CPHQ questions - Certified Professional in Healthcare Quality (CPHQ) Updated: 2023
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Exam Code: CPHQ Certified Professional in Healthcare Quality (CPHQ) questions November 2023 by Killexams.com team|
CPHQ Certified Professional in Healthcare Quality (CPHQ)
The content validity of the CPHQ examination is based on a practice analysis which surveys healthcare quality professionals on the tasks they perform as a part of their job. Each question on the exam links directly to one of the tasks listed in the content outline. Each question is designed to test if the candidate possesses the knowledge necessary to perform the task and/or has the ability to apply it to a job situation.
1. Organizational Leadership (35 items)
A. Structure and Integration
1. Support organizational commitment to quality
2. Participate in organization-wide strategic planning related to quality
3. Align quality and safety activities with strategic goals
4. Engage stakeholders to promote quality and safety (e.g., emergency preparedness, corporate compliance, infection prevention, case management, patient experience, provider network, vendors)
5. Provide consultative support to the governing body and clinical staff regarding their roles and responsibilities (e.g., credentialing, privileging, quality oversight, risk management)
6. Facilitate development of the quality structure (e.g., councils and committees)
7. Assist in evaluating or developing data management systems (e.g., data bases, registries)
8. Evaluate and integrate external best practices (e.g., resources from AHRQ, IHI, NQF, WHO, HEDIS, outcome measures)
9. Participate in activities to identify and evaluate innovative solutions and practices
10. Lead and facilitate change (e.g., change theories, diffusion, spread)
11. Participate in population health promotion and continuum of care activities (e.g., handoffs, transitions of care, episode of care, outcomes, healthcare utilization)
12. Communicate resource needs to leadership to Improve quality (e.g., staffing, equipment, technology)
13. Recognize quality initiatives impacting reimbursement (e.g., pay for performance, value-based contracts)
B. Regulatory, Accreditation, and External Recognition
1. Assist the organization in maintaining awareness of statutory and regulatory requirements (e.g., CMS, HIPAA, OSHA, PPACA)
2. Identify appropriate accreditation, certification, and recognition options (e.g., AAAHC, CARF, DNV GL, ISO, NCQA, TJC, Baldrige, Magnet)
3. Assist with survey or accreditation readiness
4. Participate in the process for evaluating compliance with internal and external requirements for:
a. clinical practice guidelines and pathways (e.g., medication use, infection prevention)
b. service quality
d. practitioner performance evaluation (e.g., peer review, credentialing, privileging)
e. gaps in patient experience outcomes (e.g., surveys, focus groups, teams, grievance, complaints)
f. identification of reportable events for accreditation and regulatory bodies
5. Facilitate communication with accrediting and regulatory bodies Certified Professional in Healthcare Quality Detailed Content Outline1
C. Education, Training, and Communication
1. Design performance, process, and quality improvement training
2. Provide education and training on performance, process, and quality improvement (e.g., including improvement methods, culture change, project and meeting management)
3. Evaluate effectiveness of performance/quality improvement training
4. Develop/provide survey preparation training (e.g., accreditation, licensure, or equivalent)
5. Disseminate performance, process, and quality improvement information within the organization
2. Health Data Analytics (30 items)
A. Design and Data Management
1. Maintain confidentiality of performance/quality improvement records and reports
2. Design data collection plans:
a. measure development (e.g., definitions, goals, and thresholds)
b. tools and techniques
c. sampling methodology
3. Participate in identifying or selecting measures (e.g., structure, process, outcome)
4. Assist in developing scorecards and dashboards
5. Identify external data sources for comparison (e.g., benchmarking)
6. Collect and validate data
B. Measurement and Analysis
1. Use data management systems (e.g., organize data for analysis and reporting)
2. Use tools to display data or evaluate a process (e.g., Pareto chart, run chart, scattergram, control chart)
3. Use statistics to describe data (e.g., mean, standard deviation, correlation, t-test)
4. Use statistical process control (e.g., common and special cause variation, random variation, trend analysis)
5. Interpret data to support decision-making
6. Compare data sources to establish benchmarks
7. Participate in external reporting (e.g., core measures, patient safety indicators, HEDIS bundled payments)
3. Performance and Process Improvement (40 items)
A. Identifying Opportunities for Improvement
1. Facilitate discussion about quality improvement opportunities
2. Assist with establishing priorities
3. Facilitate development of action plans or projects
4. Facilitate implementation of performance improvement methods (e.g., Lean, PDCA, Six Sigma)
5. Identify process champions
Certified Professional in Healthcare Quality
Detailed Content Outline1
B. Implementation and Evaluation
1. Establish teams, roles, responsibilities, and scope
2. Use a range of quality tools and techniques (e.g., fishbone diagram, FMEA, process map)
3. Participate in monitoring of project timelines and deliverables
4. Evaluate team effectiveness (e.g., dynamics, outcomes)
5. Evaluate the success of performance improvement projects
6. Document performance and process improvement results
4. Patient Safety (20 items)
A. Assessment and Planning
1. Assess the organization's culture of safety
2. Determine how technology can enhance the patient safety program (e.g., electronic health record (EHR), abduction/elopement security systems, smart pumps, alerts)
3. Participate in risk management assessment activities (e.g., identification and analysis)
B. Implementation and Evaluation
1. Facilitate the ongoing evaluation of safety activities
2. Integrate safety concepts throughout the organization
3. Use safety principles:
a. human factors engineering
b. high reliability
c. systems thinking
4. Participate in safety and risk management activities related to:
a. incident report review (e.g., near miss and real events)
b. sentinel/unexpected event review (e.g., never events)
c. root cause analysis
d. failure mode and effects analysis
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Certified Professional in Healthcare(R) Quality (CPHQ)
Which of the following are hardware components that would be included in a
computerized management information system?
