[2024年11月]更新のCPHQ問題集PDFでCPHQリアル試験問題解答
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質問 # 122
Accountability for quality ultimately rests with the
- A. quality manager.
- B. governing body.
- C. department leader.
- D. CEO.
正解：B
解説：
Accountability for quality ultimately rests with the governing body of a health care organization, such as the board of directors or trustees. The governing body is responsible for setting the vision, mission, values, and strategic goals of the organization, as well as overseeing its performance, compliance, and risk management. The governing body also appoints, evaluates, and supports the CEO, who is accountable to the governing body for implementing the organization's strategy and ensuring quality and safety throughout the organization.
The quality manager, the CEO, and the department leader are all important roles in ensuring quality within their respective scopes of authority and responsibility, but they are not the ultimate source of accountability for quality. The quality manager is responsible for designing, coordinating, and evaluating quality improvement initiatives, as well as providing education, training, and support to staff and leaders on quality methods and tools. The CEO is responsible for providing leadership, direction, and oversight to the organization's operations, finances, and culture, as well as ensuring alignment and integration of quality across all functions and levels. The department leader is responsible for managing the daily activities, resources, and performance of a specific unit or service, as well as ensuring compliance with quality standards and policies within their area of responsibility.
However, none of these roles can ensure quality without the support, guidance, and accountability of the governing body, which has the ultimate authority and responsibility for the organization's quality and safety. The governing body sets the tone and expectations for quality at the top, and holds the CEO and other leaders accountable for delivering quality outcomes and improving quality processes.
The governing body also monitors and evaluates the organization's quality performance and improvement efforts, and ensures that the organization has the necessary resources, structures, and systems to support quality. The governing body also ensures that the organization engages with external stakeholders, such as regulators, accreditors, payers, and patients, to demonstrate its commitment and accountability for quality.
Reference: NAHQ Code of Ethics, Principle 1: The healthcare quality professional acts as a change agent and leader within the organization and community, promoting a culture of excellence in quality, safety, and performance outcomes.
NAHQ Learning Lab: The Role of the Healthcare Quality Professional in Population Health Management, Module 1: Introduction to Population Health Management, Slide 9: The Role of the Governing Body NAHQ Journal for Healthcare Quality, Volume 41, Issue 2, March/April 2019, Article: The Role of the Board in Quality and Safety Performance: Perceptions of Board Members and Quality Leaders, Page 72:
Abstract and Page 77: Discussion
質問 # 123
An organization Is shirting paradigms from top-down leadership to participatory management. The process of moving forward Includes the four Identified phases below:
1. gathering baseline data
2. evaluating effectiveness and Improvement
3. making the commitment
4. Implementing the program
Which of the following Is the most logical sequence for these phases?
- A. B. 1.3.2.4
- B. 3.4.1.2
- C. 1.2,4,3
- D. 3.1,4.2
正解：D
解説：
* The most logical sequence for the phases of shifting from top-down leadership to participatory management is to start with making the commitment, then gathering baseline data, implementing the program, and evaluating effectiveness and improvement.
* Making the commitment is the first step because it involves creating a shared vision, setting goals and objectives, and securing support and resources for the change process12. Without a clear and strong commitment, the other steps may not be feasible or successful.
* Gathering baseline data is the second step because it helps to assess the current situation, identify the gaps and needs, and establish a baseline for comparison and measurement13. Data can be collected from various sources, such as surveys, interviews, observations, and records, and can cover aspects such as organizational culture, performance, quality, satisfaction, and costs13.
* Implementing the program is the third step because it involves putting the plan into action, engaging and empowering the staff and stakeholders, and monitoring andadjusting the process as needed14. Implementation can be done in phases, pilots, or trials, depending on the scope and complexity of the program14.
* Evaluating effectiveness and improvement is the fourth step because it helps to measure the outcomes, impacts, and benefits of the program, compare them with the baseline data and the goals and objectives, and identify the strengths, weaknesses, and areas for improvement15. Evaluation can be done using quantitative and qualitative methods, such as indicators, metrics, feedback, and stories, and can be conducted at different levels, such as individual, team, and organizational15.
References: 1: Participatory Leadership for Health 2: Quality improvement and person-centredness: a participatory mixed methods study to develop the 'always event' concept for primary care 3: Why healthcare leadership should embrace quality improvement 4: PARTICIPATIVE MANAGEMENT IN HEALTH CARE SERVICES 5: [Utilization of Improvement Methodologies by Healthcare Quality Professionals During the COVID-19 Pandemic]
質問 # 124
There is a story of an intensive care unit (ICU) at Dominican Hospital in Santa Cruz Country, California.
