ASF Standards · Hospital · Standard 1
Standard 1 — Access & Arrival
Criteria in this standard
1.1 — Findable Before Arrival
1.2 — Hospital Grounds and Territory Entrance
1.3 — Physical Access, or a Real Plan
1.4 — Emergency Entrance, Marked and Clear
1.5 — Wayfinding Without Staff Dependence
1.2 — Hospital Grounds and Territory Entrance
1.3 — Physical Access, or a Real Plan
1.4 — Emergency Entrance, Marked and Clear
1.5 — Wayfinding Without Staff Dependence
1.1
Findable Before Arrival
Non-Negotiable
The facility's name, address, phone number, and mapped location are correct, current, and independently verifiable by anyone searching as a patient would.
In plain terms: Anyone — a patient, a relative, an ambulance driver — can find your hospital's correct name, address, phone number and map location without help.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Full | Full | Full | Full |
Why this matters
Patients search for a hospital the same way they search for anything: on their phone. If your Google Maps pin is 800 metres off, your listed phone number rings dead, or the address on your website is the old one, a patient in pain arrives late, a relative panics, an ambulance loses minutes. This is not a marketing issue. Every year facilities are found with the wrong address on official listings, and nobody noticed because staff never search for their own workplace. The cost of getting this wrong is measured in delayed arrivals, missed appointments, and for emergencies, in outcomes.
What good looks like
- Name, address, and phone number are correct and independently verifiable.
- A patient can call cold and reach the front desk within a minute.
- The mapped pin matches the real, physical entrance exactly.
Common failure modes
- An old address still listed on letterhead, alongside a correct current one online.
- Listed number rings out with no voicemail; no way to confirm the location at all.
- A map pin one street over from the real building, with no correction requested.
Worked example
In practice
A 120-bed regional hospital in a mid-sized city, on a street renamed three years ago.
BeforeThe Coordinator searched the hospital's name on Google. The map pin pointed to the old outpatient annex, 600 metres away. Two of the three phone numbers listed on the website were disconnected. A patient-review site listed opening hours from 2019. Staff had never noticed because they walk in the same door every day and never search for the address.
ActionThe Coordinator (1) claimed the Google Business listing and corrected the pin, address, phone and hours; (2) checked the website, the Ministry of Health directory, and the two main local directories and fixed each; (3) called each listed phone number from an outside line to confirm it rang and was answered; (4) added a quarterly check to the calendar.
AfterSearching the hospital name now returns one correct listing with a working phone. The Monitor tested it independently from a personal phone, called the number, and confirmed a human answered. Criterion verified.
If you are starting from zero — do this first
- Search your hospital name on Google Maps from a personal phone — where does the pin land?
- Call every phone number you list publicly, from an outside line.
- Check your address on the Ministry directory and your own website — do they match?
- Note every discrepancy in one list before fixing anything.
The most common mistake: Facilities check their own website and assume the map and directories say the same thing — they usually don't.
Self-assessment questions
1. Is the facility name, address, and phone number correct on your own website and any public listing? — Not the address on file with a regulator years ago — what a patient searching today would actually find.
Evidence: Website screenshot, public listing
Evidence: Website screenshot, public listing
2. Does the phone number listed actually connect to your facility when called? — Tested directly, not assumed because it was correct when first published.
Evidence: Call log or test record
Evidence: Call log or test record
3. If a map location is used, does the pin match the real entrance, not a nearby approximation? — A pin one block off sends ambulances to the wrong street in an emergency.
Evidence: Map screenshot
Evidence: Map screenshot
Common reasons for a PARTIAL answer
- The website was never updated after a move. — The clinical team changed address but nobody told whoever manages the website — a common, low-cost, high-consequence gap.
- The phone number is correct but nobody answers as "the facility." — Calls connect to a generic switchboard that cannot confirm this is the right place.
- The map pin was set once, years ago, and never checked again.