A. Binary and decimal coding
B. Flow chart and program
C. Instructions and data
D. Printer and random access memory
Which of the following monitors provides patient outcome information?
A. Nosocomial infection rate
B. Degree of compliance with nursing care documentation
C. Degree of compliance with renewal of antibiotics therapy
D. Equipment malfunction rate
One major difference between traditional quality assurance (QA) and quality
improvement (QI) is that QI:
A. Stresses peer review, while QA focuses on the customer
B. Focuses on the individual, while QA focuses on the process
C. Stresses management by objective, while QA stresses team management
D. Focuses on the process, while QA focuses on individual performance
Measures of central tendency describe the:
A. Typical or middle data point
B. Extent to which the data points are scattered
C. Type and number of classes for dividing the data
D. Average distance of any point in the data set from the mean
The following represents two samples of five hospitals hysterectomy rates per 1,000
women aged 40-60 years of age:
Rates Mean Standard Deviation
Sample A 3, 5, 7, 8, 5 5.6 1.8
Sample B 4, 5, 6, 7, 5 5.4 1.1
In analyzing this information, it can be concluded that:
A. sample A has more variability than sample B
B. sample As performance is superior to sample Bs
C. There are more cases in sample B
D. There is a data collection error in sample B
The primary benefit of adopting a countrywide or global uniform set of discharge data is
A. Facilitate computerization of data
B. Validate data being collected from other sources
C. Facilitate collection of comparable health information
D. Assist medical records personnel in collecting internal data
I n order to perform a task for which one is held accountable, there must be an equal
balance between responsibility and:
A patient was in the operating room when a piece of a surgical instrument broke off and
was left in the patients body. The patient was readmitted for removal of the foreign
object. Which of the following would most likely apply in this situation?
A. Res ipsa loquitur
B. Contributory negligence
C. Contractual liability
D. Tort liability
Which of the following types of budgets itemizes the major equipment to be purchased in
the next year?
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 this project?
A. A newly hired staff member who has demonstrated competence and has time to
complete the task
B. A knowledgeable staff member who works best on defined tasks
C. A motivated staff member who is actively seeking promotion
D. A competent staff member who has good interpersonal skills
A surgeons wound infection rate is 32%. Further examination of which of the following
data will provide the most useful information in determining the cause of this surgeons
A. Mortality rate
B. Facility infection rate
C. Use of prophylactic antibiotics
D. Type of anesthesia used
The separate services of Pharmacy and Nursing are having difficulty developing an
action plan for medication errors. Pharmacy Services states that Nursing Services causes
the majority of the problems related to errors, while Nursing Services states the opposite.
The quality professionals role in resolving this problem is to:
A. Provide them with directives on how to solve the problem
B. Facilitate discussion between the groups to enable them to assume ownership of their
portions of the problem
C. Assign the task to an uninvolved manager
D. Refer the problem to the facility wide quality council
Which of the following is most likely to be a benefit of concurrent ambulatory surgical
A. Decreased medical record review at discharge
B. An increase in the number of cases failing screening criteria
C. An increase in reviewer competence
D. Decreased employee turnover
The primary purpose of an emergency preparedness program is to
A. Conduct evaluations of emergency training
B. Provide evaluations of semiannual evacuation drills
C. Prevent internal disasters that disrupt the facilitys ability to provide care and
D. Manage the consequences of disasters that disrupt the facilitys ability to provide care
According to Joint Commission standards, the safety program must include all of the
A. Monthly safety committee meetings
B. Planned response to natural disasters
C. Orientation and continuing education on safety issues
D. Review of safety policies and procedures for all departments
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Therapist answering questions from a client
Are you on the fence about going to see a therapist? Is talking something that gives you a lot of anxiety? If so, you can calm your nerves by knowing your therapist understands the apprehensiveness of starting therapy. Usually, weâve been on the other side of the notebook and get what it feels like to be a client. We also know itâs natural to be nervous at your first appointment with a new therapist because we were, too!
Before you meet with them, you may have thoughts like, âWhat will they be like,â or âWill it be a good fit,â or you might even question, âIs therapy right for me?â These are all valid things to consider, but as you prepare for your session, try to come up with questions to ask your therapist. But are you supposed to ask your therapist questions?
Are You Supposed To Ask Your Therapist Questions?
Absolutely! Therapy isnât all about listening; itâs a safe space to ask your therapist questions about your assessment, treatment and diagnosis. We want you to ask us questions so you can give informed consent to participate in the therapy process. This means that you understand the facts, risks, benefits, alternatives and consequences of therapy, allowing you to make an independent, well-researched decision.
