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Why Most People Won’t Become CPHQs

The International Certified Professional in Healthcare Quality (CPHQ) credential is widely regarded as the paragon for healthcare quality management. People pursue it—or at least think of pursuing it—for a variety of reasons: career advancement, job security, higher income, professional development, networking opportunities, etc. These are all good reasons for attaining CPHQ status.

But many people don’t make it. Why?

After years of observing people who go on to pass the CPHQ exam and others who don’t, I believe the answer is a simple one.

And, in case you have zero interest to become a CPHQ, you may find that my thoughts on this matter apply to many other aspects of life which require decision making regarding change with at least moderate consequences for yourself. This could include interpersonal relationships, financial investments, career change, etc.

The Case of Why Not

Whenever I meet CPHQ candidates for the first time, or people who are considering to take the CPHQ exam, I ask them (among other things) why they want to become CPHQs—I like to understand what motivates them and it’s a way of warming up the conversation. Typical answers are summarized in the first paragraph above.

I used to think that one or more of the following reasons represented the main motivator(s) for CPHQ candidates:

  • To be recognized for their expertise in healthcare quality management;
  • To be in line for a promotion or at least to save their job; or
  • To be part of a fraternity and to meet people with similar interests.

I was wrong. Perhaps my assumption came from my own experience—each of these three factors played a role in my quest to become a CPHQ despite the challenges (which I share below).

While it’s true that some people are driven by these factors, for the vast majority, these things are not motivators. They are merely inspirators—things that give people a short-lived “(s)timulation of the mind or emotions to a high level of feeling or activity”. These inspirators often fail to provide sustained motivation to study the text on a regular basis, attend courses, try practice questions, join discussion groups, etc. in preparation for the CPHQ exam.

Why this phenomenon occurs has been of great interest to me in the last year or so.

Despite the diversity of people who consider sitting the CPHQ exam (in terms of professional training, nationality, years of work experience, work responsibilities, organizational rank, etc.), the Achilles heel for most people is strikingly similar. So much so that I’ve concluded this must be a symptom of the human condition.

At some (usually early) stage in the process of working toward the CPHQ credential, these individuals introduce the question of why NOT to take the CPHQ exam, and the answers to this question become their overwhelming reasons (at least in their mind) of why they should not sit the exam—I call this line of thinking “The Case of Why Not”—it’s counter-intuitive, self-deprecating and absolutely non-productive.

I’ll give you a hypothetical (but realistic) scenario:

Trained as a nurse, Michelle is a mid career healthcare quality professional of a hospital. She finds herself quite dissatisfied with her current job situation—lack of challenging work, lack of career and promotion prospects, and on a comparatively low pay. Someone tells her that if she obtains the CPHQ credential, she’ll be eligible for a promotion, or she could seek other interesting job opportunities. Being certified in healthcare quality management would almost certainly mean that she’ll have more meaningful work, greater recognition of her skills, and better compensation for her work. Most importantly, Michelle would have earned herself respect.

Then The Case of Why Not creeps in: “Why shouldn’t I take the exam?”

Michelle builds quite an ominous list of possible answers:

  1. Because I won’t be able to afford the time to study—I’ve got a husband and two kids to look after
  2. Because I don’t know if I’ll pass the exam (i.e. I don’t think I’ll pass the exam)
  3. Because I should be doing a Masters course instead
  4. Because no one I know is a CPHQ
  5. Because no one is going to guarantee me a better job if/when I become a CPHQ
  6. Because I don’t know if I can afford all the preparatory materials
    etc.

So she eventually decides that pursuing the CPHQ status is not such a good idea after all and abandons the plan completely.

I would have thought a more intuitive approach would be to figure out how to (vs how not to) pass the exam and to identify potential obstacles and figure out ways to manage them.

I had my fair share of challenges while preparing for the exam, which included:

  • Juggling a full-time job and family commitments
  • A work environment that was far from conducive to preparing for a professional certification exam (and that’s putting things lightly)
  • A debilitating illness that saw me lose more than 15 kg, or nearly 18% of my body weight
  • Being an international candidate, who had some, but limited, exposure to the US healthcare system
  • No one else in my country had taken the CPHQ exam and passed. I could not speak with anyone (face-to-face) about their experience preparing for and taking the exam.