Implementation plan
| When | What |
|---|---|
| Week 1 | Search for your own facility exactly as a patient would, across every platform patients actually use. |
| Week 2 | Correct the address and phone number on your own website and any listing you control directly. |
| Week 3 | Call your own listed number from an outside line and time how long it takes to confirm you've reached the right place. |
| Ongoing | Recheck all public listings every six months. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| OBSERVE | Public search test | Independently searches for the facility exactly as a patient would — by name, address, phone number — using only public information. |
| DOCUMENT | Address cross-check | Confirms the mapped or listed address matches what is physically found on arrival. |
| ASK | Cold-call directions test | Calls the listed number posing as a first-time patient asking for directions, and notes whether the answer is accurate without hesitation. |
Supervisor tips
- Search cold, don't ask the facility for directions first. — The whole point is testing what a stranger finds.
- Call from a number the facility won't recognise. — A number in the facility's own contact list may get special handling a real patient wouldn't.
Evidence base
World Health Organization. Emergency care system framework. Geneva: WHO; 2018.
Pons PT, Markovchick VJ. Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome? J Emerg Med. 2002;23(1):43-48.
Train your team: H-01 · Access & Arrival on GMJ Academy →
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1.2
Hospital Grounds and Territory Entrance
Non-Negotiable
The hospital's territory begins at its first point of entry — the gate, main entrance, or boundary of the grounds — not at the building door. This entire approach is safe, clean, and clearly the hospital's own space from that first point.
In plain terms: The hospital's responsibility starts at its gate or boundary, not at the building door — the whole approach must be safe, clean, and clearly identifiable as the hospital.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
A patient's first impression forms at the gate, not the reception desk. Broken lighting on the approach path, rubbish at the boundary, an unclear point where the street ends and the hospital begins — each of these tells a frightened patient that nobody is in charge. It also creates real hazards: unlit paths at night, uneven ground for wheelchairs, unclear boundaries where security cannot act. Facilities that maintain the building beautifully but neglect the grounds have a blind spot the patient sees first and remembers longest. The cost is trust lost before the first clinical contact.
What good looks like
- The grounds boundary is clearly identifiable, safe, and well maintained from the first point of entry.
- A single, unambiguous route leads from the entrance to the building.
- Lighting, walkways, and general upkeep of the grounds reflect the same standard expected inside the building.
Common failure modes
- The territory boundary is unclear, with no obvious sense of where hospital responsibility begins.
- Grounds are neglected, poorly lit, or unsafe to walk, even though the building itself is well kept.
- Multiple ambiguous paths from the entrance leave a first-time visitor uncertain which way to go.
Worked example
In practice
A district hospital on a large plot, with a main gate 150 metres from the building.
BeforeThe gate had no hospital name on it — only a faded municipal sign. The path from gate to entrance had two broken lights and a section where paving had collapsed. Motorbike taxis parked across the pedestrian route. Patients arriving at night reported feeling unsafe. Management considered the grounds 'outside' and had no maintenance schedule for them.
ActionThe Director walked the route at night with the Coordinator and facilities manager. They fixed the lights and paving within two weeks, painted the hospital name and logo on the gate, marked a pedestrian route with bollards, and added the grounds to the weekly maintenance checklist with a named person responsible.
AfterThe Monitor walked from the street to the entrance at 8pm. The route was lit, clear, and unmistakably the hospital's from the gate onward. The maintenance log showed weekly checks. Verified.
If you are starting from zero — do this first
- Walk from the public street to your front door as a first-time visitor would — note everything.
- Repeat the walk after dark.
- Identify exactly where 'hospital territory' begins and whether that point is marked.
- Add the grounds to the maintenance schedule with a named owner.
The most common mistake: Treating the car park and approach path as someone else's problem — the municipality's, a contractor's — so no one owns it.
Self-assessment questions
1. Is the boundary of the hospital's grounds — gate, fence line, or first entry point — clearly identifiable as the hospital's own territory? — Not the building itself — the point where a visitor first enters land the hospital is responsible for.
