CPHRM EXAMS TEST PAPER QUESTIONS AND
ANSWERS SET A+
✔✔Distinguish between a patient complaint and a grievance - ✔✔COMPLIANT vs
GRIEVANCE
Compliant - concerns, dissatisfactions expressed by a patient or rep regarding care of
services.
➣ issues generally resolved promptly (e.g., 24-48 hrs).
➣ issues less significant such as cleanliness of rooms, quality of food, noise, etc.
➣ informal response may be in person, phone, letter/email.
Grievance - formal verbal/written complaint regarding any aspect of operations,
activities, or behavior of a provider.
➣ issues that cannot be resolved immediately, take more time, investigation, etc.
➣ significant issues (violation of patient rights, appropriateness of care, etc.)
➣ formal response, must be in writing.
✔✔Define federal regulations governing patient complaints and grievances - ✔✔CMS
Conditions of Participations (CoP) addresses a facility's duties regarding patient
complaints and grievances. Requires facilities to have a formal process for prompt
resolution, as per 42 CFR 482.13, at a min:
➣ hospital must establish a policy and procedure for submission of a patient's
written/verbal grievance.
➣ Grievance process must specify time frames for review and response.
➣ In the resolution, the hospital must provide the patient a written notice of its decision.
✔✔Discuss elements that should be addressed in response to a grievance and
resolution - ✔✔Written response should include:
➣ review of concerns understood by the facility.
➣ steps taken to investigate.
➣ findings from the investigation.
,➣ data of resolution.
➣ name and contact info of a facility rep for patient to contact if any questions regarding
the response.
Grievance has reached resolution when patient is satisfied with the action taken in
response to the concerns. When patient remains dissatisfied in spite of facility's efforts,
facility may consider the grieve resolved and advise patient of closure.
✔✔Discuss accreditation standard addressing complaints and grievances - ✔✔TJC
developed standards the facility must comply, including:
➣ inform patient about complaint resolution process.
➣ recognized patient's rights ( or patient's rep)
➣ collect data regarding complaint/grievance and incorporate them within the facility's
process improvement activities.
➣ report complaint/grievance data and performance improvement activities to the
governing body.
✔✔List the actions that a facility can take to address patient complaints and grievance -
✔✔List of actions to address complaints/grievances include:
➣ develop and implement a process to identify and address complaints and grievances.
➣ identify roles to facilitate review and response to patient, designation of staff and
committees.
➣ provide education to employees, leadership, medical staff.
➣ provide intensive training for frontline staff on active listening and patient/family
expectations.
➣ empower frontline staff to resolve small issues before they escalate.
➣ maintain data/reporting system to identify trends and implement corrective actions.
➣ ensure patient rights documents are distributed to all patients, methods of reporting
and contact information for filling a grievance.
➣ periodically evaluate the grievance process/policy for effectiveness and
improvement.
✔✔Discuss the provider-patient privilege in relation to confidentiality of patient
information - ✔✔The provider-patient privilege recognizes the importance of open
communication to build trust, and prohibits providers from disclosing patient information
without patient's consent, except:
➣ the privilege does not provide protection for de-identified info. Rather, to be afforded
protection, the information disclosed must be individually identifiable, which means that
health info identifies or could reasonably be used to identify the individual patient.
➣ if the patient brings a personal injury claim, the defendant becomes entitled to access
the patient's health info because medical treatment for the injury is applicable to the
claim.
➣ the privilege is not recognized in criminal cases.
, ✔✔Discuss the mandatory requirements for a healthcare facility in regard to suspected
child abuse - ✔✔Healthcare facilities are mandatory reporters of child abuse or
suspected child abuse. Requirements vary by state, but it must be reported to the
state's child protective services department.
Providers who report are generally immune from civil or criminal liability if they report in
good faith.
When in doubt about whether a situation should be reported, the provider should
consult with the agency to which they are mandated to report. The agency can help the
provider determine how to proceed. The provider should document the consultation in
order to minimize liability because relying upon the advice of authorities on questions of
reportability is a reasonable approach that meets the standard of care.
✔✔Discuss the special protection afforded HIV and alcohol and drug abuse treatment
records - ✔✔Federal law grants special protection to alcohols and drug abuse treatment
records as outline in 42 USC Chapter 1, Part 2.
Some states also protect HIV info and mental health records from disclosure through
the enactment of confidentiality laws. These laws were enacted to encourage patients
with abuse problems and highly sensitive diagnoses to seek the medical treatment they
need without fear of prosecution and the stigma often associated with these conditions,
should the medical information be disclosed to others.
Under these laws, it protects this information to be disclosed without patient's consent.
✔✔Discuss TJC as a voluntary surveying body, accreditation benefits - ✔✔TJC is an
independent, non-profit organization, created in 1951. It was formed by the collaboration
of several professional medical organizations to improve the quality of healthcare by
developing a set of standards and objectively evaluate an org for safe and quality
patient care.
Surveys are unannounced and occur every 18-36 months.
Benefits:
➣ Elevate patient safety and quality care
➣ increased confidence in the community
➣ competitive advantage in the healthcare market
CMS granted authority to TJC, meaning they can determine whether a facility meets the
Medicare and Medicaid certification requirements.
✔✔Define a sentinel event, and types - ✔✔Sentinel event: a serious, unexpected
occurrence that results in death, permanent harm, or severe temporary harm to a
patient. An event that is not related to the natural course of patient's illness or
underlying conditions.
