The CPHQ Exam Competence Pyramid

When preparing for the CPHQ exam, three things that build on one another are required: basic knowledge in healthcare quality and healthcare quality management, the skills to apply this knowledge, and good study and exam techniques.

One of the questions I get asked the most is: “How do I prepare for the CPHQ exam?”

You might think this is an easy question to answer. In a way, it is – I could just list all the things that people do to prepare for the CPHQ exam (regardless of whether they are effective or not). But I feel uncomfortable doing so because people might actually assume they have to perform all those things to pass the exam.

The good news is that the majority of CPHQ candidates do not need to do very much to pass the exam.

And they certainly do not necessarily need to buy any particular book available on the market to pass the exam (Only the marketers – and misinformed – will tell you that you do. They need to see the data that clearly indicates otherwise!) This piece of information, by the way, answers another common question: “Which book should I buy?”

The bad news is that for me to be able to tell you what you need to do to adequately prepare for the CPHQ exam, with the least possible resources (i.e. effort, time, and money), I will require more than an email with two lines describing your background and your occupation. Sorry.

As a professional CPHQ trainer/coach/mentor, assessing what a person needs to achieve CPHQ status is a serious business.

Since I started professional CPHQ training about 12 years ago, literally thousands of individuals have benefited from my programs. In particular, my flagship CPHQ coaching program has not seen any student score less than 103/125 on the exam. In other words, everyone who has successfully completed my coaching program has passed the exam. A 100% pass rate (!) among my private students. This is even more remarkable when you consider the fact most people with whom I work with (on the CPHQ exam) have had trouble or expect to experience difficulty in passing. (To make best use of my resources, I don’t accept into my private coaching program those whom I believe will be able to pass the exam without my assistance.)

When I think about what I do to assess the needs of my private students (each student receives a customized assessment and action plan), I think others get a raw deal if they are simply told to study a book or try more practice questions. Therefore, since around 2010, I stopped dispensing “one-size-fits-all” advice to persons who are thinking of sitting the CPHQ exam.

It might be OK for others to share how they got themselves ready for the exam – after all, they are dishing out advice based on their experience (a sample size of only 1) and most have the best of intentions. They rarely take into account the circumstances of the individual candidate. There is zero accountability; if the advice is wrong and things don’t work out as expected, no one is going to take responsibility.

I am accountable to my students, as I am to my corporate clients. After all, I am a consultant, so accountability is a big part of what I do every day. Lack of accountability on my part would mean an unsustainable business – I would not have a consulting firm whose business has grown by at least 30% every year since inception (in 2009) and in the face of any challenging macroeconomic environment, even the COVID-19 pandemic. I have to consider very carefully whatever advice I give and provide the best possible counsel to advance the interests of my clients/students (not mine or my firm’s) – my business model relies on a long term relationship, not short term gains.

In summary, I believe it is irresponsible and unethical to answer the question of what someone needs to do to be adequately prepared for the CPHQ exam without knowing quite a lot about the individual.

Nevertheless, I think many people considering how they should plan their CPHQ exam preparation can benefit from a simple model, which I call the CPHQ Exam Preparation Pyramid. This concept, like several others I have developed for tackling the CPHQ certification exam, is deliberately simple but conveys the main point.

The CPHQ Exam Competence Pyramid considers the 3 important areas of CPHQ exam preparation: knowledge, interpretation/application, and study and exam techniques.

The model considers three different areas:

  1. Knowledge: Basic knowledge and skills in quality and quality management in healthcare.
  2. Interpretation/Application: How the knowledge and skills are applied in real-life settings.
  3. Study and Exam Techniques: Methods to help candidates to learn new information quickly and efficiently, and to perform optimally on the actual exam.

It is quite easy to understand; you may even say it’s intuitive.


All candidates need sufficient knowledge and skill in healthcare quality management. Although this may sound obvious, in my experience, it is not always so to many people. Before I started giving Introductory Courses in CPHQ Certification, about half the participants that turned up at my CPHQ exam preparation workshops failed to demonstrate adequate basic knowledge in healthcare quality and healthcare quality management to achieve a passing score on the exam. I suspect many of these people either overestimated their abilities, had an inaccurate perception of the level of difficulty of the CPHQ exam and/or overestimated my ability to get them from the level they were at to CPHQ-material in 3 days. If you don’t have the fundamentals correct, you will not go very far.

Even if you manage to pass the exam by fluke (as many do), you will not be able to perform on the job and, believe me, this problem will be detected quickly. If your deficiencies are discovered, your career may reach a roadblock instead of progressing (the latter usually being the reason why people pursue the CPHQ credential in the first place). Without being able to add value to employers, you may even be an unemployed CPHQ.