Dominican, a 379-bed community hospital, is part of the 41-hospital Catholic Healthcare West system. "We used to replace ventilator circuit for incubated patients daily because we thought this helped to prevent pneumonia," explained Lee Vanderpool, vice president. "But the evidence shows that the more you interfere with that device, the more often you risk introducing infection. It turns out it is often better to leave it alone until it begins to become cloudy, or 'gunky,' as the no clinicians say." The hospital staff learned an important lesson from this experience that:
- A. Intuition is more powerful than evidence
- B. Introduction of a new protocol, or any new idea, involves education
- C. Efforts improve mortality rate
- D. Evidence is more powerful than intuition
正解：D
質問 # 125
In healthcare, many terms call for more precise operational definitions that how do an organization define the terms
such as:
- A. An accurate environmental compliance
- B. Qui turnaround time
- C. A patient fall (a partial fall, a fall with injuries, or an assisted fall)
- D. Surgical end time
正解：B、C
質問 # 126
If you decided to interview ten patients in your emergency room on a given day and drew conclusions about your
emergency services from these people. You have taken limited data and made a huge jump in logic. This jump is
known as:
- A. Over-generalization
- B. Quota sampling
- C. Stereotyping
- D. Ecological fallacy
正解：D
質問 # 127
This example shows the relationship between:
- A. A concept and specific measures
- B. Effectiveness and concept
- C. Specific measures and specific indicators
- D. Specific indicator and milestone
正解：A
質問 # 128
The best way a healthcare organization can measure whether it is meeting its goals and targets is to compare its performance:
- A. Benchmarking
- B. With the world's top healthcare organizations
- C. Against itself over time
- D. With other healthcare organizations of its status
正解：A
質問 # 129
Which of the following Is the best example of effective learning in a learning organization?
- A. management team taking a posttest after reading a bulletin on a regulatory standard
- B. staff watching a video on how to complete a patient admission assessment
- C. management team auditing staff performance after a training program
- D. staff using the results of a root cause analysis to change processes and improve patient safety
正解：D
解説：
A learning organization is one that facilitates the learning of its members and continuously transforms itself. The best example of effective learning in such an organization is when the staff uses the results of a root cause analysis to change processes and improve patient safety. This is because it involves learning from past mistakes, implementing changes based on what was learned, and improving future outcomes, which is the essence of a learning organization.
Reference: NAHQ Code of Ethics
The Role of the Healthcare Quality Professional in Population Health Management Utilization of Improvement Methodologies by Healthcare Quality Professionals during the COVID-19 Pandemic
質問 # 130
Once you have resolved these issues, the data collection should go smoothly. Unfortunately, many quality improvement teams do not spend sufficient time discussing their data collection plans. They want to move immediately to data collection step.
This haste usually guarantees that the team will:
- A. Reschedule the time and cost
- B. Collect the wrong data
- C. Collect too much (or too little) data
- D. Become frustrated with the entire measurement journey
正解：B、C、D
質問 # 131
Why is it important to convene a multidisciplinary team when conducting a failure mode and effects analysis (FMEA)?
- A. so that all steps in the process are captured and evaluated
- B. so the effective evaluation of the proposed changes may be accomplished
- C. to help distribute the workload involved in a FMEA
- D. to gain buy-in from senior leadership
正解：A
解説：
A Failure Mode and Effects Analysis (FMEA) is a systematic method used to identify potential failures in a process and assess their impact.
Convening a multidisciplinary team is crucial for the following reasons:
Comprehensive Process Understanding:
A multidisciplinary team brings together diverse expertise, ensuring that all aspects of the process are considered. Different professionals can provide insights into various steps that may not be evident to others.
Capturing All Potential Failures:
Each discipline involved in the process can identify specific failure modes that others might overlook.
For instance, a nurse might identify different potential issues in patient care compared to a pharmacist or a physician.
Holistic Evaluation:
The presence of various disciplines ensures that both clinical and non-clinical aspects of the process are evaluated. This thorough evaluation is critical in identifying all potential risks and mitigating them effectively.
Avoiding Blind Spots:
By involving a multidisciplinary team, the FMEA is less likely to miss critical steps or potential failure points, leading to a more robust and effective analysis.