Evidence: Photo of grounds boundary and entry point
Evidence: Photo of grounds boundary and entry point
2. Is the approach from that entry point to the building itself safe, maintained, and clean? — Walkways, lighting, and general upkeep of the grounds themselves, not just the building interior.
Evidence: Grounds maintenance record
Evidence: Grounds maintenance record
3. Is there a single, clear route from the territory entrance to the main building, not multiple ambiguous paths? — A confusing arrival sequence undermines confidence before the visit has even properly begun.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
Common reasons for a PARTIAL answer
- The building is well maintained, but the grounds have never received the same attention. — Maintenance budgets and attention often stop at the building's own walls, leaving the approach overlooked.
- The main route is fine but a secondary or older entrance is neglected. — A less-used entrance can quietly fall out of the same maintenance cycle as the primary one.
- Lighting is adequate during the day but poor at night, when it matters most for safety.
Implementation plan
| When | What |
|---|---|
| Week 1 | Walk the full grounds approach, from territory boundary to building, and log every maintenance or safety gap found. |
| Week 2 | Address the highest-priority safety gaps first — lighting, walkway condition, obstruction. |
| Week 3 | Clarify signage or physical routing so the path from entrance to building is unambiguous. |
| Ongoing | Include grounds maintenance in the same routine inspection cycle as the building itself. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| OBSERVE | Grounds boundary check | Physically walks the entire approach from the territory's first entry point to the building, checking maintenance and safety. |
| OBSERVE | Route clarity test | Approaches as a first-time visitor would, checking whether the route from entry point to building is unambiguous. |
| DOCUMENT | Grounds maintenance record review | Reviews maintenance and upkeep records for the grounds themselves, separate from building maintenance. |
Supervisor tips
- Walk the actual approach yourself, don't assess the building alone. — This standard is specifically about what happens before the building door, which is easy to overlook.
- Check lighting and safety after dark if possible, not only during a daytime visit. — Genuine safety gaps often concentrate in conditions the standard assessment visit doesn't naturally cover.
Evidence base
Ulrich RS, Zimring C, Zhu X, et al. A Review of the Research Literature on Evidence-Based Healthcare Design. HERD. 2008;1(3):61-125.
WHO, Emergency Care System Framework (2 May 2018).
Train your team: H-01 · Access & Arrival on GMJ Academy →
This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.
1.3
Physical Access, or a Real Plan
Non-Negotiable
At least one entrance is usable by a wheelchair user without staff needing to lift or carry them. Where full access does not yet exist, the facility holds a specific, budgeted, dated plan to close the gap.
In plain terms: A wheelchair user can enter through at least one door without being carried — or, if not yet, you have a real plan with money and a date to fix it.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
Being carried into a hospital is undignified and dangerous — for the patient and for the staff lifting them. Many older buildings were built without ramps, and fixing that costs money the facility may not yet have. ASF does not pretend otherwise. But there is a sharp line between 'we have no ramp and a dated, budgeted plan to build one' and 'we have no ramp and no plan.' The first is a facility on a path; the second is a facility that has decided some patients matter less. The legal exposure is real too: disability access is a legal requirement in most countries, and a documented plan is the difference between good faith and negligence.
What good looks like
- A clear, unobstructed accessible route verified on the day of assessment.
- A funded, dated plan with a contractor already selected and visible first steps taken.
- Front-line staff describe genuine, dignified assistance procedures without hesitation.
Common failure modes
- "We've been meaning to build a ramp" — no document, no budget, no date, unchanged from the year before.
- A ramp exists on paper but is blocked by stored equipment on the day of the visit.
- Staff describe assistance as improvised, with no actual procedure or training behind it.
Worked example
In practice
A 60-bed hospital in a 1970s building with three steps at every entrance.
BeforeWheelchair patients were lifted up the front steps by porters. Two porters had back injuries in the previous year. The Director knew a ramp was needed but there was no budget line, no drawing, no date — just an intention. When asked, staff said 'we manage.'