But I developed an action plan that dealt with those things and executed the plan methodically. As they say, the rest is history.

The following diagram illustrates an intuitive approach.

Intuitive Approach

In truth, the majority of these individuals talk themselves out of joining the CPHQ program. They introduce The Case of Why Not and enter a mindset that prevents any progress toward the goal:

Counter-Intuitive Approach

“Why would any person do this?”, you might ask. I suspect there are two key problems:

  1. Fear of Failure
  2. Fear of Work

Both these fears might not have reached pathological proportions, in which case they’d be called Atychiphobia and Ergophobia respectively. It’s precisely because these fears are not fulminant that they often go unnoticed and they might even be considered “normal”.

Fear of Failure

Singaporeans and Malaysians use the term kiasi, a Hokkien word which literally translated means “afraid of death”, to describe an attitude or behaviour that implies risk avoidance. Though difficult to find an English language equivalent, the term kiasiism certainly applies to many individuals who have decided not to pursue the CPHQ credential.

Embarrassment of failing exams (or not doing well in them) is common among Asian cultures, and this certainly plays a part. I know of some senior staff members who have avoided the CPHQ exam for fear of possibly failing it and thus suffer the (perceived) ignominy.

IF everyone was guaranteed a passing score for the CPHQ exam, and was therefore granted freedom from the possibility of failure (and the fear of failure), it might be a completely different matter altogether—I’m confident that The Case of Why Not would disappear. Most individuals would then recall the reasons for them wanting to sit the exam in the first place, and proceed to do the necessary work. Which leads me to the other fear—the Fear of Work.

Fear of Work

IF people considering the CPHQ exam were told that they were guaranteed a passing score AND there was no minimal preparatory work involved, even more would attempt the exam. The Case of Why Not may still afflict some people but I suspect this would be extremely rare.

Call it the human condition, but my observation is that many people have an aversion to work, no matter what the circumstances. I call this a “fear” of work but it might simply be a “strong dislike”—in either case, the observed behaviour associated with the emotion is work avoidance to the extent possible.

Unfortunately, without some work (the exact amount of which depends on your relevant experience, training, expertise, etc), you are not likely to pass the CPHQ exam.

“Everybody wants to go to heaven. Nobody wants to die.”

Summary

Ultimately, people tend to build the framework in their life to create the right conditions to meet their goals, which in turn determines their results. It’s a self-programmed path of inevitability. If your goal is to attain the CPHQ credential, you will get there. However, if your overriding goal is to shield yourself from a sense of failure, to feed your aversion to work, or some other factor that led you to conclude you should not sit the CPHQ exam, then you will never become a CPHQ.

In the words of Henry Ford, “Whether you believe you can, or you can’t, you are right.”

Andy Teh, CPHQ
Motivated

{ 27 comments… add one }
  • Lim Zhi Yi November 10, 2010, 2:46 pm

    Dear Dr Andy,

    Thanks for sharing your detail analysis/study of this particular human behavior in relation to persuing CPHQ status; In my humble opinion, i would relate this to procrastination- the behavior pattern of procratination can be triggered in many different ways, more obvious reason is because most people (e.g. like Michelle) are overwhelmed with too much on their plates, and perhaps procrastination is a way to escape; in addition to the two key problems that you’ve mentioned above: “Fear of Failure and fear of work”.

    I am glad that now you are the real live model who is available and capable in helping those who are thinking of persuing CPHQ status, thank you for the excellence job that you’ve done! Personally i completely agree with you for all those good reasons for attaining CPHQ status, may be advice to overcoming procrastination is what some people really needed.

    Zhi Yi, Lim

    • Andy Teh November 26, 2010, 5:13 pm

      @Lim Zhi Yi—Thank you. I apologise for the delay in replying; I’ve taken some time to consider your comments. We might be describing two sides of the same coin. Being overwhelmed by practical concerns may be a genuine problem. But it is also a good reason to pursue the CPHQ credential – it certainly broadens your horizon and therefore helps you get out of a rut. Despite the necessary investments in time, effort and money, developing new skills (while acquiring an internationally recognized credential) is almost certainly a good thing… another arrow in your quiver, if you like. Procrastination is common—I think it’s a symptom of a few possible things—perfectionism (or perhaps kiasiism), lack of drive, lack of proper guidance/coaching/training, etc. Some of these things are easier to tackle than others. Mindset is often a difficult issue. Nevertheless, I’m constantly reminded of the words of St Thomas Aquinas:

      “To convert someone, go and take them by the hand and guide them.”