I start every initial session by asking clients if thereâs anything they want to know about me, my office, different treatment styles, and other subjects related to their mental health care. Some people come to their first appointment knowing exactly what they want to work on, while others may need a bit more guidanceâthatâs what weâre here for.
Asking questions is a part of developing the therapeutic relationship with your provider, which some experts say influences how successful therapy services areâand I agree. The professional relationship is significant because it determines your trust in your therapistâs ability to provide quality care. Plus, since youâre spilling out all your deepest and darkest secrets to them, you need to know theyâre a safe person to do so with.
5 Questions Your Therapist Wants You To Ask
1. "What is therapy?"
Asking about the basics of therapy is a question to ask during a consultation with your therapist or at your first appointment. As I mentioned, understanding this is part of giving informed consent to participate in mental health treatment. Other questions you might ask related to this are:
Despite the myths portraying mental health treatment as something bad, going to therapy is very beneficial for everyoneâno matter what youâre looking to get help for. You should leave your first session feeling more confident than you left in your progress and with a solid understanding of therapy.
2. "Can you rephrase that?"
The language therapists use during a session might not make sense to you, and thatâs normal! If theyâre throwing around a bunch of clinical terms or jargon, itâs okay to stop them and ask what they mean. However, if you have to ask this question at every session, you may need to discuss whether the therapistâs treatment style is a good fit for you. Psychoeducation is an essential part of therapy, but thereâs a big difference between learning something and feeling confused after every session.
For example, I use a lot of metaphors, analogies, and other types of stories with clients to help them relate to the concept weâre learning about. Sometimes, the metaphor might have a clear meaning to me but not to my client. Taking the time to explain what I mean rather than jumping to another example helps my clients comprehend it better and allows me to know how they learn best.
3. "Have you been in therapy before?"
Youâve probably heard that you shouldnât ask your therapist personal questions; the answer to this question isnât a simple yes or no. All therapists must follow a code of conduct, which serves as the framework of what we ethically should or shouldnât do in a session or talk about with clients. And while keeping a separation between our personal and professional lives is important, we want you to know weâre human and not some clinical robot that only cares about insurance and scheduling.
That said, asking your therapist a personal question, like if theyâve been in therapy before, is pretty basic. It can be incredibly validating to know that your therapist has life experience with their services, creating a sense of connection and empathy.Â
So, you can absolutely ask, but they may or may not answer it depending on whether they believe it is or isnât in the best interest of your therapeutic relationship.
4. "Can I schedule another appointment?"
Sometimes, life happens in between sessions. When stress arises and you need more support, donât hesitate to contact your therapist and ask for an additional appointment. We want to know that sessions are helping, which is one way we can measure the effectiveness of our interventions. Every therapist has different policies and availability, but this should be something you discuss at your first appointment. Plus, knowing how to schedule your regular sessions or additional appointments ensures you maintain a consistent therapeutic routine, something thatâs vital to help you progress in therapy.
5. "What do I do if I feel like it isnât a good fit?"
Out of all the questions your therapist wants you to ask, this one is the most important. If you ever feel that the connection between you and your therapist isnât working, itâs necessary to address it.
However, you should always, always, always communicate. Ghosting isnât cool for anyone. Simply sharing how you feel helps you leave on good terms, which is what we always strive for. I tell clients that I would rather have a brief, awkward moment if it means that theyâll feel satisfied and comfortable with whatever their concerns are.
Itâs our job to listen, so know that your therapist wants you to be open and honest with them. When you are, we can help you address the issue and explore solutions like modifying your treatment plan, referring you to a different therapist, or clearing up a miscommunication.
Are you thinking about seeking the help of a therapist? If certain issues have been causing problems in your life and you aren't sure how to make the necessary changes, therapy can help. With the help of a professional, you can get out of an unhealthy cognitive, emotional, and behavioral pattern.
Fill out the following questionnaire truthfully, paying special attention to the specified time period to which the questions refer. The results will only be helpful if you answer in an honest and complete manner.
This test is intended for informational and entertainment purposes only. It is not a substitute for professional diagnosis or for the treatment of any health condition. If you would like to seek the advice of a licensed mental health professional you can search Psychology Today's directory here.
The WHO has called for action to integrate physical activity promotion into healthcare settings, yet there is a lack of consensus on the competencies required by health professionals to deliver effective movement behaviour change support. The objective of this study was to establish key competencies relevant for all health professionals to support individuals to change their movement behaviours. Consensus was obtained using a three-phase Delphi process. Participants with expertise in physical activity and sedentary behaviour were asked to report what knowledge, skills and attributes they believed health professionals should possess in relation to movement behaviour change. Proposed competencies were developed and rated for importance. Participants were asked to indicate agreement for inclusion, with consensus defined as group level agreement of at least 80%. Participants from 11 countries, working in academic (55%), clinical (30%) or combined academic/clinical (13%) roles reached consensus on 11 competencies across 3 rounds (n=40, n=36 and n=34, respectively). Some competencies considered specific to certain disciplines did not qualify for inclusion. Participants agreed that health professionals should recognise, take ownership of, and practise interprofessional collaboration in supporting movement behaviour change; support positive culture around these behaviours; communicate using person-centred approaches that consider determinants, barriers and facilitators of movement behaviours; explain the health impacts of these behaviours; and recognise how their own behaviour influences movement behaviour change support. This consensus defines 11 competencies for health professionals, which may serve as a catalyst for building a culture of advocacy for movement behaviour change across health disciplines.
