A. Introduction

Accreditation in the healthcare has proven to be a driving force in improving quality care delivery to the patient. The shift in focus on improving standards in the ambulatory care settings has had a constructive long term impact on quality, cost-effectiveness, improvement and reliability. The standards in the ambulatory care would provide aid in identification, guidance and improvement on areas in a systematic and strategic manner.

B. Aim

The standards identify those aspects of program structure and operation that the HCAC regards as essential to program quality and achievement of ambulatory health care goals. They specify the optimal requirements for programs to ensure quality services related to patient management including patient care and the outcomes of the care, patient satisfaction, and patient safety. It also serves as an education guide for facilities that wish to establish new programs or improve existing programs.

C. Framework and guiding principles of HCAC Hospital Standards

The ambulatory care standards were developed in line with the non-inpatient care framework which emphasizes that ambulatory care that takes place as a day attendance at a health care facility has to be provided according to the best practice care to assure safe and sustainable, patient focused care. The non-inpatient care term covers a broad range of care delivery from preventative and primary care, through to specialist services and tertiary level care, and is collectively referred to as non-inpatient care. This Framework^[2] does not imply that all these services will be delivered outside of hospitals; some services will and should continue to be delivered in hospitals for reasons of patient safety, quality and efficiency. However many services currently delivered in the hospital settings can be provided safely and effectively in the community setting.

The framework is aligned with the following guiding principles:

• Improved access to services
• Provide safe, high quality evidence based health care
• Promote a patient centered continuum of care
• Optimize public and private services
• Improve the balance of preventative, primary and acute care
• Support a highly skilled and dedicated workforce

What does patient -centered mean?

Patient-centered care is based on several key principles:

Dignity and respect:
Incorporating the values, beliefs and cultural backgrounds of clients into the planning and delivery of care; resolving complaints and conflicts as soon as possible.

Information sharing:
Encouraging clients to share their perspectives & questions and healthcare professionals providing information regarding illness & treatment options in terms that the client can understand.

Participation:
Preparing and supporting clients and families to participate in care at the level they choose.

Continuity:
Providing care across the continuum; designing systems that promote seamless transitions between home, hospital, primary health care, and the community.

D. Eligible Institutions

All organizations provide ambulatory care services are eligible to apply.

E. Organization of the standards Manual

The standards will provide facilities with a framework for addressing service delivery and coordination, planning, policy, management and the relationship with other service providers and the wider community. The standards introduce the most important elements of patient safety to a facility and create the capacity for the ambulatory care to continually improve its quality of services to benefit patients

The standards are organized into key functions referred as “clusters”, they are divided into general clusters that are applicable to all ambulatory care organizations and adjunct clusters that might be applicable to ambulatory care organizations according to the scope of service provided. The clusters are arranged as follows:

General clusters:

Cluster 1: Patient Rights

Cluster 2: Leadership and Management

Cluster 3:Human Resources Management

Cluster 4: Ambulatory Care Access and Continuity of Care

Cluster 5: Ambulatory Care Facilities and Premises

• Facilities and premises
• Ambulatory care organization safety
• Infection prevention and control
• Emergency management

Cluster 6: Quality Improvement

Cluster 7: Ambulatory Care Information Management

• Documents and records management

Cluster 8: Ambulatory Care Clinical Records Management

Adjunct clusters:

Cluster 9: Patient assessment and Care

• Patient assessment
• Patient care

Cluster 10: Anesthesia care

Cluster 11: Surgical care

Cluster 12: Emergency care

Cluster 13: Laboratory services

Cluster 14: Pharmaceutical services

Cluster 15: Imaging services

For each cluster, there is an intent statement that assists the ambulatory care staff members to understand the standards and a list of the key documents that are required for review by the surveyors. In each cluster, every standard is listed followed by the measurable elements

F. Classification of standards

A number of standards have been identified as essential according to the following criteria:

• central organizational processes;
• processes requiring workforce competencies;
• processes with immediate impact on patient safety and clinical effectiveness;
• address laws and regulations