Circulation 122,210 • Volume 31, No. 2 • October 2016   Issue PDF

Professional Certification in Patient Safety: An Opportunity for Expanding the Horizons for Anesthesia Professionals

Patricia McGaffigan, RN, MS, CPPS; Jeffrey B. Cooper, PhD

Anesthesia professionals are leaders in patient safety and have been since before the Institute of Medicine brought widespread attention to the issue of medical error through its report, To Err Is Human. A combination of technological advances, education, awareness, and adoption of practices from other high-risk industries has resulted in anesthesiology becoming far safer today than it was 30 years ago.1

Still, we have a long way to go; health care is not yet as safe as it could be.2 The National Patient Safety Foundation (NPSF), like the Anesthesia Patient Safety Foundation (APSF), has a broad agenda for working with multiple stakeholders to advance progress in patient safety. And, like APSF, NPSF is committed to encouraging, promoting, and supporting the professional development of patient safety leaders. The leadership of APSF sees development of a cadre of anesthesia patient safety leaders as one of its most important strategic goals.

As a means toward these ends, in 2011, NPSF formed the Certification Board for Professionals in Patient Safety to develop and oversee the Certified Professional in Patient Safety (CPPS) credentialing program. This article discusses the importance of certification in patient safety for health professionals, including anesthesia professionals.

The Value of Certification of Patient Safety Professionals

Patient safety concepts and practices have spread to virtually every specialty and practice setting. Where 30 years ago, few (if any) hospitals had an employee dedicated to patient safety, now it is not uncommon to see patient safety departments, committees, and officers at the highest levels of leadership. Patient safety is now recognized as a science and a unique discipline.3

For any health professional, patient safety knowledge—and the ability to apply it—are critical competencies. NPSF recognized that a process of certification of patient safety professionals would be one of the best ways to encourage and foster the acquisition of that knowledge and the application skills.

A professional certification in patient safety serves multiple purposes:4

  • To establish core standards for the field of patient safety, benchmark requirements necessary for certified professionals, and set an expected proficiency level
  • To provide health professionals a means to demonstrate their proficiency and skill in the discipline of patient safety and create for them a specific aspirational goal
  • To provide a way for employers to validate a potential candidate’s patient safety knowledge and skill base.

Since the certification program was introduced in 2012, more than 1,300 health professionals have successfully completed the requirements of the program and are entitled to use the Certified Professional in Patient Safety (CPPS) credential. By profession, they include physicians (of varying specialties including anesthesiologists), nursing professionals (including CRNAs), pharmacists, safety, quality, and risk management professionals, health care executives, and others who hold the requisite education and experience required to sit for the exam.

Developing an Evidence-Based Examination

The certification examination was developed through a rigorous process that started with a job analysis first conducted in 2011. An advisory committee representing various health care settings in the U.S. created the job analysis survey, which was sent to a wide range of health professionals. The information gathered from the analysis was used to develop a relevant, valid certification examination supported by evidence-based data.

The CPPS Expert Oversight Committee (EOC) is responsible for overseeing the examination and re-credentialing processes for the CPPS credential, and assuring that certification continues to meet the high standards required for the profession. In keeping with the need to remain current in the field, a second job analysis survey was conducted in 2014, and included global representation, resulting in updates to the examination and the current content domains:

  • Culture
  • Leadership
  • Patient Safety Risks & Solutions
  • Measuring & Improving Performance
  • Systems Thinking & Design/Human Factors.

Candidates are eligible to sit for the CPPS examination if they possess academic and professional experience at one of the following levels:

  • Baccalaureate degree or higher plus three years of experience (includes time spent in clinical rotations and residency programs) in a health care setting or with a provider of services to the health care industry
  • Associate degree or equivalent plus five years of experience (includes time spent in clinical rotations) in a health care setting or with a provider of services to the health care industry

“The CPPS examination provides a common denominator for all disciplines and backgrounds of patient safety practitioners,” said Kathryn Rapala, DNP, JD, RN, CPPS, vice president, Clinical Risk Management, Aurora Health Care, and chair of the CPPS Expert Oversight Committee. “We really want to see this certification integrated within the broader health care community.”

As would be expected, the commitment of time necessary to prepare for certification varies based on the individual’s background and experience. In a personal interview, Kenneth Rothfield, MD, CPPS, former chairman of the Department of Anesthesiology at Ascension’s Saint Agnes Hospital in Baltimore, Maryland, and chief medical officer and chief quality officer at St. Vincent’s HealthCare, part of Ascension Healthcare, notes that the preparatory work would not be “exhaustive” for those already working in some areas of patient safety.