Physical activity and sedentary behaviour are two critical movement behaviours that are closely linked to health and well-being outcomes.1 2 Increasing population levels of physical activity and reducing sedentary behaviour is a recognised global public health priority.3 However, 1.4âbillion adults worldwide are classified as insufficiently active4 and up to two-thirds of adults engage in levels of sedentary behaviour that place them at high-risk of poor health outcomes.5 Physical inactivity costs health systems approximately US$27âbillion annually, equating to a total cost of US$300âbillion between 2020 and 2030 if physical inactivity prevalence remains stable.3 The WHO has devised a Global Action Plan, calling for multilevel action to reduce the prevalence of physical inactivity by 2030, including the integration of physical activity promotion into primary and secondary healthcare services.6
Health professionals are well placed to promote these important health behaviours given the diversity of settings where healthcare is delivered and services provided, as well as their repeated opportunities to promote health-related behaviours over time.7 They are regarded as credible sources of health information,8â14 with one in four patients reporting they would be more active if they were advised to by a health professional.15 Physical activity and/or sedentary behaviour change counselling by health professionals is desired by patients16 and can lead to increases in physical activity15 and reductions in sedentary behaviour.17 However, many patients do not receive any advice about these behaviours from their healthcare providers.18 Although various health professionals typically acknowledge that physical activity promotion is a part of their role,19â21 they report low levels of knowledge, skills and sometimes confidence to do so,19 21â23 which can contribute to a lack of physical activity promotion in their practice.21
Training programmes, either preprofessional or in-service, show promise in addressing these barriers and in increasing the delivery of physical activity advice to patients.24 Important physical activity course areas relevant for health professionalsâ training have been identified25; however, there is currently no consensus on the specific minimum competencies required by all health professionals to provide movement behaviour change support. Further, to date, the focus has been on physical activity promotion, with less literature investigating sedentary behaviour change in healthcare settings,17 despite sedentary behaviour being a distinct, but related, health behaviour.26
To address these evidence gaps, this study aimed to gain consensus on the key competencies required for all health professionals to support individuals to change their movement behaviour, specifically, physical activity and sedentary behaviour, by using a multiround Delphi method.27 Specifically, our objectives were: to gain opinions from a range of health professionals regarding the knowledge, skills and attributes all health professionals need in order to promote positive movement behaviours; to use these data to generate draft competencies; and to determine the importance and relevance of these identified competencies for all health professionals from the perspectives of this expert panel and subsequently establishing expert consensus.
The Delphi method was chosen as it allows for greater validity of findings in collecting the opinions of a group, rather than opinions of individuals.28 A traditional Delphi study design was used,29 with multiple phases included (figure 1). In phase 1 (exploration and design), the steering group was established, consisting of experts from the UK, Australia, New Zealand and The Netherlands with expertise in movement behaviour and behaviour change, and experience in practising, or conducting research, in healthcare settings (TA, EL, SB, RF, CLH, GH, KM, HR, IR and SG). The steering group designed and developed the study protocol and identified potential participants (detailed below). Phases 2â3 involved recruitment of participants and a series of structured survey rounds to facilitate discussion among experts and to reach consensus regarding competencies required by all health professionals to support individuals to change their movement behaviours. Surveys were administered online, hosted by Qualtrics. Email was used to send survey links to participants for each round. Conducting and Reporting Delphi Studies (CREDES) guidelines were followed to ensure adequate study conduct and reporting.30
Equity, diversity and inclusion statement
Our authorship team (and steering committee) consisted of nine women and one man, including junior, mid-career and senior physical activity researchers from a range of health professional disciplines (physiotherapy, exercise physiology, medicine and public health). All authors have experience in practising, and/or conducting research, in healthcare settings. Members of the authorship group were from Australia, the UK and the Netherlands. We made efforts in our recruitment strategy to sample a range of ages, genders, demographic characteristics and, in line with inclusion criteria, expertise in physical activity and sedentary behaviour in healthcare contexts.
Phase 1: steering groupâexploration and study design
The steering group were responsible for selection of the study design and protocol development, and preparation of the content for the Delphi rounds. The steering group did not participate in the surveys; however, the steering group supervised and monitored the process across rounds. All steering committee meetings were designed to accommodate the geographical differences among members, resulting in a mix of synchronous interactions via online meetings, as well as asynchronous, offline, opportunities for feedback. This hybrid approach ensured that all members, including individuals from different locations, could actively contribute and participate in discussions. By incorporating both online and offline components, the meetings provided flexibility and allowed for contributions in a variety of contexts.
Phase 2: selection, identification and recruitment of participants
Participants were identified in two ways. First, we used purposive sampling by asking steering group members to identify potential participants with expertise in the field. Inclusion criteria included individuals with considerable knowledge, experience and education in physical activity and sedentary behaviour within healthcare contexts. Professional backgrounds targeted included: (1) academics/researchers and published authors in the physical activity and sedentary behaviour field and (2) public health and health professionals involved in the fields of physical activity and sedentary behaviour, or where their key role was the promotion/delivery of movement behaviour change. Efforts were made to recruit participants from diverse regions, roles and disciplines in an effort to gather a broad range of perspectives, and no specific exclusion criteria were applied in these aspects. Second, we used snowball sampling by asking the potential participants identified by the steering group to nominate peers. The steering committee decided whether nominated individuals met the inclusion criteria. A minimum of at least 30 experts was set as the target sample size by the steering committee. This was greater than the recommended minimum of 10â18 experts31 to account for prospective dropouts and to allow for the range of experience deemed necessary to inform this work (settings, academics, clinicians, country, professional backgrounds, rurality).
