ASF Standards · Ambulatory Clinic · Standard 1

Standard 1 — Access & Arrival

4 criteria · 3 non-negotiable · 1 core · Version 3.0

Criteria in this standard

1.1 — Findable Before Arrival
1.2 — A Genuinely Usable Entrance for Disabled Patients
1.3 — Approach and Grounds Safety
1.4 — Wayfinding Without Staff Dependence

1.1

Findable Before Arrival

Non-Negotiable

The clinic'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 clinic'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 clinic 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 cold call and reach the clinic within a minute.
The mapped pin matches the real, physical entrance exactly.

Common failure modes

An old address is still listed on letterhead, alongside a correct current one online.
Listed number rings out with no voicemail, no way to confirm this is the right place.
A map pin one street over from the real building, with no correction requested.

Worked example

In practice

A 12-room regional clinic in a mid-sized city, on a street renamed three years ago.

BeforeThe Coordinator searched the clinic'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 clinic 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 clinic 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 clinic name, address, and phone number correct on your own website and any public listing? — Not the address on file years ago — what a patient searching today would actually find.
Evidence: Website screenshot, public listing

2. Does the phone number listed actually connect to your clinic when called? — Tested directly, not assumed correct because it was correct when first published.
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 patients to the wrong door, or ambulances to the wrong street.
Evidence: Map screenshot

Common reasons for a PARTIAL answer

The website was never updated after a move. — The clinical team changed but nobody told whoever manages the website — a common, low-cost, high-consequence gap.
The phone number is correct but nobody answers as "the clinic." — 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 clinic 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 clinic exactly as a patient would — by name, address, phone — 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 clinic for directions first. — The whole point is testing what a stranger finds.
Call from a number the clinic won't recognise. — A number in the clinic's own contact list may get special handling a real patient wouldn't.

Evidence base

[1] World Health Organization. Emergency care system framework. Geneva: WHO; 2018.

Train your team: AMB-01 · Access & Arrival on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

1.2

A Genuinely Usable Entrance for Disabled Patients

Non-Negotiable

At least one entrance is step-free or served by a compliant ramp, with a door wide enough for a wheelchair to pass through without difficulty and hardware operable with one hand. Where this does not yet exist, the clinic holds a specific, budgeted, dated plan to close the gap.

In plain terms: A wheelchair user can get through at least one door on their own — no step, wide enough, opens with one hand — or you have a dated, budgeted plan to make it so.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Disabled patients are the most frequent users of healthcare and the most often excluded from it by a single step at the door. A ramp that is too steep, a door too narrow for a wheelchair, a handle that requires two hands — each turns a clinic into a place the patient cannot enter without being carried. For a clinic, this is doubly important: there is no porter, and the receptionist cannot leave the desk. The standard accepts that older buildings cannot be fixed overnight, but only if there is a real plan: a quote, a budget line, a date. 'We help them in' is not a plan.

What good looks like

At least one entrance is genuinely step-free or ramped to a safe healthcare-grade gradient.
The door is wide enough for a standard wheelchair to pass without assistance.
Where access doesn't yet exist, a specific, funded, dated plan is in place and visibly being followed.

Common failure modes

The only entrance has steps with no ramp alternative at all.
A ramp exists but is too steep to be genuinely safe, effectively decorative.
No specific plan exists — only a general acknowledgement that access "should be improved sometime."

Worked example

In practice

A 10-room clinic in a converted ground-floor apartment with two steps at the entrance.

BeforeWheelchair patients were lifted up the steps by whoever was available — sometimes the patient's relative, sometimes the receptionist. The door was 70 cm wide; standard wheelchairs are 65–70 cm. There was no plan and no budget. The clinic owner said 'we've never had a complaint.'

ActionThe Coordinator got a quote for a compliant ramp (1:12 gradient) and widening the door to 90 cm with a lever handle. The owner approved a budget line with a completion date four months out. A portable ramp was bought immediately. The plan was written on one page and signed.

AfterThe Monitor reviewed the signed plan, the quote, the budget line, and observed the portable ramp in use. The criterion is met on the plan; the Monitor will re-check at the date. Verified.

If you are starting from zero — do this first

Measure your entrance door width. Under 85 cm fails.
Count steps at every public entrance. Any step without a ramp fails.
Get one quote for the cheapest compliant fix.
Write a one-page plan with cost, date, and owner — signed by the Director.

The most common mistake: Confusing 'we manage to get wheelchair users in' with access — being carried is not access.

