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Within the Performance and Process Improvement domain, the NAHQ CPHQ exam stresses the importance of data validation and trend analysis before taking corrective or disciplinary action. A single month of performance data is insufficient to determine whether an observed gap represents a true performance issue, random variation, or an isolated anomaly.

The NAHQ competency framework emphasizes that quality professionals must use longitudinal data to identify patterns and establish baseline performance. Reviewing three to four months of data allows the manager to assess consistency, variation, and potential contributing factors before intervening. This approach supports fair evaluation and avoids premature conclusions.

Talking privately with the provider (Option A) or discussing findings publicly (Option D) without adequate data may undermine trust and credibility. Encouraging medical assistants to complete screenings (Option C) bypasses accountability and does not address whether the provider issue is systemic or temporary. The correct next step is to analyze additional data over time, ensuring that any subsequent action is evidence-based and aligned with improvement principles. This methodical approach reflects NAHQ expectations and is commonly tested on the CPHQ exam.

According to the NAHQ CPHQ exam blueprint, aligning safety culture with improvement requires transparent communication and staff engagement. Sharing and discussing safety culture survey results helps staff understand strengths, weaknesses, and priorities for improvement.

Option B is correct because debriefing staff promotes organizational learning, fosters trust, and encourages frontline involvement in safety initiatives. This supports a just culture and aligns improvement activities with identified cultural gaps.

Option A reinforces blame rather than learning. Option C addresses survey logistics rather than alignment. Option D may discourage reporting and undermine safety culture.

The CPHQ framework consistently emphasizes feedback and dialogue as essential for strengthening safety culture and sustaining improvement.

Sentinel events usually result from process failures—breakdowns or variations in how care is delivered, such as communication failures, procedural lapses, or system errors (The Joint Commission, Sentinel Event Policy, 2024; AHRQ, Patient Safety and Quality, 2023).

While staffing and competence impact care, process issues are more commonly root causes.

Structure refers to physical or organizational infrastructure, less commonly the direct cause.

Implementing a new electronic health record (EHR) system in an outpatient clinic often introduces challenges that impact patient safety and workflow. NAHQ CPHQ study materials emphasize that post-implementation evaluation should focus on identifying barriers to effective use, as these can undermine the system’s benefits, such as improved medication safety and care coordination. Common metrics in such evaluations include system-related medication errors, help desk calls, downtime events, overrides, workarounds, and staff complaints, which reflect user experience and system performance.

Since the chart is not provided, I’ll base the answer on typical CPHQ scenarios for EHR implementation. The options suggest the chart includes data on e-prescribing stability, system-related medication errors, help desk calls, downtime events, overrides, workarounds, and complaints. Option D, “Overrides, workarounds, and complaints indicate there are underlying barriers to use,” aligns with a common finding in EHR post-implementation reviews. Overrides (e.g., bypassing alerts), workarounds (e.g., using paper notes instead of the EHR), and complaints typically signal usability issues, such as a poorly designed interface, inadequate training, or system inefficiencies. These barriers can lead to errors, staff frustration, and reduced patient safety, requiring targeted interventions like workflow redesign or additional support.

Option A, “While e-prescribing processes are now stable, additional training is needed to improve staff competency,” assumes e-prescribing stability, which may not be supported without specific chart data showing consistent performance (e.g., no recent errors). It also assumes training is the primary issue, which isn’t directly indicated without evidence of competency gaps. Option B, “There is a strong positive correlation between system-related med errors and help desk calls,” requires specific data showing a statistical correlation (e.g., both metrics trending together), which cannot be confirmed without the chart. Option C, “Minimal IT-related med errors and downtime events indicate that the system has improved patient safety,” assumes low error and downtime rates, but the presence of overrides, workarounds, and complaints (implied by option D) suggests ongoing safety risks, contradicting this conclusion. NAHQ emphasizes identifying and addressing barriers to EHR adoption to ensure patient safety, making option D the most likely conclusion based on typical post-implementation challenges.