      By coaching people—guiding them by the hand—I guess I help to take away their fear of failure and of work.

      As the winner of our recent lucky draw contest, you will have the opportunity to learn first hand how to pass the CPHQ exam with relative ease using our proprietary methods. You’ll benefit from a simple, structured and efficient approach – at no financial cost to you!

      • D January 1, 2017, 1:41 am

        Hi Andy. Do you have any advice for those considering the certification but do not currently hold clinical roles?

        • Andy Teh January 1, 2017, 2:21 pm

          @D—A clinical position is not a prerequisite for CPHQ certification, and clinical experience is probably not necessary to pass the certification exam, though it may be helpful if you’re looking at a quality position.

          To be clear, there are two separate issues here:

          1. CPHQ certification. Most people who succeed use little, if any, of their clinical knowledge or skills to help them pass the exam—the CPHQ exam tests concepts related to healthcare quality and patient safety; and
          2. What you do after being certified. Let’s be honest, the vast majority of people who take the CPHQ exam want the certification to advance their career in some way. This is where I think those with clinical experience, e.g. nurses, have an advantage over candidates who don’t. If you’re interested in the field of healthcare quality, you could benefit from learning terms and concepts commonly used in clinical work. And develop special skills (e.g. statistics, communicating with medical staff, compliance requirements) that are valued by potential employers. I know of some highly effective (and, therefore, successful) non-clinical CPHQs.
  • ALABI June 21, 2011, 8:06 pm

    i am motivated by this write up,i have known of CPHQ since 2009,even bought an online study material but has constantly postponed preparing for and writing the exams…thank you for the school of hard knocks.

    • Andy Teh June 24, 2011, 6:29 pm

      @ALABI—You should be aware that the CPHQ exam content outline has changed since 2009 and, therefore, the material you purchased two years ago may no longer be relevant.

      • Shadia Al Zaatari March 25, 2013, 1:56 am

        Dear Andy,
        Thank you for this comprehensive and very logical analysis and hypothesis.
        I have passed the CPHQ Exam 2 days ago and it was my first time to sit for this exam. To me, there is nothing in the world called impossible, and “when there is a will, there will always be a way” and this what makes the difference among people. We just need to believe in our selves and we can make miracles out of a mere belief and will….

        And yes, it is very true what Henry Ford has said, “Whether you believe you can, or you can’t, you are right.” …. Its all a matter of believing…

        Finally, allow please to note that there is a newly published series of very useful books that I have used as a reference for studying the CPHQ related materials, they are called “Q Solutions”. They are recommended by NAHQ on their website as one of the study materials for CPHQ exam.
        Thank you again and I wish all CPHQ applicants the best of luck

        When you BELIEVE, you ACHIEVE

        Shadia Al Zaatari

        • Andy Teh March 25, 2013, 10:04 pm

          @Shadia Al Zaatari—Congratulations on passing the exam! Thank you for letting us know about your certification and for sharing your experience with Q Solutions. I’ve recommended the book in the past—to be used as a reference text, not to “study” from. However, our experience is that, no matter what book(s) candidates decide to use, the overall pass rate (among our fairly large and growing sample) doesn’t vary much. I interpret this finding to mean that any reasonable book in healthcare quality will likely provide a similar contribution to the candidate’s exam result.

  • J.K January 14, 2016, 5:35 am

    Hi Andy, great post! I also saw a screenshot of your post by another certified CPHQ on another website, you are definitely inspiring!
    Would you please contact me through email? I would like more details on this CPHQ program and its elaborate details, I’m not sure if it is a right fit for me, although I am highly interested in it

    • Andy Teh January 17, 2016, 11:04 am

      @JK—ALL the information you need about the CPHQ program can be found in the CPHQ Candidate Examination Handbook. We will be happy to answer specific questions, especially ones about CPHQ exam preparation, but you should contact the Healthcare Quality Certification Commission (HQCC) directly for general information.