Other options like gaining buy-in, evaluating proposed changes, or distributing workload are important but secondary to the primary goal of ensuring a comprehensive evaluation of all process steps in the FMEA.
Reference: NAHQ Guide to Risk Management and Patient Safety
NAHQ Healthcare Quality Competency Framework: Process Improvement
質問 # 132
_________________ refers to the "degree to which individuals and groups are able to obtain needed services."
- A. Access
- B. Responsiveness to patient preferences
- C. Amenities
- D. Equity
正解：A
質問 # 133
______________ can be measured by how well evidence-based practices are followed, such as the percentage of time diabetic patients receive all recommended care at each doctor visit, the percentage of hospital-acquired infections, or the percentage of patients who develop pressure ulcers (bed sores) while in the nursing home.
- A. Effective care
- B. Timely care
- C. Equitable care
- D. Safe care
正解：A
質問 # 134
Interpersonal relationships are the fundamental part of a management system. They basically coordinate activities of
different departments in a unit. What is the role of Interpersonal relationships in Healthcare delivery systems?
- A. Promotion of cordial relationships
- B. It relates to Medical Ethics
- C. Clinicians who relate well to their patients are more likely to elicit a more complete and accurate history from their
patients - D. None of the above
正解：C
質問 # 135
An effective method to increase an organization's board of directors engagement in patient safety is to
- A. foster teamwork and good communication at all levels of the organization and conduct training for both of these skill sets.
- B. guide them through a recent failure mode and effects analysis (FMEA) that was conducted prior to the launch of a new technology.
- C. structure the board agenda so that quality and safety are given the same amount of attention as financial issues.
- D. focus on improvement projects that are important to the medical staff in the organization.
正解：C
解説：
To increase the board of directors' engagement in patient safety, structuring the board agenda to give quality and safety the same amount of attention as financial issues is the most effective method. This ensures that patient safety is a priority at the highest level of organizational governance, signaling its importance to the entire organization. It also provides the board with regular, detailed updates on safety initiatives, outcomes, and areas needing attention.
Fostering teamwork and communication (A): While important, this approach is more relevant to operational levels rather than engaging the board directly.
Focusing on improvement projects important to the medical staff (C): This can enhance engagement, but broader board engagement is better achieved through strategic prioritization of quality and safety.
Guiding them through a recent FMEA (D): This is valuable for education, but not as impactful for ongoing engagement compared to consistently prioritizing safety on the board's agenda. Reference NAHQ Body of Knowledge: Governance and Leadership in Quality Improvement NAHQ CPHQ Exam Preparation Materials: Board Engagement in Quality and Safety
質問 # 136
An organization's culture is best assessed by examining the
- A. collaboration of medical staff and administration.
- B. involvement of each patient care department in strategic planning.
- C. behavioral alignment with the core values.
- D. number of performance improvement activities.
正解：C
解説：
An organization's culture is best assessed by examining the behavioral alignment with its core values.
Culture is reflected in how closely the actions, decisions, and behaviors of employees at all levels align with the organization's stated values. When there is strong alignment, it indicates a cohesive culture that reinforces the organization's mission and vision. Conversely, a disconnect between behaviors and core values can signal cultural issues that need to be addressed.
Collaboration of medical staff and administration (B): Collaboration is important but is just one aspect of culture.
Number of performance improvement activities (C): The quantity of activities doesn't necessarily reflect cultural values or behaviors.
Involvement of each patient care department in strategic planning (D): While important, involvement in planning is more related to governance and strategy than to overall culture.
Reference
NAHQ Body of Knowledge: Organizational Culture and Core Values
NAHQ CPHQ Exam Preparation Materials: Assessing and Aligning Organizational Culture
質問 # 137
A healthcare organization had three medication incidents associated with narcotics. None of the events led to permanent loss of function or death, but could be considered near misses. Which of the following would be the best tool to use to identify influencing factors?
- A. root cause analysis (RCA)
- B. proactive risk assessment
- C. report from electronic health record (EHR)
- D. nominal group technique
正解：A
解説：
In the case of three medication incidents involving narcotics that were near misses, the best tool to identify influencing factors is a Root Cause Analysis (RCA). RCA is a systematic process used to investigate and understand the underlying causes of adverse events or near misses. The goal is to identify contributing factors and underlying system issues that need to be addressed to prevent future occurrences. RCA is particularly suited for situations where an incident has already occurred and the organization needs to understand how and why it happened.