Individuals who met the inclusion criteria were invited to join the study by email, sent by a person external to the research team, outlining the study objectives and design and the commitment required for participation, including a link to the information sheet, consent form and online survey should they choose to participate.
Phase 3: data collection and analysis
An all-rounds approach32 was used, where participants consenting in round one were invited to participate in all subsequent rounds irrespective of whether they responded in the preceding round/s. Throughout the Delphi process, participants were identifiable to the research team but not to each other. The survey was anonymous, but in the first-round survey participants were asked to generate their own unique identification code, which they were asked to use for each subsequent round. Survey data were separated from identifiable data, with the identifying codes used to organise survey responses and to indicate where follow-up reminder emails were required. As the Delphi method uses an iterative process, each survey round was built from the findings from the previous one and was accompanied by a cover sheet that outlined the intentions of the round. It was anticipated that three rounds would be undertaken, with the steering group conscious of participant dropout, which can frequently limit the number of rounds performed.31 Stop criteria were defined as completion of five rounds, or if consensus was reached.
The two lead authors (TA and EL) and the senior author (SG) developed the first-round survey questions. They were then piloted with the other steering group members (SB, RF, CLH, GH, KM, HR and IR), with adjustments made to the questions and format of the survey based on their feedback. It was then piloted with a working clinician (occupational therapist) external to the research team, with feedback provided on the usability and clarity of the content. This pilot phase served as an important step in refining the round one survey. The clinician had the opportunity to interact with the survey and to provide informal feedback on various aspects, including its usability, clarity of instructions and overall content. The informal nature of the feedback allowed for open and candid discussions, enabling identification of potential areas for improvement.
Participants were first asked to complete a brief demographic questionnaire, which included gender, age, country of residence, current primary role, education, years of experience working in their field, clinical settings worked in and clinical background. Participants were then asked five open-ended questions to understand the knowledge, skills, attributes, systems and any other elements they believed health professionals needed to possess or learn to effectively deliver movement behaviour change in healthcare settings (online supplemental file 1). For the purpose of this study, participants were asked to consider the definition of health professionals in line with the International Standard Classification of Occupations, which stipulates health professionals as those who âconduct research, Improve or develop concepts, theories and operational methods and apply scientific knowledge relating to medicine, nursing, dentistry, pharmacy and the promotion of healthâ.33
Qualitative responses were independently collated and reviewed by two authors (TA and EL) to produce a list of statements reflective of the data collected. Thematic analysis was then undertaken to condense responses into key themes using an inductive approach.34 The themes identified were then developed into 32 proposed competencies by two authors (TA and EL), before being reviewed by the steering committee for consistency with the raw data. Wherever possible, the expertsâ own words were used to maintain authenticity and reduce bias. When shaping the competencies after round one responses, the steering group omitted any concepts resembling broader professional competencies as they would be addressed in specific health discipline programmes, through competency statements and accreditation standards. To ensure comprehensibility of the draft competencies, written formal feedback on the clarity of the draft competencies was sought from an external multidisciplinary clinician working group (consisting of a nurse, physiotherapist, dietician and doctor). Each member of the clinician group was invited to review the draft competencies and provide written feedback, focusing on aspects such as clarity of language. The steering group then had a final discussion to confirm the 32 proposed competencies to present back to participants for the second round.
In round two, the survey presented the proposed competencies developed in round one and asked participants to score each proposed competency on an 11-point Likert scale (ranging from 0=extremely unimportant to 10=extremely important). Using a measure of central tendency as a definition of consensus,35 the cut-off for item inclusion was a median score of â„7. Quantitative data were analysed in Microsoft Excel to produce measures of central tendency and dispersion (median and quartile deviation) for each item. In round two, participants were also given the opportunity to comment on each competency and provide feedback or suggestions for any refinements. Qualitative feedback was thematically analysed by two authors (TA and EL), and reviewed with the steering group to determine what, if any, modifications were required before the competencies were presented in round three.
In round three, the survey presented the remaining competencies identified as important in round two. For each competency, participants were asked to give one of three responses regarding whether it should be included as a competency for all health professionals: agree; disagreeâdepends on profession; disagree. An open-text response box was also available if participants selected disagreeâdepends on profession, so they could provide further details on which profession/s they thought the competency would be relevant for. Using per cent agreement as a definition of consensus,35 we prespecified a score of â„80% agree as the cut-off for element inclusion.