  • naz April 12, 2016, 7:25 am

    i really have lot of passion for quality and i did work hard for exam . I gota score of 86 at my first attempt. Am really disappointed as i feey i did good and was expecting to pass. but i don’t know why i could not make it and just missed by 6 more questions to be right like six more questions right and i could have been there .

    • Andy Teh April 13, 2016, 12:09 am

      @naz—You might like to consider using CPHQ Tutor for a couple of months. It will raise your score for your next attempt at the CPHQ exam for a nominal fee. Our methods are slightly unorthodox but extremely effective, as evidenced by the thousands of paid subscribers over the past 7 years who went on to become CPHQs and leaders in the healthcare quality field.

  • candace nunley June 6, 2016, 6:41 pm

    Can LPN sit for this test, or RN only. I have been told I am “JUST LPN” for so long I have had it up to my eye balls…… I am in management now, however I feel I could always grow. this could be a great opportunity.

    • Andy Teh June 7, 2016, 3:24 am

      @Candace—Being an LPN is not a barrier to becoming a CPHQ, i.e. you are eligible to take the CPHQ certification examination. If you pass this exam, you will be deemed certified. However, you should also be aware that passing the exam requires a degree of knowledge and skill in healthcare quality management. Read our article “Am I Eligible to Take the CPHQ Examination?” to learn more.

  • Varun July 3, 2016, 12:04 pm

    Hello Team,
    It would be great if you can advise me the benefits of having CPHQ certificate as I am a Physiotherapist.

    When I did research I found the advantage like Career Advancement, Job Security, Higher Income, Professional Development, Networking opportunity etc.. But they didn’t elaborate these information.

    I believe the certification is for all officials in the medical industry!! so how the certificate and training will differ.

    Awaiting your advise at the earliest.

    Varun
    9663271949
    [email protected]

    • Andy Teh July 5, 2016, 2:48 pm

      @Varun—Individuals pursue CPHQ certification for different reasons. You’ve mentioned a few—one or more may apply for any particular individual. According to the Healthcare Quality Certification Commission (HQCC), “The purpose of certification in the healthcare quality field is to promote excellence and professionalism. The program certifies individuals who demonstrate they have acquired a body of knowledge and expertise in this field by passing a written international examination. The CPHQ designation provides the healthcare employer and the public with the assurance that certified individuals possess the necessary skills, knowledge and experience in healthcare quality to perform competently.” In essence, certification shows that you have the necessary knowledge and skills in the field. The ability to demonstrate one’s knowledge and skills may be valuable (i) personally (external validation of their knowledge, skills, and expertise; self-actualization) and (ii) professionally.

      At a professional level, CPHQ certification may be beneficial because:

      1. Some organizations, mainly in the US, require their staff who hold quality positions to be CPHQ certified (e.g. you need to be certified within, say 2 years, to stay in the job);
      2. Some job ads require or prefer candidates to be CPHQ certified. In other words, you don’t get an interview, let alone land the job, if you aren’t certified;
      3. In some organizations, a CPHQ will be given more responsibilities than a person who isn’t CPHQ-certified (because the organization in general, and the CPHQ’s boss in particular, understandably believes a CPHQ is more likely than a non-CPHQ to do the job more satisfactorily, e.g. more effectively, more efficiently, faster, etc.);
      4. Because of his/her greater responsibilities (and presumably special and externally validated skills) (see the previous point, i.e. 3, above), the individual will be in a position to attract a higher income, compared to a non-CPHQ, all else being equal; and
      5. Being CPHQ-certified provides some networking opportunities because, if people trust you know your stuff and that stuff is important to them in some way, they will tend to want to connect with you at some level. For example, I get a few e-mails per day from people I’ve never met asking me either about the CPHQ exam or to help them pass the CPHQ exam, presumably because I am CPHQ-certified and I’ve been coaching healthcare providers to CPHQ status for years. I can’t imagine receiving this number of enquiries if I didn’t have the CPHQ credential. (Disclosure: I should make it clear that your Inbox is unlikely to be inundated with e-mails about the CPHQ exam if/when you become certified; my situation is unique not only because I’m a CPHQ and a CPHQ coach— other important factors include: over 20 years of clinical experience, US and international healthcare experience, global consulting experience in healthcare quality and patient safety, pioneering work in CPHQ coaching and CPHQ exam preparation, unique presentation and communication skills, a long and distinguished track record of successfully helping individuals achieve CPHQ certification despite all sorts of challenges, to name a few. Some may use more superlative terms to describe my skill set but I’ll leave it as described for now. Bottomline: The CPHQ credential is important, but it’s only part of the story!)