Identify types of events that meet the definition, may include one of the following:
➣ suicide of any patient within 72 hours of discharge
➣ unanticipated death or a full-term infant
ANSWERS SET A+
✔✔Distinguish between a patient complaint and a grievance - ✔✔COMPLIANT vs
GRIEVANCE
Compliant - concerns, dissatisfactions expressed by a patient or rep regarding care of
services.
➣ issues generally resolved promptly (e.g., 24-48 hrs).
➣ issues less significant such as cleanliness of rooms, quality of food, noise, etc.
➣ informal response may be in person, phone, letter/email.
Grievance - formal verbal/written complaint regarding any aspect of operations,
activities, or behavior of a provider.
➣ issues that cannot be resolved immediately, take more time, investigation, etc.
➣ significant issues (violation of patient rights, appropriateness of care, etc.)
➣ formal response, must be in writing.
✔✔Define federal regulations governing patient complaints and grievances - ✔✔CMS
Conditions of Participations (CoP) addresses a facility's duties regarding patient
complaints and grievances. Requires facilities to have a formal process for prompt
resolution, as per 42 CFR 482.13, at a min:
➣ hospital must establish a policy and procedure for submission of a patient's
written/verbal grievance.
➣ Grievance process must specify time frames for review and response.
➣ In the resolution, the hospital must provide the patient a written notice of its decision.
✔✔Discuss elements that should be addressed in response to a grievance and
resolution - ✔✔Written response should include:
➣ review of concerns understood by the facility.
➣ steps taken to investigate.
➣ findings from the investigation.
,➣ data of resolution.
➣ name and contact info of a facility rep for patient to contact if any questions regarding
the response.
Grievance has reached resolution when patient is satisfied with the action taken in
response to the concerns. When patient remains dissatisfied in spite of facility's efforts,
facility may consider the grieve resolved and advise patient of closure.
✔✔Discuss accreditation standard addressing complaints and grievances - ✔✔TJC
developed standards the facility must comply, including:
➣ inform patient about complaint resolution process.
➣ recognized patient's rights ( or patient's rep)
➣ collect data regarding complaint/grievance and incorporate them within the facility's
process improvement activities.
➣ report complaint/grievance data and performance improvement activities to the
governing body.
✔✔List the actions that a facility can take to address patient complaints and grievance -
✔✔List of actions to address complaints/grievances include:
➣ develop and implement a process to identify and address complaints and grievances.
➣ identify roles to facilitate review and response to patient, designation of staff and
committees.
➣ provide education to employees, leadership, medical staff.
➣ provide intensive training for frontline staff on active listening and patient/family
expectations.
➣ empower frontline staff to resolve small issues before they escalate.
➣ maintain data/reporting system to identify trends and implement corrective actions.
➣ ensure patient rights documents are distributed to all patients, methods of reporting
and contact information for filling a grievance.
➣ periodically evaluate the grievance process/policy for effectiveness and
improvement.
✔✔Discuss the provider-patient privilege in relation to confidentiality of patient
information - ✔✔The provider-patient privilege recognizes the importance of open
communication to build trust, and prohibits providers from disclosing patient information
without patient's consent, except:
➣ the privilege does not provide protection for de-identified info. Rather, to be afforded
protection, the information disclosed must be individually identifiable, which means that
health info identifies or could reasonably be used to identify the individual patient.
➣ if the patient brings a personal injury claim, the defendant becomes entitled to access
the patient's health info because medical treatment for the injury is applicable to the
claim.
➣ the privilege is not recognized in criminal cases.
, ✔✔Discuss the mandatory requirements for a healthcare facility in regard to suspected
child abuse - ✔✔Healthcare facilities are mandatory reporters of child abuse or
suspected child abuse. Requirements vary by state, but it must be reported to the
state's child protective services department.
Providers who report are generally immune from civil or criminal liability if they report in
good faith.
When in doubt about whether a situation should be reported, the provider should
consult with the agency to which they are mandated to report. The agency can help the
provider determine how to proceed. The provider should document the consultation in
order to minimize liability because relying upon the advice of authorities on questions of
reportability is a reasonable approach that meets the standard of care.
✔✔Discuss the special protection afforded HIV and alcohol and drug abuse treatment
records - ✔✔Federal law grants special protection to alcohols and drug abuse treatment
records as outline in 42 USC Chapter 1, Part 2.
Some states also protect HIV info and mental health records from disclosure through
the enactment of confidentiality laws. These laws were enacted to encourage patients
with abuse problems and highly sensitive diagnoses to seek the medical treatment they
need without fear of prosecution and the stigma often associated with these conditions,
should the medical information be disclosed to others.
Under these laws, it protects this information to be disclosed without patient's consent.
✔✔Discuss TJC as a voluntary surveying body, accreditation benefits - ✔✔TJC is an
independent, non-profit organization, created in 1951. It was formed by the collaboration
of several professional medical organizations to improve the quality of healthcare by
developing a set of standards and objectively evaluate an org for safe and quality
patient care.
Surveys are unannounced and occur every 18-36 months.
Benefits:
➣ Elevate patient safety and quality care
➣ increased confidence in the community
➣ competitive advantage in the healthcare market
CMS granted authority to TJC, meaning they can determine whether a facility meets the
Medicare and Medicaid certification requirements.
✔✔Define a sentinel event, and types - ✔✔Sentinel event: a serious, unexpected
occurrence that results in death, permanent harm, or severe temporary harm to a
patient. An event that is not related to the natural course of patient's illness or
underlying conditions.
Identify types of events that meet the definition, may include one of the following:
➣ suicide of any patient within 72 hours of discharge
➣ unanticipated death or a full-term infant
