CPHQ Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

Add the department-level raw data behind each measure as an appendix: More detail adds volume, not clarity; the board still cannot see direction.

Show a few strategic measures trended against targets and benchmarks: Correct. Trends over time against targets and benchmarks answer the board's question, and a short strategic set keeps attention on oversight rather than operations.

Color-code each of the 45 measures red, yellow, or green against target: Status colors show this quarter only and keep all 45 measures; they still do not show trends.

Replace the measures with narrative summaries from each department: Narrative alone loses the data the board needs to judge performance.

Board quality reports should show a few strategic measures over time against targets and comparisons, so trustees can see direction and act.

Answer: C

1. Weighted score = (3 × safety) + (2 × alignment) + (1 × feasibility).
2. Falls reduction: 15 + 4 + 2 = 21 points.
3. Discharge timing: 6 + 10 + 5 = 21 points.
4. Medication reconciliation: 12 + 8 + 3 = 23 points.
5. ED throughput: 9 + 6 + 4 = 19 points.
6. Medication reconciliation ranks first (23 points); recommend it as the top priority, with falls reduction and discharge timing tied for second.

12 points — discharge timing: Adds the raw scores without the weights (2 + 5 + 5 = 12), so the heavily weighted safety criterion counts no more than feasibility.

21 points — falls reduction: Picks the project with the top score on the heaviest criterion; its weighted total of 21 is below 23.

23 points — medication reconciliation: Correct. 3(4) + 2(4) + 1(3) = 12 + 8 + 3 = 23, the highest weighted total; falls reduction and discharge timing both score 21 and ED throughput 19.

27 points — discharge timing: Reverses the weights (feasibility ×3, safety ×1): 2 + 10 + 15 = 27.

In a weighted prioritization matrix, multiply each criterion score by its weight and add the products; unweighted totals ignore what leaders said matters most.

Answer: A

Transport and pharmacy account for 70% of delays and should be the focus: Correct. The Pareto principle directs effort to the vital few categories; the first two bars account for 70% of delays.

Transport delays alone account for most of the delayed discharges: Transport is the largest category at 42%, which is less than half.

Family availability should come first because it is likely the easiest fix: Choosing by ease ignores what the Pareto chart shows; this category is only 7%.

The discharge process is out of control because one reason exceeds 40%: A Pareto chart has no control limits; it cannot show whether a process is stable.

A Pareto chart sorts categories in descending order with a cumulative line so the team can focus on the vital few.

Answer: C

1. RPN = severity × occurrence × detection.
2. Failure mode 1: 9 × 1 × 8 = 72.
3. Failure mode 2: 5 × 8 × 3 = 120.
4. Failure mode 3: 6 × 5 × 5 = 150.
5. Failure mode 4: 10 × 2 × 4 = 80.
6. Failure mode 3 has the highest RPN (150), so it is addressed first; many teams also act on any failure mode with a very high severity regardless of RPN.

Failure mode 1: Has the highest sum (9 + 1 + 8 = 18), but the RPN multiplies the ratings: 9 × 1 × 8 = 72.

Failure mode 2: Has the highest S × O (40) when detection is left out; the full RPN is 5 × 8 × 3 = 120.

Failure mode 3: Correct. RPN = S × O × D = 6 × 5 × 5 = 150, the highest of the four (72, 120, 150, 80).

Failure mode 4: Has the highest severity (10), but its RPN is 10 × 2 × 4 = 80.

RPN = S × O × D; rank failure modes by RPN, not by a single rating or a sum.

Answer: C

Awareness: Nurses already understand why the change is needed.

Desire: Nurses say they want to use the tool, so desire is present.

Knowledge: Correct. Awareness and desire are present, but staff cannot describe the steps; knowledge of how to change is the next gap.

Ability: Ability (performing the skill in practice) comes after knowledge of what to do.

ADKAR moves in order: Awareness, Desire, Knowledge, Ability, Reinforcement; address the first missing element.

Answer: C

Raise the overall target from 78% to 85% for every patient group: A higher overall target does not focus effort on the group with the gap.

Exclude the Spanish-speaking group from the measure as an outlier: Removing the group hides the disparity instead of fixing it.

Find barriers with Spanish-speaking patients and test targeted changes: Correct. The Spanish-speaking group is 22 points below English speakers with an adequate sample; co-designing targeted changes and tracking the stratified rate addresses the gap directly.

Add reminder calls for all patients and keep tracking the overall rate: A universal change can raise the overall rate while the gap persists, and the overall rate would not show it.

Act on disparities with targeted, co-designed changes for the affected group and keep monitoring the stratified measure.

Answer: A

Administrative claims linked with laboratory results data: Correct. Claims identify every member with diabetes across all clinics, and linked lab results show which members are poorly controlled.

Chart abstraction from one large clinic in the network: One clinic's charts miss members seen elsewhere.

Member satisfaction survey results from last year: Surveys measure experience, not clinical control, and reach only respondents.

Hospital discharge summaries for admitted members: Covers only members who were hospitalized.

Population health views need data that reach the whole defined population, such as claims combined with clinical data.

Answer: D

No signal is present, because no points fall outside the upper or lower limits: A run chart has no control limits; run-chart rules (shift, trend, runs) are used instead.

A trend is present, showing that counts are still falling: A trend needs 5 or more consecutive points all going down (or up); after week 10 the counts go up and down.

More baseline data are needed before any run-chart rule can be applied: Ten baseline points are enough to set a median and apply the rules.

A shift is present, indicating a non-random change after the new process: Correct. Weeks 10 through 18 are 9 consecutive points below the baseline median, more than the 6 needed for a shift, so the drop is unlikely to be random and coincides with the new triage process.