ActionThe Coordinator got a quote for a compliant ramp at the side entrance (the cheapest option). The Director put it in the next budget with a named completion date eleven months out. Meanwhile they bought a portable ramp for the side door as an interim measure and wrote a one-page plan: what, where, cost, date, who is responsible.
AfterThe Monitor reviewed the signed plan with the budget line, the quote, and the date. They observed the portable ramp in use. The criterion is met on the basis of a genuine plan — not yet on full access — and will be re-checked at the date.
If you are starting from zero — do this first
- Try to enter every public door in a wheelchair, or with someone who uses one.
- If none works: get one written quote for the cheapest compliant fix.
- Put that quote in front of the Director with a proposed completion date.
- Write the plan on one page: what, where, cost, date, owner — and have the Director sign it.
The most common mistake: Saying 'we plan to build a ramp' without a budget line, a date, or a document — an intention is not a plan.
Self-assessment questions
1. Is there at least one entrance a wheelchair user can use without staff physically lifting or carrying them? — A step, a narrow doorway, or a heavy unassisted door all count as a barrier.
Evidence: Photo of entrance route
Evidence: Photo of entrance route
2. If not, is there a specific, budgeted, dated plan to close the gap? — Not "we've discussed it" — a named structural change, a budget line, a date.
Evidence: Capital plan or board minutes
Evidence: Capital plan or board minutes
3. Has any real step already been taken toward that plan? — A quote obtained, materials ordered, or work scheduled — not just intention.
Evidence: Quote, order, or contract
Evidence: Quote, order, or contract
Common reasons for a PARTIAL answer
- A ramp exists but was never checked for actual usability. — Grade too steep, surface uneven, or door at the top too heavy — built once, never tested by an actual wheelchair user.
- A plan exists in someone's head but was never written down or costed. — Good intentions with no budget line are indistinguishable from no plan once someone asks for the document.
- Access exists at one entrance but staff don't know to direct people there.
Implementation plan
| When | What |
|---|---|
| Week 1 | Physically test your own accessible route and document every barrier found. |
| Week 2 | Get a real quote for the smallest fix that closes the largest gap. |
| Week 3 | Put a specific budget line and date in front of whoever approves facility spending, in writing. |
| Month 2 | Train front-line staff on a real, dignified assistance procedure for the gap between now and the fix. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| OBSERVE | Physical route check | Walks the accessible route from the street or car park to the entrance, checking for steps, doorway width, and obstructions. |
| DOCUMENT | Plan verification | If access is incomplete, requests the accessibility plan directly. |
| ASK | Front-line staff interview | Asks a front-line staff member how they would actually assist a wheelchair user arriving right now. |
Supervisor tips
- Walk the route yourself, don't take a photo's word for it. — Grade and surface texture matter in ways photos hide.
- Ask for the plan document before commenting on what you observed. — A facility that produces a real document quickly usually has a real plan.
Evidence base
United Nations. Convention on the Rights of Persons with Disabilities, Article 9 — Accessibility. New York: UN; 2006.
United Nations. Convention on the Rights of Persons with Disabilities, Article 4(2) — Progressive Realisation. New York: UN; 2006.
Train your team: H-01 · Access & Arrival on GMJ Academy →
This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.
1.4
Emergency Entrance, Marked and Clear
Non-Negotiable
Where the facility has a distinct emergency entrance, it is clearly marked from the approach a person would actually take, visible before arrival, and kept clear at all times.
In plain terms: If you have a separate emergency entrance, a stranger arriving by car or on foot can see the sign for it before they reach the wrong door — and the route is never blocked.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Full | Full | Full | Full |
Why this matters
When someone is having a heart attack in the back seat, the driver does not have time to read three signs and reverse. If your emergency entrance is only marked once you are already in the car park, you have wasted the seconds that matter most. The second failure is subtler: the route is signed but a delivery truck parks across it every morning, or bins are left in the ambulance bay. A route that is clear when you check it and blocked at 7am on Tuesdays is not clear. Emergency access failures rarely appear in incident reports because nobody records the two minutes lost — but they are lost.
