempt to eliminate the factors.
B. Conduct tests to confirm the factors are constraints.
C. Develop a solution that ignores the factors.
D. Improve the factors first before addressing the MRSA
infections.
Answer: B
A constraint is a factor that cannot be changed and,
therefore, will limit the number of options that the team can
realistically consider. Examples of true constraints might be
the project's budget, the combined technical ability of team
members, and unwritten rules in the organizational culture.

Before accepting any factor as a constraint, some tests

should be done to confirm that they are real constraints.

Content Category: Performance/Quality Measurement and

Improvement
Cognitive level required for a response: Application
Tasks on the CPHQ exam content outline to which the
Question is linked: Coordinate or participate in quality
improvement projects