CPPS Exam Flashcards

Q: What are the four domains on the CPPS exam blueprint?

Per the CBPPS/IHI Examination Content Outline published September 2024, the CPPS exam covers four domains: Culture (20%), Systems Thinking, Human Factors Engineering, and Design (20%), Safety Risks and Responses (35%), and Performance Measurement, Analysis, Improvement and Monitoring (25%). Safety Risks and Responses is the largest domain, covering risk assessment, harm recognition, barriers to safety, and safety responses.

Q: How many questions are on the CPPS exam and how long do I have?

The CPPS exam has 120 total questions — 100 scored and 20 unscored pretest items mixed in unmarked — administered over 2.5 hours (150 minutes) by computer at a PSI test center or via live remote online proctoring.

Q: What score do I need to pass the CPPS exam?

You need a scaled score of 500 out of a 200-800 range. CBPPS sets the passing score using the criterion-referenced Angoff method, where subject-matter experts estimate item difficulty for a minimally qualified candidate — there is no 'curve' and candidates don't compete against each other.

Q: What happens if I fail the CPPS exam?

You must wait 30 days before retaking it, and you may attempt the exam up to 3 times within a 12-month period. If you fail on your third attempt, you must wait a full year before testing again. The full exam fee applies to every attempt.

Q: How often do I need to recertify as a CPPS, and what does it require?

CPPS certification must be renewed every 3 years, either by completing 45 hours of continuing education that follows the CPPS content outline, or by successfully retaking the exam.

Question 1

Under Marx's Just Culture algorithm, what response fits an inadvertent human error (a slip or lapse)?

Accepted Answer

Console the individual rather than punish them, and investigate the system and process factors that allowed the error to occur. Punishing honest mistakes suppresses reporting and hides system-level risks.

Question 2

Under Just Culture, how should a manager respond to at-risk behavior (a risky shortcut where the person did not perceive the risk)?

Accepted Answer

Coach the individual — increase risk awareness, remove the incentive to drift from the safe process, and reinforce correct behavior. Coaching, not discipline, addresses behavioral drift.

Question 3

Under Just Culture, what response fits reckless behavior (a conscious disregard of a substantial and unjustifiable risk)?

Accepted Answer

Discipline is appropriate, because the individual consciously chose to disregard a known, substantial risk. This is the only one of the three behavior types (error, at-risk, reckless) that warrants punitive action.

Question 4

Define psychological safety in a patient safety context.

Accepted Answer

A shared belief that the team is safe for interpersonal risk-taking — staff can speak up about errors, near misses, or concerns without fear of punishment or humiliation. It is a prerequisite for reliable incident reporting.

Question 5

What distinguishes a 'learning culture' from a culture that merely reports events?

Accepted Answer

A learning culture does not just collect reports — it systematically analyzes events, disseminates findings, and changes the system in response. Reporting without follow-through analysis and action does not improve safety.

Question 6

What is the difference between safety climate and safety culture?

Accepted Answer

Safety climate is a point-in-time snapshot of staff perceptions and attitudes toward safety, usually captured by survey. Safety culture is the deeper, enduring set of shared values, norms, and behaviors that shape how an organization actually manages risk.

Question 7

Name two validated instruments CPPS professionals use to assess an organization's safety culture.

Accepted Answer

The AHRQ Surveys on Patient Safety Culture (SOPS) and the Safety Attitudes Questionnaire (SAQ). Both are used to benchmark culture, target improvement domains, and track change over time.

Question 8

What is 'open disclosure' (a communication and resolution program) after an adverse event?

Accepted Answer

A structured, transparent process of promptly telling patients and families what happened, apologizing where appropriate, and explaining the steps being taken — contrasted with the historical 'deny and defend' approach, which erodes trust and increases litigation risk.

Question 9

Who is a 'second victim' in patient safety, and what does the organization owe them?

Accepted Answer

A healthcare worker who is traumatized by involvement in an unanticipated adverse event. Organizations owe them structured peer support, confidential debriefing, and a non-punitive review process, since staff well-being directly affects future safety performance.

