The growth of ambulatory care services is having a dramatic impact on how health care is delivered in Canada. Better management of ambulatory care sensitive conditions, being able to treat more people without hospital admission, and continuing to enhance primary care all have great potential to decrease costs and the demand on in-patient services. It also means, however, that today’s ambulatory care providers are delivering an increasingly broad range of services in a high-pressure environment. Strengthening the focus on quality improvement can help maintain best practices and contribute to safer and more efficient and effective care.

Accreditation Canada is an independent, not-for-profit organization that has been setting standards and accrediting health care organizations since 1958. In other words, the roots of our knowledge, expertise, and accreditation experience go very deep. The more than 1,100 health care and social service organizations across Canada who choose our programs do so as a mark of pride and as a way to create a strong and sustainable focus on quality and safety within their walls. As they integrate our evidence-based standards into their operations, they identify what they are doing well and where they need to improve, and learn how to better plan and focus their quality improvement initiatives. In the end, staff, service providers, patients, families, and the health care system as a whole reap the rewards.

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We accredit a diverse range of public and private health care and social service providers and while we began as a hospital-based program, we now have standards for a broad range of services, including ambulatory care services offered in and outside the hospital.

Standards are the foundation of the program. We undertake a rigorous and comprehensive development process that includes literature reviews, research, testing, and extensive consultation with subject matter experts, client organizations, surveyors, and other stakeholders. This wide-spread consultation leads to standards that hold direct and immediate relevance to health care providers and others working in the field.

Accreditation Canada offers two sets of standards for ambulatory care. The Ambulatory Care Services Standards outline the policies, processes, and procedures that need to be in place to deliver safe, high-quality ambulatory services in any discipline. The Ambulatory Systemic Cancer Therapy Standards are a more clinically based set of standards that address the key safety issues in the delivery of systemic cancer therapy in an ambulatory setting.

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The standards define ambulatory care as non-emergency, condition-specific single visit or episodic care generally provided on an outpatient basis in support of primary care. They are designed to assess quality at the point of service delivery and are based on five key elements of service excellence – clinical leadership, people, process, information, and performance – as follows:

• Investing in ambulatory care services: Community needs assessment, working with partners, leadership and support, setting collaborative service goals and objectives, resource identification and development
• Engaging prepared and proactive staff: Interdisciplinary teamwork, skills and competencies, orientation, training, professional development, worklife balance
• Providing safe and appropriate services: Access and scheduling, assessment, medication management/reconciliation, patient and family involvement and consent, ethics, service delivery, case planning, information transfer, referrals
• Maintaining safe and appropriate equipment and devices: Preventive maintenance, reprocessing and sterilization
• Maintaining accessible and efficient clinical information systems: Confidentiality, access to patient records, use of technology
• Monitoring quality and achieving positive outcomes: Evidence-based guidelines, research ethics and protocols, risk assessment, falls prevention, establishing and using indicators to improve services

This broad yet in-depth approach supports ambulatory service providers who are, like so many other health care disciplines, struggling to do more with less, and to always do it better.

Quality matters Becoming accredited is a powerful mechanism to improve quality and ultimately, patient outcomes. The Accreditation Canada standards and programs help organizations demonstrate their commitment to quality improvement and patient safety as well as identify and act on opportunities to mitigate risk and reduce adverse events. The accreditation journey is an ongoing process of improving quality, safety, and efficiency to offer Canadians the best possible health care services. Because quality matters.