A total of 63 prospective participants were identified by the steering committee and invited to participate. Of those, 40 were recruited, provided consent and subsequently completed the first survey (64% recruitment rate). In total, 63 of the 40 participants completed the second survey (90% response rate) and 34 completed the third survey (85% response rate). A total of 32 participated in all three rounds, resulting in a full completion rate of 80%. Participants resided in 11 different countries. Most resided in the UK (33%, 33% and 29% of those who responded in rounds one, two and three, respectively), Australia (20%, 17% and 15%) and Singapore (18%, 19% and 21%). Remaining participants resided in Canada, the USA, the Netherlands, New Zealand, Belgium, Chile, South Africa and Brazil. Participant characteristics for each round are presented in table 1. All participants had over 5âyearsâ experience in movement behaviour change promotion, with clinical backgrounds across eight different disciplines. Participants were mostly currently working in an academic role (55%, 56% and 59%) followed by clinical (30%, 28% and 29%) and combined academic/clinical (13%, 14% and 12%) roles.
In the first round, participants felt that health professionals have a shared responsibility to promote movement behaviours using tailored approaches to care and that they need to know about principles of movement, health promotion, assessment tools and how to promote sustainable change, while considering resources (particularly time management) and organisational factors. Themes derived from the qualitative data are summarised in online supplemental file 2. These themes were developed into 32 proposed key competencies, which are listed (in no particular order) in online supplemental file 3.
Participants in round two rated their perceived importance of the 32 proposed competencies. Qualitative feedback was considered for each competency and discussed among the steering committee to determine what, if any, modifications were to be made to the competencies. All 32 competencies had a final median score >7, indicating that participants perceived all competencies as important for inclusion with no competencies excluded in this round. Based on qualitative feedback, 2 competencies were combined meaning 31 competencies were taken forward to round 3. However, participants also provided consistent feedback that many of the competencies were only relevant for some professions. Although stipulated in the instructions to participants, the research team felt it may have been overlooked that participantsâ ratings should be based on the relevance of these competencies for all health disciplines, given some discrepancies between rated level of agreement for inclusion and qualitative data. For example, where some participants rated a high level of agreement of inclusion, but then commented that this would only be relevant for some disciplines. Subsequently, round three was modified to ensure participants would rate whether competencies should be included in the final set for all health professionals. If they disagreed, they had the opportunity to note if this was because it was only relevant to some health professionals (and if so, to list those health professionals). A summary of measures of central tendency, level of consensus and modifications made based on round two findings are presented in online supplemental file 4.
Participants in round three rated whether they agreed or disagreed that each of the 31 modified competencies (see online supplemental file 4) should be included. A total of 11 competencies reached agreement >80%âand so were included in the final set, which is listed in table 2 ordered by level of agreement. A total of 20 competencies did not reach agreement and were excluded, with 18 of those rated by 20% or more of participants as not being suitable for the final set due to only being relevant for some health disciplines. A summary of the findings from round three (including level of agreement, consensus of all competencies and a summary of the qualitative findings) is provided in online supplemental file 5. The findings are also provided in an infographic (figure 2) and a lay summary (online supplemental file 6).
Using a Delphi method, 11 competencies for all health professionals to support movement behaviour change (specifically, physical activity and sedentary behaviour) were established. Expert participants agreed that all health professionals should recognise and take ownership of their role in supporting movement behaviour change; work interprofessionally to support patients to change their movement behaviours and assist with creating a positive culture around movement behaviour; understand and be able to communicate the important health impacts of movement behaviours; consider individual health determinants which could influence patient movement behaviour; and recognise how their own movement behaviours can impact their willingness to provide movement behaviour change support in their practice. To our knowledge, this is the first attempt to develop consensus on competencies for all health professionals regarding movement behaviour change.
âRecognise that all health professionals have an important role in supporting movement behaviour changeâ was the competency rated as most important in round two (median 10.5) and had the highest level of agreement (100%) in round three. This finding is consistent with previous research reporting that most health professionals agree that they have a role in promoting movement behaviour change.36 However, different disciplines often view their role in the promotion of movement behaviour change differently, view movement behaviour change as relevant only for movement specialists (such as exercise physiologists and physiotherapists)21 and/or are uncertain of the extent to which they should provide advice.19 37 For instance, nurses tend to view their role as minimal compared with other health professionals21 and are less inclined to accept responsibility for their role in promoting movement behaviours.19 However, they have contact with a large number of patients across a variety of settings and have the potential to leverage their trusted patient relationships to promote positive movement behaviour change and, if required, refer to relevant members of the interprofessional team.38 This presents a challenge in identifying competencies that are relevant for all health professionals to support individuals to change their movement behaviour. This is a difficulty often encountered in the health field when trying to create competencies across a number of disciplines, due to the breadth of practice trying to be captured.39â41 We addressed this in our consensus development by including a third round in the Delphi process, where we asked participants to clarify whether competencies were relevant to all health professionals. This resulted in consensus for 11 competencies common to all health professionals.
Interprofessional collaboration was recognised as a key competency for all health professionals. The importance of collaboration between health professionals is supported by previous research that has highlighted the role of the interdisciplinary team in helping patients to adopt and sustain healthier behaviours.42 43 Effective collaboration requires shared knowledge, practices and effective methods of communication.44 45 However, research suggests that health professionals from a range of disciplines feel underprepared to provide movement behaviour change support in practice,21 46â48 which may limit their contribution in interprofessional teams. Integration of established competencies can address this barrier by ensuring that all health professionals share common foundational knowledge and skills to support collaborative practice.