Question 10

How should leadership WalkRounds function as a culture-building tool?

Accepted Answer

Leaders make visible, regular rounds to front-line units, ask staff directly about safety hazards and near misses, and follow up with visible action. The visibility and follow-through — not just the rounding itself — is what builds trust and reporting.

Question 11

What does the SEIPS model (Systems Engineering Initiative for Patient Safety) say determines a care process's safety?

Accepted Answer

Safety emerges from the interaction of the work system's elements — person, tasks, tools/technology, environment, and organization — not from any single element in isolation. Redesigning one element without considering its interactions can create new hazards.

Question 12

In the Swiss Cheese Model, what do the holes in each defensive layer represent, and when does harm occur?

Accepted Answer

The holes represent active failures (sharp-end unsafe acts) and latent conditions (upstream design or management flaws). Harm occurs only when holes in multiple layers momentarily align, letting a hazard trajectory pass through every defense.

Question 13

List the five principles of a High Reliability Organization (HRO), per Weick and Sutcliffe.

Accepted Answer

(1) Preoccupation with failure, (2) reluctance to simplify interpretations, (3) sensitivity to operations, (4) commitment to resilience, and (5) deference to expertise. HROs treat small anomalies as signals of latent system weakness.

Question 14

Distinguish Safety-I thinking from Safety-II thinking.

Accepted Answer

Safety-I focuses on preventing things from going wrong by analyzing failures after the fact (reactive). Safety-II focuses on understanding why things go right most of the time, so the system can adapt under varying conditions (proactive, resilience-based).

Question 15

What is 'normalized deviance' and why is it dangerous?

Accepted Answer

The gradual acceptance of an unsafe shortcut as 'normal' because nothing bad happened the first few times it was used. It is dangerous because risk quietly accumulates until an accident trajectory finally lines up with a rare failure.

Question 16

What is a 'forcing function' in human factors design?

Accepted Answer

A hard physical or software constraint that makes it impossible, not just difficult, to complete an unsafe action — e.g., an IV connector that cannot physically attach to an oxygen line. Forcing functions are a 'strong' safety intervention because they do not rely on human vigilance.

Question 17

How do cognitive load, fatigue, and interruptions relate to error-proneness?

Accepted Answer

They all reduce a clinician's working-memory capacity and attentional resources, raising the likelihood of slips, lapses, and missed steps. Human factors engineering designs workflows to reduce these demands rather than expecting perfect vigilance.

Question 18

How does Marx's model differentiate 'human error' from 'at-risk behavior' from 'reckless behavior'?

Accepted Answer

Human error is inadvertent, with no intent and no risk perceived. At-risk behavior is a conscious drift where the risk is not recognized as substantial. Reckless behavior is a conscious, unjustifiable disregard of a known substantial risk. The distinction drives whether the response is console, coach, or discipline.

Question 19

What is 'usability' as a design consideration in safety-critical technology?

Accepted Answer

How easily and accurately a user can operate a device or system as intended under real working conditions. Poor usability, such as confusing alarms or lookalike interfaces, creates latent conditions that set clinicians up to fail regardless of skill or vigilance.

Question 20

What is resilience engineering's goal in system design?

Accepted Answer

To build systems that can anticipate, monitor, respond to, and learn from both expected and unexpected disruptions — sustaining safe performance even as conditions vary, rather than relying solely on rigid, static procedures.

Question 21

Is FMEA a proactive or a reactive risk-analysis tool?

Accepted Answer

Proactive (prospective) — it identifies and scores potential failure modes for a process before an event occurs, so a team can redesign high-risk steps preemptively.

Question 22

How is the Risk Priority Number (RPN) calculated in FMEA?

Accepted Answer

RPN = Severity x Occurrence x Detectability. Higher RPNs, meaning a worse outcome, more frequent occurrence, and harder detection, get prioritized first for redesign.

Question 23

Is Root Cause Analysis (RCA) a proactive or reactive tool, and what triggers it?

