Most individuals fail to achieve CPHQ status, not due to lack of ability, but because of a counter-intuitive mindset that scuttles any hope of realizing a worthy goal.

The 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 “stimulation 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

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.

Figure 1 illustrates an intuitive approach.

Intuitive approach to CPHQ exam which involves problem solving
Figure 1. An intuitive approach to the CPHQ exam, which involves problem solving.

In truth, the majority of 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. See Figure 2.

Counter-intuitive approach to CPHQ exam which involves negative self-talk.
Figure 2. A counter-intuitive approach to the CPHQ exam, which involves negative self-talk.

“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 behavior 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 (and some other) 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 behavior 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.”


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