Throughout each round of surveys, qualitative and quantitative data highlighted the importance of the health professionalâs own movement behaviours in their promotion of movement behaviour change, with the final competency list including ârecognise how the health professionalâs own movement behaviours can influence their engagement with movement behaviour change deliveryâ. This has been established in previous research that has reported associations between the health behaviours of health professionals and their promotion of movement behaviours to patients.49â52 This highlights the importance of promoting positive movement behaviours to clinicians as well as patients, which could be achieved through stakeholders and organisations providing staff well-being initiatives. There may be the potential for a multilayered effect of improving the health and well-being of health professionals, increasing their engagement with the promotion of movement behaviour change and ultimately, enhancing patient outcomes.
Strength and limitations
A key strength of the study was its diverse range of international participants with relevant expertise, which supports the generalisability of the findings across international settings. The study intentionally prioritised recruitment of a heterogeneous sample of participants who were experienced in research, teaching and delivering movement behaviour change in practice, and who were from a wide variety of professions across different settings. Although we recognise the final sample may not adequately represent the full spectrum of views held by individuals within every profession, the Delphi design has its strengths in generating group-level rather than individual-level findings. The Delphi method is a well-established research approach that uses expert opinions to identify consensus, but there are no standard quality parameters to evaluate Delphi methods in healthcare research. The present study was designed in line with quality indicators proposed by Diamond,35 and reported in line with CREDES guidelines30 to enhance transparency of the research process and replicability of the findings.
Several limitations must also be noted. Despite the strengths of a Delphi study design, it is important to acknowledge that consensus does not automatically equate to the correct conclusion and the exclusion of other competencies based on the absence of consensus does not render them irrelevant. Rather, other competencies where disagreement was present may warrant further investigation as to why conflicting views were present. It was not possible to analyse the stability of responses between rounds, as the nature of the questions changed. However, by examining the descriptive statistics, in concurrence with thematic analysis, we were able to gain a better understanding of the stability of participant responses and identify any notable shifts or trends that may have occurred throughout the Delphi process. Analysis of qualitative data from round two led us to modify round three questions; however, we acknowledge if this modification to make the intended aims of the study more explicit was done in earlier rounds, this may have reduced the total number of rounds. Despite efforts to recruit a diverse range of expert participants, there is under-representation from the global south and from some health professional disciplines. This may limit the generalisability of the findings. Recognising the importance of global perspectives and the need for equitable representation, future research endeavours should prioritise efforts to explore the relevance of the competencies among participants from under-represented groups and regions, ensuring a more comprehensive understanding of movement behaviour across diverse contexts. Finally, steering group members were all from high-income countries, namely Australia, UK or Europe, and thus the group did not include representation from all regions. Attempts were made to address this through intentionally recruiting participants from a range of countries and disciplines.
Implications of the findings
There is a need to reduce sedentary time and increase physical activity to reduce the burden on healthcare systems and optimise health and well-being outcomes of populations around the world. The WHO has called for the integration of physical activity promotion into healthcare settings, capitalising on the credibility afforded to health professionals and their access to a large proportion of the population across the lifespan.6 To enable health professionals to deliver such support, they must have a foundational level of competence and this competency must be achieved across disciplines given the shared responsibility of movement behaviour change support. The development of competencies for all health professionals is a foundational step to enhancing the provision of quality health professional education, which is necessary in ensuring they are capable of integrating movement behaviour change support into their practice.
Translating these competencies into the education of health professionals is the next challenge in advancing and accelerating this agenda. It will require buy in from multiple stakeholders across multiple levels, including government, professional bodies and societies, institutional leaders, educators and learners, along with consultation with consumers. Institutional leaders, educators and learners will need to use the competencies to inform the development of learning outcomes, which describe the specific expectations of what the learner will be able to do, know or value on completion of their study.53 Learning outcomes will need to be course specific and discipline specific, recognising that integration needs to complement existing professional standards, curricula and discipline specific scope of practice. While delivery of quality training (at both the preservice and in-service level) is critical to equip healthcare professionals with the necessary knowledge and skills to promote movement behaviour change in practice, buy in from the âtopâ, including government and professional bodies will ultimately ensure accountability through policy and professional standards in an environment where there are competing priorities and increasing concerns about crowded curricula.54 55 Monitoring the extent to which health professionalsâ integrate movement behaviour change support will help to inform whether the competencies are changing practice and what further action might be needed.
Health professionals have a key role to play in the provision of the movement behaviour change support needed to Improve health and well-being outcomes among patients and reduce the burden on healthcare systems globally. Ensuring health professionals are well-equipped to support their patients to Improve health behaviours is critical in contributing to global targets of increasing physical activity and reducing sedentary time. The established competencies have the potential to advance practice and to promote a coordinated, collaborative approach to achieving these targets.
Patient consent for publication
This study involves human participants. The study received ethics approval from the University of Queensland (2022/HE000859). Participants gave informed consent to participate in the study before taking part.