* Report from electronic health record (EHR) (A): While EHR data can provide useful information, it is not a tool for identifying root causes of incidents.
* Proactive risk assessment (C): This would be more appropriate before incidents occur, not after near misses.
* Nominal group technique (D): This is a group decision-making process and is less suited for detailed analysis of incidents compared to RCA.
References
* NAHQ Body of Knowledge: Root Cause Analysis in Incident Investigation
* NAHQ CPHQ Exam Preparation Materials: Incident Analysis Tools
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質問 # 138
Payers are more likely to embrace the optimization definition of care which can put them at odds with:
- A. Physicians
- B. Clinicians
- C. Health administrators
- D. Both A & B
正解：D
質問 # 139
__________ is a term applied when the proper clinical car process is not executed appropriately, such as giving the wrong drug to a patient or incorrectly administering the correct drug.
- A. Misuse
- B. Underuse
- C. Overuse
- D. Illegal use
正解：A
質問 # 140
A focused professional practice evaluation (FPPE) Is Initiated
- A. during the survey corrective action period.
- B. annually for all providers on staff.
- C. when new privileges are granted.
- D. at the discretion of the chief medical officer (CMO).
正解：C
解説：
A Focused Professional Practice Evaluation (FPPE) is a process used to assess a practitioner's competence in performing specific privileges, including new ones1234. This process is initiated when a practitioner is granted new privileges1234. The FPPE process is designed to ensure that practitioners can competently perform the privileges requested at the organization1. It is also used when there is a question about a currently privileged practitioner's ability to provide safe, high-quality patient care1. The FPPE process must be predefined and consistently implemented for all newly requested privileges1. The period of FPPE begins at the time privileges are granted1.
Reference: 1234
質問 # 141
Which of the following tools should be used to determine the root cause of variations in a process?
- A. Ishikawa diagram
- B. histogram
- C. scatter plot
- D. Shewhart chart
正解：A
解説：
The Ishikawa diagram, also known as a fishbone diagram or cause-and-effect diagram, is the best tool to determine the root cause of variations in a process. This diagram helps teams visually map out all potential causes of a problem, categorizing them into major factors such as methods, machinery, materials, and people.
By exploring these potential causes systematically, teams can identify the root causes of variations and focus their improvement efforts accordingly.
* Histogram (A): A histogram is used to display the distribution of data points but does not help in identifying root causes.
* Shewhart chart (C): Also known as a control chart, it monitors process stability over time but is not specifically for root cause analysis.
* Scatter plot (D): A scatter plot shows relationships between two variables but does not identify root causes of variations.
References
* NAHQ Body of Knowledge: Root Cause Analysis Tools in Quality Improvement
* NAHQ CPHQ Exam Preparation Materials: Using Ishikawa Diagrams for Root Cause Analysis
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質問 # 142
Stratification is the separation and classification of data into reasonably homogenous categories. It allows
understanding of differences in the data caused by all of the following EXCEPT:
- A. Day of the week
- B. Area of facility
- C. Type of order
- D. Time of the day
正解：B
質問 # 143
The percentage of patients with congestive heart failure who are receiving an ACE inhibitor is an example of retrospective measure. The use of ACE inhibitors in the population is indicated for all patients with an ejection fraction of less than 40 percent. The ejection fraction is not part of the typical administrative database.
Sometimes the information is contained:
- A. In a stand-alone database in cardiology department and is generated in accessible
- B. In a worksheet
- C. In an ERP system
- D. In a separate computer record
正解：A
質問 # 144
Generally, effective performance measurement benefits organizations in the following way/s EXCEPT:
- A. Illustrate improvement
- B. Provides factual evidence of performance
- C. Promotes ongoing organization self-evaluation and improvement
- D. Helps to meet internal patients' care requirements
正解：D
質問 # 145
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 t his project ?
- A. A knowledgeable staff member who works best on defined tasks
- B. A competent staff member who has good interpersonal skills
- C. A newly hired staff member who has demonstrated competence and has time to complete the task
- D. A motivated staff member who is actively seeking promotion
正解：B
質問 # 146
Basically an operational definition is a description in quantifiable terms, of what to measure and the specific steps needed to measure it constantly.
A good operational definition (Choose two):
- A. Is no doubt clear but somewhat ambiguous
- B. Enables consistently in data collection
- C. Gives communicable meaning to a concept or an idea
- D. Is a decision-making criteria
正解：B、C
質問 # 147
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