Accepted Answer

Reactive (retrospective) — it is triggered after an adverse event, sentinel event, or serious near miss, working backward to find the underlying system causes rather than just the proximate cause.

Question 24

What is the single biggest practical difference between FMEA and RCA?

Accepted Answer

FMEA analyzes a process before failure happens, for prevention. RCA analyzes an event after it happened, for investigation. Teams often use both — RCA findings can even trigger a targeted FMEA on the redesigned process.

Question 25

What does 'RCA²' (RCA and Actions) add beyond a traditional RCA?

Accepted Answer

It places explicit emphasis on identifying strong, sustainable corrective actions, not just root causes, and on measuring whether those actions actually reduced risk — addressing the common failure of RCAs that produce findings but no lasting fix.

Question 26

Rank these safety interventions from strongest to weakest: double-checks, forcing functions, and policy reminders.

Accepted Answer

Strongest to weakest: forcing functions/automation, then double-checks/redundancy, then training, policy, and reminders. Interventions that do not depend on human memory or vigilance are the most reliable.

Question 27

Define a 'near miss' in patient safety terms.

Accepted Answer

An event or situation that could have resulted in harm but did not, either by chance or through timely intervention. Near misses are treated as valuable, low-cost warning signals of latent system weakness.

Question 28

Define a 'sentinel event.'

Accepted Answer

An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof, that is unrelated to the natural course of the patient's illness. It demands immediate investigation and response, typically an RCA.

Question 29

Define a 'never event' and give an example.

Accepted Answer

A serious, largely preventable adverse event that should never occur if safety systems function correctly — for example, wrong-site surgery or a retained surgical instrument. The National Quality Forum maintains a formal list of these 'serious reportable events.'

Question 30

Name the core elements of a CLABSI (central line-associated bloodstream infection) prevention bundle.

Accepted Answer

Hand hygiene, maximal sterile barrier precautions at insertion, chlorhexidine skin antisepsis, optimal catheter site selection, and daily review of line necessity with prompt removal when no longer needed.

Question 31

Name the core elements of a CAUTI (catheter-associated urinary tract infection) prevention bundle.

Accepted Answer

Insert catheters only for validated indications, use aseptic insertion technique, maintain a closed sterile drainage system, and review necessity daily to remove the catheter as soon as it is no longer needed.

Question 32

Name the core elements of a surgical site infection (SSI) prevention bundle.

Accepted Answer

Appropriately timed prophylactic antibiotics, appropriate hair removal by clipping rather than shaving, maintenance of perioperative normothermia and glycemic control, and skin antisepsis with an appropriate agent.

Question 33

What does the SBAR communication tool structure, and what does each letter stand for?

Accepted Answer

A standardized handoff and escalation format: Situation, Background, Assessment, Recommendation. It reduces ambiguity in urgent clinician-to-clinician communication, a major contributor to sentinel events.

Question 34

What is TeamSTEPPS, and what are its core competency domains?

Accepted Answer

An evidence-based teamwork system from AHRQ and the Department of Defense, built around four core competencies: leadership, situation monitoring, mutual support, and communication — designed to improve team performance and reduce errors in high-risk clinical settings.

Question 35

What do the CUS words signal in a safety escalation, and why are they effective?

Accepted Answer

'I am Concerned, I am Uncomfortable, this is a Safety issue' is a scripted escalation phrase that gives any team member, regardless of hierarchy, a clear, unambiguous way to stop unsafe action. It flattens hierarchy-driven communication failures.

Question 36

Why are transitions of care (handoffs) considered a high-risk point for patient safety?

Accepted Answer

Information can be lost, distorted, or omitted each time responsibility for a patient transfers between providers, shifts, or care settings. Standardized handoff tools, like SBAR, exist specifically to close this gap.

Question 37

What is the Beers Criteria used for, and what are 'high-alert medications'?