The acquisition of knowledge in healthcare quality is usually through work experience, not college courses or reading books.

Some people have a notion that reading a book or two is all they need to pass the exam. A book may help to fill gaps in knowledge, but usually people need to have a practical understanding of healthcare quality management in the first place for the content of the book to make much sense. At least in my experience, a working knowledge of healthcare quality concepts among persons thinking of sitting the CPHQ exam is often sadly lacking. No matter what book is used, a complete novice in the field is unlikely to gain much benefit from reading that book alone.

A college course in quality management may be helpful, but the content is usually too theoretical to be of much use for the CPHQ exam, which is practice-based. (Reminder: the CPHQ exam is a professional exam, not a college exam.)

So how does a novice without any work experience learn more about healthcare quality and healthcare quality management? What if they were not in a position to gain real-life experience? My solution for such cases is to provide a more practical approach to teaching/learning healthcare quality, one that has a balance between examples from my experience working with diverse organizations and providing the essential theoretical knowledge in order to get his/her fundamentals strong.

I believe most adult learners will benefit from training that bridges what they already know and what they need to know for the exam. Just ask people like Dr Aparna Sundar how quickly and effectively I can teach the basics in healthcare quality management in my Healthcare Quality 101 course. Some people may not be complete novices but may also not be sure if they have enough knowledge and experience. Evaluation of how much such individuals know – and don’t know – with respect to the CPHQ exam content outline is as much an art as it is a science. This assessment is critical because it affects what I recommend in terms of an action plan.


Having attained all the necessary fundamental knowledge is not good enough to pass the exam; the candidate also needs to be able to apply the knowledge. This includes being able to interpret various quantitative data (results), and to use judgment when making decisions.

This is where books fail terribly. Books are generally poor in helping candidates apply theoretical knowledge. Work experience in the field is far more useful. Without the required work experience, candidates will need alternative ways of learning how to apply their theoretical knowledge.

Impossible? No.

I have successfully taught people with zero or limited work experience how to apply general information through a series of exercises, which are proprietary. (All of them who went on to take the CPHQ exam passed.)

Study/Exam Techniques

Some people may have both strong fundamentals and ability to apply their knowledge. But they still struggle to pass the exam because of poor study and/or exam techniques. Their methods are antiquated and ineffective; they might have worked 10 or 20 years ago when these people were in college or school but not for a professional exam, such as the CPHQ exam.

Many of my students tell me that they had never considered or come across the methods that I teach. More importantly, they report that they believed these methods helped them achieve their passing score.

Each Area Builds on One Another

Before you are able to apply knowledge, you need to acquire the knowledge. Before you are able to use fancy study and exam techniques, you need to have the necessary knowledge and know how to apply it. My model above builds on itself.

My approach is contrary to what a lot of people do. Many people start their CPHQ exam preparation journey by attempting practice questions (perhaps with the assumption that they have the fundamentals in the bag) and/or using “clever” tricks (almost certainly a bad first move in the long term). No endeavor will go the full distance without the basics being right.

CPHQ Exam Preparation Requires Strategy

When people give a recommendation of what book to study for the CPHQ exam (and not much else), it’s what I call a tactic. It is short-term and does not fit into anything else in the overall approach to getting prepared for the exam and passing it. It’s certainly not my style and I don’t recommend or practice it.

CPHQ exam preparation is like a game of chess.

I think about CPHQ exam preparation more like a game of chess. Each move is part of an overall strategy; it builds on previous moves. Every move is deliberate, planned at least a few steps ahead, and has a clear purpose. And just as a good chess player is always in control of the game, a good CPHQ candidate should always be in full control of his/her exam preparation.

The difference between a chess game and the CPHQ exam is this: in chess, your opponent may actually be a better player than you; the CPHQ exam, on the other hand, has a fixed level of difficulty and is surmountable in 99% of cases.


Each individual CPHQ candidate is different. Each candidate’s abilities and needs, in terms of the CPHQ exam, are different. Nevertheless, every candidate needs three things: basic knowledge in healthcare quality and healthcare quality management, the skills to apply this knowledge, and sound study and exam techniques. These three things build on one another.

Dr Andy Teh is the Founder, Owner and Principal of Teh & Associates, and is recognized as a leading thinker on CPHQ exam preparation. For more information on the Healthcare Quality 101 Course conducted by Dr Teh, or any of the other training programs mentioned in this article, please send us an email.

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