Self-assessment questions

1. Is there at least one step-free entrance, or a ramp meeting a genuine healthcare-grade gradient, not a makeshift board? — A steep improvised ramp can be more dangerous than stairs — this means a real, safe gradient.
Evidence: Photo of entrance and ramp

2. Can a standard wheelchair pass through the entrance door without the user needing help to squeeze through? — A specific, measurable width, not a visual impression that it looks wide enough.
Evidence: Door width measurement

3. Where full access doesn't yet exist, is there a specific, dated, budgeted plan to fix it — not a general intention to "look into it eventually"? — A plan with a number and a date, the same standard applied throughout this whole framework.
Evidence: Written access improvement plan

Common reasons for a PARTIAL answer

A ramp exists but was built to a residential, not healthcare-grade, gradient. — A ramp steep enough for general use can still be unsafe for a wheelchair user managing it alone.
The main entrance is accessible but a secondary or side entrance patients sometimes use is not. — Accessibility needs to hold at whichever entrance a patient is actually directed to, not just the primary one.
A plan exists but has no specific budget or date attached to it.

Implementation plan

When	What
Week 1	Measure your actual entrance — door width, ramp gradient if one exists — against the healthcare-specific guideline.
Week 2	If full access isn't achievable immediately, write a specific plan with a real budget figure and completion date.
Week 3	If a temporary workaround is needed in the meantime, make it genuinely safe, not just present.
Ongoing	Revisit the plan's progress against its own stated date.

How the Monitor verifies this

Method	What	Detail
OBSERVE	Physical entrance check	Directly tests the entrance and ramp gradient, and attempts entry as a wheelchair user would.
DOCUMENT	Door width measurement	Measures the actual clear door width against the healthcare-specific guideline threshold.
DOCUMENT	Access plan review	Where full access doesn't exist, reviews the specific plan for a real budget and date, not a vague aspiration.

Supervisor tips

Try to enter as a wheelchair user would, don't just look at the ramp. — A ramp that looks adequate can still be unsafe to actually use alone.
Ask for the specific budget figure and date in the access plan, not a general description of intent. — Specificity is what distinguishes a real plan from a good intention.

Evidence base

[2] International Health Facility Guidelines. Part C — Access, Mobility and OH&S. Sydney: Health Facility Guidelines; and United Nations. Convention on the Rights of Persons with Disabilities. New York: UN; 2006. Article 9.

Train your team: AMB-01 · Access & Arrival on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

1.3

Approach and Grounds Safety

Non-Negotiable

The immediate approach to the clinic — parking area, entryway, path from the street — is safe, clean, and well lit, not merely the building interior once a patient has already arrived.

In plain terms: The car park, path, and entrance are safe, clean, and lit — the clinic's responsibility starts at the street, not the door.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A patient who trips on broken paving in the car park has been injured at your clinic. A patient who cannot see the entrance at 6pm in winter goes home. A patient who has to cross a rubbish-strewn alley to reach you has already formed their opinion. The approach is where the patient is most vulnerable — often alone, often unwell, often in the dark — and it is the part of the premises clinics most often treat as someone else's problem. It is not. If the patient has to walk it to reach you, it is yours to make safe.

What good looks like

The approach is free of trip hazards, well lit, and genuinely walkable.
The route stays consistently clear of obstruction.
A specific person or role owns approach safety and maintenance.

Common failure modes

Uneven paving or poor lighting on the approach has never been addressed.
The entryway is regularly blocked by parked vehicles or stored equipment.
Nobody can identify who is responsible for noticing or fixing a hazard on the approach.

Worked example

In practice

A 12-room clinic on the ground floor of a commercial building with a shared car park.

BeforeThe car park had two potholes and no lighting. The path from the car park to the clinic entrance crossed a loading bay used by a neighbouring shop. There was no sign visible from the road. Evening patients had complained about feeling unsafe. The clinic considered the car park the landlord's responsibility.

ActionThe Coordinator walked the approach at 7pm and documented every hazard with photographs. The landlord was asked in writing to fix the potholes and lighting; when they declined, the clinic paid for two lights and pothole repair itself. A painted pedestrian path was added around the loading bay. An illuminated sign was mounted at the road.

AfterThe Monitor walked from the road to the entrance at dusk: lit, clear, signed, with a marked path. Verified.

If you are starting from zero — do this first

Walk from the street to your door at your latest opening time. Photograph everything.
List every hazard: lighting, surface, obstruction, signage.
Ask the landlord in writing. If refused, fix it yourself — it is your patients.
Add the approach to your monthly safety walk.

The most common mistake: Treating the car park as the landlord's problem while your patients fall in it.