What good looks like
- A sign is visible from the main road, before the turn into the grounds, with the route kept clear.
- Staff give the same, immediate, confident directions when asked separately.
Common failure modes
- Signage only becomes visible once already in the car park.
- Two staff members give two different answers when asked directly.
Worked example
In practice
A 200-bed hospital with a dedicated emergency entrance on a side street.
BeforeThe only 'EMERGENCY' sign was above the emergency door itself — invisible from the main road. Drivers routinely arrived at the main entrance and were redirected, losing three to five minutes. The Coordinator asked three staff for directions; each described a different route. Deliveries parked in the ambulance bay between 6 and 8am.
ActionThe Coordinator drove the approach from both directions and timed when the sign became visible: never, from the main road. They installed a large sign at the main road turn and another at the car park entrance. Facilities painted the ambulance bay red with 'NO PARKING — AMBULANCE' and briefed the delivery contractor. All front-line and security staff were given one printed direction script.
AfterThe Monitor drove the approach and saw the emergency sign 200 metres before the turn. They visited at 7am and found the bay clear. Two staff, asked separately, gave identical directions. Verified.
If you are starting from zero — do this first
- Drive or walk toward your hospital from the main road — when do you first see 'EMERGENCY'?
- Ask three staff members separately how to direct someone to the emergency entrance.
- Check the route at your busiest delivery time, not at a quiet moment.
- Fix the single biggest visibility gap first — usually a sign at the road.
The most common mistake: Confirming the emergency sign exists instead of testing when it becomes visible to an approaching driver.
Self-assessment questions
1. Is the emergency entrance signed clearly enough to be seen before arriving at the main door? — Visible from the approach a real ambulance or member of the public would take.
Evidence: Photo from approach point
Evidence: Photo from approach point
2. Is the route to it kept physically clear at all times? — Not just clear when checked — clear as a matter of routine.
Evidence: Routine clearance log, if kept
Evidence: Routine clearance log, if kept
3. Would two different staff members give the same directions to it if asked separately? — Inconsistent directions from staff usually means the signage itself is inadequate.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
Common reasons for a PARTIAL answer
- Signage was designed for vehicles, not pedestrians, or the reverse. — A facility serving both often only signs for one.
- The route is clear during the day and blocked by deliveries at other times. — Assessed once, on a quiet day, the gap between routine and exception can go unnoticed.
- Signage exists but wasn't updated when the entrance itself moved.
Implementation plan
| When | What |
|---|---|
| Week 1 | Walk and drive the actual approach routes, timing when signage becomes visible. |
| Week 2 | Fix the single biggest visibility gap first. |
| Week 3 | Brief all front-line and security staff on a single, consistent set of directions. |
| Ongoing | Recheck route clearance at different times of day. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| OBSERVE | Approach visibility test | Approaches from the direction the public or an ambulance would arrive, checking when signage first becomes visible. |
| OBSERVE | Route clearance check | Checks whether the route beneath the signage is physically clear. |
| ASK | Staff consistency test | Separately asks two different staff members for directions, without either knowing the other was asked. |
Supervisor tips
- Time the approach, don't just confirm the sign exists. — A sign visible only for the last five metres fails the same way as no sign.
- Ask directions from someone who isn't reception. — Reveals whether the knowledge is actually distributed.
Evidence base
World Health Organization. Emergency care system framework. Geneva: WHO; 2018.
United Nations. Convention on the Rights of Persons with Disabilities, Article 9(1)(b). New York: UN; 2006.
Train your team: H-01 · Access & Arrival on GMJ Academy →
This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.
1.5
Wayfinding Without Staff Dependence
Core
Basic wayfinding allows someone with no prior knowledge of the building to locate reception, toilets, and the main clinical areas without stopping to ask for directions more than once.