Accepted Answer

The Beers Criteria lists medications that carry elevated risk in older adults and should generally be avoided or used with caution. High-alert medications, such as anticoagulants, insulin, opioids, and concentrated electrolytes, are a broader category of drugs that cause disproportionate harm when used in error, warranting extra safeguards like independent double-checks.

Question 38

What are the four steps of a PDSA cycle?

Accepted Answer

Plan (design a small test of change), Do (carry it out), Study (analyze the results against predictions), Act (adopt, adapt, or abandon the change) — a rapid-cycle test-and-learn approach to improvement.

Question 39

What three questions frame the Model for Improvement before running PDSA cycles?

Accepted Answer

(1) What are we trying to accomplish? (2) How will we know a change is an improvement? (3) What change can we make that will result in improvement? These questions set the aim, measures, and change ideas before testing begins.

Question 40

What is the key difference between a run chart and a control chart?

Accepted Answer

A run chart plots data over time against the median to visually detect non-random patterns or trends. A control chart adds statistically calculated upper and lower control limits, letting a team formally distinguish common-cause variation from special-cause variation.

Question 41

Distinguish common-cause variation from special-cause variation in statistical process control.

Accepted Answer

Common-cause variation is routine, expected 'noise' inherent to a stable process — improving it requires redesigning the whole system. Special-cause variation is an unusual, assignable signal, such as a single outlier event, that warrants investigating that specific cause.

Question 42

Differentiate process, outcome, and balancing measures in an improvement project.

Accepted Answer

Process measures track whether the steps intended to produce the outcome are actually being followed, such as hand-hygiene compliance rate. Outcome measures track the ultimate result, such as infection rate. Balancing measures check whether the change caused unintended harm elsewhere in the system.

Question 43

What does the Donabedian model say about evaluating healthcare quality?

Accepted Answer

Quality can be assessed through three linked categories: structure (resources, staffing, facilities), process (what is actually done in care delivery), and outcome (the resulting effect on patient health). Each level should be examined, not just outcomes alone.

Question 44

Why is data stratification important when analyzing safety data?

Accepted Answer

Aggregate rates can mask important differences between units, shifts, patient populations, or providers. Stratifying the data reveals where a problem is concentrated so improvement efforts can be targeted rather than applied uniformly.

Question 45

Distinguish a leading indicator from a lagging indicator in safety performance measurement.

Accepted Answer

A leading indicator predicts future risk and can be acted on proactively, such as near-miss reports or safety rounds completed. A lagging indicator reflects harm that has already occurred, such as infection rate or mortality. Effective programs track both.

Question 46

What is required to sustain an improvement after a successful PDSA test, beyond just adopting the change?

Accepted Answer

Formal change management: standardizing the new process, training staff, building in ongoing monitoring and audit, and adjusting incentives or workflows so the old at-risk behavior does not quietly creep back in.

Question 47

What project-management and facilitation skills does a CPPS-certified professional need for improvement work?

Accepted Answer

Skills to scope and sequence a project, engage and align a multidisciplinary team, run effective meetings, manage resistance to change, and keep stakeholders informed. Technical tools like PDSA fail without these skills to drive adoption.

Question 48

After implementing a safety intervention, what must a CPPS professional do to 'monitor change'?

Accepted Answer

Continue tracking the relevant process, outcome, and balancing measures after go-live to confirm the improvement holds over time and has not introduced a new problem — improvement is not complete at implementation, only at sustained verification.

Question 49

What is the purpose of AHRQ Common Formats and metrics like the AHRQ Patient Safety Indicators (PSIs)?

Accepted Answer

They standardize how patient safety events are defined, collected, and reported across organizations, enabling valid internal trending and external benchmarking against national safety performance.

Question 50

When choosing an improvement methodology, such as PDSA versus Lean versus Six Sigma, what should drive the selection?

Accepted Answer

The nature of the problem and the team's goal. PDSA suits rapid, small-scale tests of an idea; Lean targets waste and flow in a process; Six Sigma targets reducing variation in a high-volume process with strong statistical control needs.

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CBPPS Certified Professional in Patient Safety