      Almost “anyone” is eligible to take the CPHQ certification exam, but I suggest sufficient consideration be given to the amount of preparation required. The passing rate is less than 50% among non-US candidates.

      I’m not sure what you mean by the certificate and training being different. A summary of the CPHQ program is provided by the HQCC—see above. Preparation for the certification may or may not involve formal education or training, e.g. seminars, workshops. Preparation for the CPHQ exam may also be informal, e.g. on-the-job learning. In reality, most candidates who eventually become CPHQ certified have some experience in healthcare quality and/or patient safety. This experience is helpful as they prepare for the CPHQ certification exam. Outside the US, the field of healthcare quality is still developing, i.e. in most places, the level of knowledge and skills in quality is substantially lower than that in the US (on average) even if those healthcare providers (outside the US) are extremely competent in their clinical work. There are some exceptions, e.g. we know a number of healthcare quality professionals outside the US who are very skilled (and highly effective). In general though, most candidates outside the US require some training and/or guidance or mentoring to pass the CPHQ certification examination.

  • fehmeeda begum November 5, 2016, 9:49 pm

    Hi sir, iam planning to write CPHQ exam this December 2016. My questions are: 1) do you have any online classes. 2) one month is enough for preparation – currently iam not working. Please suggest me which resources I can used for passing CPHQ.

  • Prof.Matiur Rahman November 23, 2016, 5:03 am

    Excellent and well researched piece of writing.
    I am still not sure that ABHRQ certification has equal importance and recognition in Quality circles .

    • Andy Teh November 29, 2016, 12:40 pm

      @Prof.Matiur Rahman—I’ve not heard of “ABHRQ”, so I’m not in a position to comment on it. However, I do know many employers find the CPHQ certification desirable, sometimes essential, for their quality positions.

  • Darrel January 9, 2017, 4:08 pm

    Hi. How can you acquire an accredited CE hours for recertification for ‘international’ holder of CPHQ? Thanks.

    • Andy Teh January 10, 2017, 12:54 am

      @Darrel—All CPHQs, regardless of whether they took their exam in the US or elsewhere, are required to fulfill the same continuing education (CE) requirements to maintain certification. The CE requirements are the same regardless of where the CPHQ resides, in the US or elsewhere. There are a number of ways to earn CE—see the latest version of the CPHQ Recertificant Recertification Handbook (the NAHQ/HQCC hasn’t updated it in 2017 yet). If you’re asking how to earn CE through “approved” training events, the HQCC is quite clear on this matter: “Any course, conference, seminar, or summit that aligns with the content outline is acceptable.” Needless to say, all training programs provided by Teh & Associates are aligned with the most current CPHQ exam content outline.

  • Naz January 12, 2017, 4:35 pm

    Dear Dr Andy I finally got my cphq and off course using ur website was very useful.you are inspiring

    • Andy Teh January 13, 2017, 12:52 pm

      @Naz—Congratulations on passing the CPHQ exam! I’m delighted we contributed to your success.

      Your name sounded familiar, so I looked it up and found your previous comment about not passing the exam in the first half of 2016—I’m really pleased the CPHQ Tutor website helped to not only elevate your score on CPHQ exam, compared to your previous attempt, but also give you a passing score!

  • aKOUVI August 3, 2017, 3:13 pm

    I am interested in CPHQ, and I need a help to decide. Thanks.

    • Andy Teh August 4, 2017, 8:51 pm

      @aKOUVI—The decision on whether to pursue the CPHQ credential is entirely yours to make. We can help by answering any questions you might have about the CPHQ program.

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