In plain terms: Someone who has never been in your building can find reception, a toilet, and the main clinical areas by following signs — without having to ask more than once.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Adapted | Full |
Why this matters
Staff stop seeing signs after their first week. That is why hospitals are so often confusing to patients while seeming perfectly clear to the people who work there. The people who suffer most are the ones least able to ask: someone in pain, someone who does not speak the local language well, an elderly relative, a frightened parent. Each of them ends up either wandering or stopping staff — and staff stopped for directions are staff not doing their job. Good wayfinding is not decoration; it reduces missed appointments, late arrivals to procedures, and the low-level stress that makes everything else harder.
What good looks like
- Reception, toilets, and at least one clinical area are locatable by signage alone.
- A visitor already in the building confirms wayfinding felt straightforward.
Common failure modes
- A single sign board at the main door and nothing beyond it.
- Ground-floor signage is clear; upper floors have none at all.
Worked example
In practice
A 150-bed hospital across three connected buildings with a mix of old and new signage.
BeforeThe Coordinator asked a friend who had never visited to find the outpatient X-ray department from the front door. She asked for directions four times. Signs used department names that had changed. One corridor had a sign pointing left to 'Radiology' and another pointing right to 'X-Ray' — the same place. Toilet signs were absent from two of three waiting areas.
ActionThe Coordinator mapped every decision point — every place a visitor must choose a direction — and listed what sign was needed there. They standardised names (one name per department, everywhere), removed contradictory signs, and added toilet signs at every waiting area. They tested again with a second first-time visitor.
AfterThe second visitor found X-ray with one question. The Monitor repeated the test independently, found reception, a toilet, and two clinical areas from the entrance without asking. Verified.
If you are starting from zero — do this first
- Ask someone who has never visited to find reception, a toilet, and one clinical department — count the questions.
- Walk every corridor and list every place a visitor has to choose a direction.
- Check whether each department has exactly one name on every sign.
- Fix the worst decision point first.
The most common mistake: Asking staff whether the signage is clear — staff know the building and cannot see it as a stranger does.
Self-assessment questions
1. Can a first-time visitor find reception using only your posted signage? — Not staff intercepting and redirecting.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
2. Can they find the nearest toilet and one named clinical department the same way? — Test this with someone who has genuinely never been inside the building before.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
3. Is signage consistent across every floor, or does it stop after the ground floor? — A common, specific failure.
Evidence: Photos, floor by floor
Evidence: Photos, floor by floor
Common reasons for a PARTIAL answer
- Signage exists but uses internal department codes, not patient-facing names. — Staff know what "Ward 4B" means; a first-time visitor does not.
- Ground floor is signed because it was renovated recently; upper floors were never touched. — Wayfinding quality often tracks renovation history rather than a deliberate standard.
- Signage exists in one language only, in a facility serving a multilingual population.
Implementation plan
| When | What |
|---|---|
| Week 1 | Have someone with no prior knowledge navigate the building, and log every point of confusion. |
| Week 2 | Fix the highest-traffic gap first. |
| Month 2 | Extend consistent signage to every floor, using patient-facing names. |
| Ongoing | Re-test with a genuine first-time visitor whenever the layout changes. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| OBSERVE | First-time visitor test | Enters as a first-time visitor and attempts to locate reception, toilet, and one department using only signage. |
| OBSERVE | Staff-query count | Notes exactly how many times a staff member had to be asked for directions. |
| ASK | Independent visitor check | Asks a visitor already in the building whether they found their way easily. |
Supervisor tips
- Use a genuinely unfamiliar tester. — Anyone with prior exposure fills gaps a true first-time visitor cannot.
- Count staff queries precisely, don't estimate. — "A couple of times" and "zero times" are very different outcomes.
Evidence base
Carpman JR, Grant MA. Design that cares: planning health facilities for patients and visitors. 3rd ed. San Francisco: Jossey-Bass/Wiley; 2016.
Ulrich RS, Zimring C, Zhu X, et al. A review of the research literature on evidence-based healthcare design. HERD. 2008;1(3):61-125.
Train your team: H-01 · Access & Arrival on GMJ Academy →
This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.