The authors gratefully acknowledge the participants and thank them for the application of their relevant expertise in this Delphi study. Those participants who consented to acknowledgement are listed alphabetically below. Jo Allan, Timothy Anstiss, Tracy Barnett, Anna Campbell, Oscar Castro, Nicole Culos-Reed, Susan Dawkes, Sarah Dewhurst, Harmonee Dove, Jonathan A Drezner, Sarah Martine Edney, Natalie Fini, Bruce Forrest, Nicole Freene, Philippe Gradidge, Pedro Luiz R GuimarĂŁes, David Humphries, Jennifer Jones, Natasha Jones, Cesar Kalazich, Boon Chong Kwok, Ralph Maddison, Sarah A Moore, Norman Ng, Kerry Peek, Geeske Peeters, Amanda Pitkethly, Justin Richards, Petra C Siemonsma, Jan Sinclair, Christopher Speers, Mark Stoutenberg, Bernadine Teng, Shamala Thilarajah, Jane S Thornton, Margaretha van Dijk, Rahizan Zainuldin. Multidisciplinary clinician working group: Tessa CliftonâMedical, Heidi MeyerâDietetics, Megan NebeâNursing, Daniel RyanâPhysiotherapy.
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When you walk into a doctorâs office, you expect that they have easy access to all of the relevant information they need to make the right decisions for your care. In the past, doctors actually spent large amounts of time trying to collect patient information â time that they would prefer to spend with their patients.
Health information sharing has undergone a transformation, and now VITL offers doctors, nurse practitioners, nurses, care coordinators, and other health care providers a centralized place to access a more complete patient record for each participating Vermonter, including information from places they receive care all across the state. Responsible data sharing also helps public health professionals understand the health of our population and the equity of Vermontersâ health care and target improvements in care delivery to help people stay healthy and well.Â
Here are five of the most common questions asked about VITLâs work to Improve health outcomes for everyone by sharing relevant information at the right time, with the right people.Â
1. What does âhealth information sharingâ mean? Â
The health information part of âhealth information sharingâ is your patient record. This includes basic information such as your name, age, and birthdate as well as medications, allergies, X-ray reports, and lab results. Care and instructions you receive during a provider visit are also included. Together, this information is part of your medical history available to providers and other authorized team members at the organizations where Vermonters receive health care.Â
The sharing of this information is made possible through the Vermont Health Information Exchange, run by a nonprofit organization called VITL. VITL securely collects and organizes patient health data to deliver a more complete health record for each Vermonter. Through VITL, the doctors, nurse practitioners, nurses, staff, and other authorized professionals who care for you have access to the most up-to-date information in a secure clinical portal. VITL also delivers some data to providers directly in their electronic health records. Your private information is not available to the public through this system, and it never will be.Â
2. How does this help me get good care? Â
When your health care professionals can quickly access more complete health information, they have the tools they need to best guide your treatment. The records in VITL arenât just about your care at one organization; they include information about your health from contributing hospitals, practices, specialists, pharmacies, and labs all across the state.Â
For example, if you are traveling in another part of Vermont and need to go to the emergency room at a hospital youâve never been to before, the doctors treating you may be able to see the medications youâre taking, any allergies you may have to medications, relevant past injuries and illnesses, and more. Or if you go to a checkup, your provider may be able to use VITL to pull certain information about care youâve received in other places directly into their electronic health record, including what vaccinations youâve had and which you are due for. They can alsoÂ contribute information about your health and your care from that visit, so it is available for more of your care team. Â
3. Other than health care professionals, who else has access to this information? Â
Authorized staff and providers at insurance companies can use VITL data for certain activities that help make sure their members are getting the best possible care. For example, if a member has recently been to the hospital, insurance care managers can ensure that member has access to medication and support for recovery at home.Â
Public health professionals also have access to VITL data. For example, during the height of the COVID pandemic, they were able to use VITL data to complete COVID case investigations, instead of requesting patient records from practices, so that busy health care providers could stay focused on patient care.Â
Designated staff and providers involved in some health care delivery reform programs and accountable care organizations are also able to access health data to help measure the effectiveness and equity of health care for Vermonters; help deliver well-coordinated, whole-person health care; and help reduce the cost of care for individuals and across the state.Â
4. Is my personal information safe?Â
Health information requires the highest levels of security, privacy, confidentiality, and trust. Â
Access is restricted to providers and other health care professionals who are authorized to see patient information by the organizations they work for. They commit to viewing the minimum necessary information in their work on behalf of Vermonters. All users are guided by state and federal law, the HIPAA Privacy Rule and Security Rule, and VITL policies. And all use is audited.Â
Every day, VITL staff works to keep Vermontersâ data secure. VITL adheres to national cybersecurity standards, and the team is always on alert for the latest threats. Â
VITLâs privacy and security commitment is the foundation of everything we do.Â
5. What if I want to be in control of who sees my information? Â
You can see what your providers see by requesting your records. You can also request an access audit to identify which organizations and care providers have seen your records. Â
You can opt out of data sharing at any time on the VITL website or by calling 1-888-980-1243 MondayâFriday between 9:00 a.m. and 5:00 p.m. If you have opted out in the past, you can opt back in. Â
If you want to learn more about your options, there is information on vitl.net/sharing and the VITL team is available to talk with you and answer questions about health information sharing. VITLâs toll-free number is 1-888-980-1243.Â
VITL shares health information responsibly to help Vermonters and their doctors and providers. Itâs part of making sure Vermont stays one of the healthiest states in the country. And thatâs better for all of us.
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