“Those interested in getting certified are likely already very involved in safety activities, but maybe haven’t gotten the depth of experience in every aspect required for certification,” he says. Candidates who sit for the exam are asked to complete an exit survey. From January 2015 through July 2016, the survey was sent to 860 candidates, with 389 responding (45% response rate). These candidates report using preparatory materials ranging from an online Self-Assessment Exam (76%) or a review course offered by NPSF (60%), to studying the exam content outline (55%), resource list (36%), and other reference books or study guides (16%).

CPPS and Anesthesia Professionals

With a strong focus on safety in their training and throughout their careers, anesthesia professionals are natural leaders for patient safety in perioperative care and beyond. What, you may ask, is the value of a specific certification in patient safety?

Erin White Pukenas, MD, FAACP, CPPS, a pediatric anesthesiologist who wears multiple hats, has an answer. She is System Patient Safety officer; director, Anesthesia Quality and Patient Safety; and associate director of Pediatric Anesthesiology at Cooper University Health Care as well as assistant professor of Anesthesiology at Cooper Medical School of Rowan University. In a personal interview, Dr. Pukenas explained that she sees this certification as a natural extension of the anesthesia professional’s development.

“I’m fortunate to be an anesthesiologist and to have had the opportunity to learn extensively about patient safety. In my view, certification is a tangible way to demonstrate skills to our colleagues who have studied quality, safety science, or human factors engineering exclusively,” says Dr. Pukenas. &ldq

uo;As the science and demands of quality and safety in health care grow, so too will the workforce trained in it. For me, certification was one way to show that I have a solid, learned, and practiced set of skills that I can apply successfully in today’s health care environment. CPPS certification builds on my training as an anesthesiologist and cultivates additional skills that I can use to lead our safety teams. Our specialty is uniquely positioned to create the vision for safe patient care, and we must continue to demonstrate our capacity to do so.”

A similar sentiment comes from Patrick J. Loynd, DNP, CRNA, CPPS, of Capital Health System in New Jersey, where the Anesthesia Department is an integral part of the patient safety program.

“Patient safety and injury intervention is achieved through anesthesia professionals’ participation in hospital patient safety committees; policy and procedure development; root cause analysis; and the establishment of evidence-based practice parameters,” says Dr. Loynd, who has been involved in many such efforts. “It is an honor and a privilege. Setting out to achieve a CPPS certification was my way of complementing my anesthesia expertise with the knowledge and skills required to be an effective patient safety practitioner.”

Given the broad scope of practice across the care continuum and in all settings and the developing interest in the perioperative surgical home, anesthesia professionals have much to contribute to patient safety. Certification in patient safety demonstrates knowledge of systems issues, human factors, and culture, and it amplifies the attention to safety that is already so deeply embedded in the anesthesia profession. We hope that many more of you will investigate if and how this certification can be of value to your hospital, your career achievements and satisfaction and most of all to your patients.

To learn more about this professional certification, visit


  1. Haller G. Improving patient safety in medicine: is the model of anaesthesia care enough? Swiss Med Wkly 2013;143:w13770.
  2. National Patient Safety Foundation. Free from harm: accelerating patient safety improvement fifteen years after to err is human. National Patient Safety Foundation, Boston, MA; 2015. Available at:
  3. Emanuel L, Berwick D, Conway J et al. What exactly is patient safety? In Advances in patient safety: new directions and alternative approaches (Vol. 1: Assessment). Henriksen K, Battles JB, Keyes MA, et al., eds. Rockville (MD): Agency for Healthcare Research and Quality; 2008 Aug. Available at:
  4. Certification Board for Professionals in Patient Safety. About Certification (web page). 2016. Available at:

Patricia McGaffigan is chief operating officer and senior vice president for program strategy and management at the National Patient Safety Foundation (NPSF). The Certification Board for Professionals in Patient Safety (CBPPS) is a wholly owned subsidiary of NPSF. NPSF and CBPPS are not-for-profit 501 (c) (3) organizations.

Jeffrey B. Cooper is Executive Vice President of the Anesthesia Patient Safety Foundation and a member of the National Patient Safety Foundation Board of Advisors. He is also Professor of Anaesthesia, Harvard Medical School, Department of Anesthesia, Critical Care & Pain Medicine, at the Massachusetts General Hospital and Executive Director Emeritus of the Center for Medical Simulation.