Run chart rules: shift = 6 or more consecutive points on one side of the median; trend = 5 or more consecutive increases or decreases; also check the number of runs and astronomical points.

Answer: D

Investigate December as a special cause before making any change: December is inside the limits and triggers no run rule; investigating it as special cause chases common-cause variation.

Add the sessions now, because December shows access is getting worse: Reacting to one month within the limits is tampering; nothing shows a real deterioration.

No action is needed, because every point is within the control limits: Stable does not mean acceptable: the process averages 12 days, above the 10-day target.

December is common-cause variation; redesign the process to lower its average: Correct. All points are within the limits with no run-rule signal, so the process is stable at about 12 days. Because that average misses the 10-day target, a fundamental change to the scheduling system is needed, not a reaction to one month.

A stable process that misses its target needs system redesign; reacting to individual common-cause points is tampering.

Answer: C

1. O/E for each unit = observed deaths ÷ expected deaths.
2. W: 8 ÷ 6 = 1.33; X: 5 ÷ 4 = 1.25; Y: 18 ÷ 24 = 0.75; Z: 9 ÷ 10 = 0.90.
3. Crude rates for comparison: W 2.0%, X 3.3%, Y 6.0%, Z 3.6%; these ignore case mix.
4. Interpretation: O/E < 1 means fewer deaths than expected. Unit Y (0.75) performs best relative to risk; W and X perform worse than expected despite low counts or crude rates.

Unit W: Has the lowest crude mortality (8 ÷ 400 = 2.0%), but its O/E is 8 ÷ 6 = 1.33: more deaths than its low-risk case mix predicts.

Unit X: Has the fewest deaths (5), but raw counts ignore volume and risk; O/E = 5 ÷ 4 = 1.25, worse than expected.

Unit Y: Correct. O/E = 18 ÷ 24 = 0.75, the lowest ratio: 25% fewer deaths than its high-risk patients predicted, even though it has the most deaths and the highest crude rate.

Unit Z: Better than expected (O/E = 9 ÷ 10 = 0.90), but not as far below 1.0 as Unit Y.

Compare risk-adjusted performance with the O/E ratio: below 1.0 is better than expected, above 1.0 worse. Crude rates and raw counts mislead when case mix differs.

Answer: D

1. RPN = Severity × Occurrence × Detection.
2. Original RPN for hemolysis not recognized: 7 × 5 × 4 = 140.
3. New RPN with occurrence 2: 7 × 2 × 4 = 56.
4. Reduction: 140 − 56 = 84 points.
5. Interpretation: at 56 this failure mode falls below wrong-patient label (9 × 3 × 4 = 108), transport delay (5 × 8 × 3 = 120) and wrong test code (6 × 3 × 7 = 126), so the team would address wrong test code next; re-rate after the change is in place to confirm the effect.

3: Uses the sum of the ratings instead of the product: (7 + 5 + 4) − (7 + 2 + 4) = 16 − 13 = 3.

21: Leaves detection out of both RPNs: (7 × 5) − (7 × 2) = 35 − 14 = 21.

56: This is the new RPN (7 × 2 × 4 = 56), not the reduction from the original 140.

84: Correct. Original RPN 7 × 5 × 4 = 140; new RPN 7 × 2 × 4 = 56; reduction 140 − 56 = 84 points.

RPN = S × O × D, so a control that lowers one rating lowers the RPN in proportion; recalculate all three ratings after a change and re-rank the failure modes.

Answer: D

Preoccupation with failure: Means treating small failures and near misses as warning signs; the scenario is about who makes the decision.

Reluctance to simplify: Means resisting simple explanations of complex problems; not the focus here.

Sensitivity to operations: Means awareness of what is happening on the front line now. The nurse has this awareness, but the principle shown is moving the decision to her.

Deference to expertise: Correct. Decision authority moves to the person with the most relevant knowledge, regardless of rank, which is deference to expertise.

The five HRO principles: preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, deference to expertise.

Answer: A

Coach the nurse and examine why skipping the check has become common: Correct. Choosing to drift from a rule because the risk seems justified or normal is at-risk behavior: coach the individual and remove the system incentives (workload, check design) that make the drift common.

Console the nurse, because skipping the check was an inadvertent human error: Human error is an unintended slip or lapse; this was a conscious choice to skip a step, so it is at-risk behavior.

Begin formal discipline, because a required safety step was skipped: Sanction is for reckless behavior (conscious disregard of a substantial, unjustifiable risk); drift that has become the unit norm is at-risk behavior.

Take no individual action, because no harm reached the patient: Just Culture judges the behavior, not the outcome; the lack of harm does not change the response.

Just Culture: human error → console; at-risk behavior → coach and fix system incentives; reckless behavior → sanction. Judge the behavior, not the outcome.

Answer: C

1. O/E ratio = observed events ÷ expected events.
2. 9 infections ÷ 6.0 expected = 1.50.
3. A ratio above 1.00 means more events than expected for this case mix.
4. O/E 1.50 is worse than expected; compare it with the medical staff's OPPE threshold to decide whether focused review is triggered.

O/E = 0.67; better than expected: Divides expected by observed (6 ÷ 9), which reverses the ratio.

O/E = 1.50; better than expected: The ratio is right but the direction is wrong; above 1 means more infections than expected.

O/E = 1.50; worse than expected: Correct. O/E = 9 ÷ 6.0 = 1.50; observed infections exceed the risk-adjusted expected number, so the result is worse than expected and may meet the medical staff's trigger for focused review.

O/E = 3.00; worse than expected: Uses the difference (9 − 6 = 3) instead of the ratio.

O/E = observed ÷ expected; above 1 is worse than expected, below 1 is better.