Self-assessment questions

1. Is the walkway from the street or parking area to the entrance free of trip hazards and adequately lit? — Checked directly underfoot, not assumed safe because it looks fine from a distance.
Evidence: Photo of approach, day and evening if relevant

2. Is the approach kept clear of obstruction — parked vehicles, stored materials, snow or ice where relevant? — A route that's sometimes blocked is not a reliably safe route.
Evidence: N/A — tested directly

3. Is there a specific, assigned responsibility for keeping the approach safe, not a general hope someone will notice a hazard? — Specific ownership, not diffuse responsibility that belongs to nobody in particular.
Evidence: Role assignment record

Common reasons for a PARTIAL answer

The approach is well maintained during the day but poorly lit after dark. — A hazard assessment done only in daylight can miss a genuine evening safety gap.
Maintenance happens reactively after a complaint, not on any regular schedule. — Waiting for a complaint means at least one patient experienced the hazard first.
Responsibility is informally understood by long-term staff but not written down anywhere.

Implementation plan

When	What
Week 1	Walk the approach yourself, including after dark if the clinic operates evening hours.
Week 2	Fix any immediate hazard found — lighting, uneven surface, obstruction.
Week 3	Assign specific, written responsibility for ongoing approach safety.
Ongoing	Recheck the approach on a fixed schedule, not only after a complaint.

How the Monitor verifies this

Method	What	Detail
OBSERVE	Approach walk-through	Physically walks the entire approach from the street or parking area to the entrance, checking for hazards.
OBSERVE	Obstruction check	Checks whether the approach is currently clear, and asks how recently it was last checked.
ASK	Responsibility interview	Asks who is specifically responsible for approach safety and maintenance.

Supervisor tips

Walk the approach yourself rather than asking staff to describe it. — A route staff walk daily can become invisible to them even when a real hazard exists.
Ask specifically about evening conditions if the clinic has evening hours. — Daytime safety and evening safety are genuinely different conditions.

Evidence base

[3] Ulrich RS, Zimring C, Zhu X, DuBose J, Seo HB, Choi YS, et al. A review of the research literature on evidence-based healthcare design. HERD. 2008;1(3):61-125.

Train your team: AMB-01 · Access & Arrival on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

1.4

Wayfinding Without Staff Dependence

Core

Basic wayfinding allows someone with no prior knowledge of the clinic to locate reception and the relevant waiting area 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 clinics 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

A first-time visitor reaches reception without confusion.
Signage is current, clear, and consistently used.
Where the clinic is small enough that formal signage is genuinely unnecessary, this is a real fit, not a gap being excused.

Common failure modes

Visitors regularly get lost or need multiple directions from staff.
Signage is outdated, inconsistent, or missing at key decision points.
A larger, layout-complex clinic has no signage at all, relying entirely on staff to guide every visitor.

Worked example

In practice

A 14-room clinic 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 without asking for directions more than once? — Tested directly by someone unfamiliar with the layout, not assumed from staff familiarity.
Evidence: N/A — tested directly

2. Is signage clear and consistent, not relying on informal or outdated labels? — Signage that matches how staff actually refer to a space, not a leftover label from a previous use.
Evidence: Photo of signage

3. For a very small clinic where the whole space is visible from the entrance, is a lighter approach genuinely sufficient? — A one-room clinic may not need formal signage at all — this asks whether that's a genuine fit, not an excuse.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

Signage exists for the main path but not for less obvious secondary routes. — The most complex parts of a layout are exactly where clear guidance matters most.
Signage was accurate when installed but hasn't been updated as rooms changed use. — A label pointing to a room's old purpose actively misleads rather than helps.
Reception staff have become so used to giving directions that the underlying confusion is normalised rather than fixed.

Implementation plan

When	What
Week 1	Ask someone unfamiliar with the clinic to find reception unassisted and note where they hesitate.
Week 2	Add or correct signage at the specific points of confusion identified.
Week 3	Confirm with reception staff whether directional questions have genuinely decreased.
Ongoing	Recheck signage accuracy whenever room use changes.

How the Monitor verifies this

Method	What	Detail
OBSERVE	First-time visitor test	Approaches as a first-time visitor would, checking whether reception can be found without repeated direction-asking.
OBSERVE	Signage consistency check	Checks that signage is current, consistent, and matches actual space use.
ASK	Reception burden interview	Asks reception staff how often they are asked basic directional questions during a typical day.

Supervisor tips

Use a genuinely unfamiliar person for the test, not clinic staff. — Staff familiarity makes it impossible to judge wayfinding as a real first-time visitor would experience it.
Ask reception staff directly how often they field basic directional questions. — A high frequency is itself evidence of a wayfinding gap, regardless of how staff have adapted to it.

Evidence base

[4] Carpman JR, Grant MA. Design that cares: planning health facilities for patients and visitors. 3rd ed. San Francisco: Jossey-Bass/Wiley; 2016.

Train your team: AMB-01 · Access & Arrival on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

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