Walk Into Your Next Accreditation Canada On-Site Survey With the Data Already in Hand

Accreditation Canada's Qmentum Global program rewards organizations that can produce structured, time-stamped, traceable evidence of sustained compliance with Required Organizational Practices and HSO standards — not binders rebuilt the week before the surveyor arrives. clearPath was built around that data discipline from day one.

Accreditation Canada Readiness layers a complete on-site survey-prep suite on top of the audit data clearPath already collects: a readiness dashboard, the ROP and Qmentum Global template library, one-click evidence packets, Quality Improvement plans, tracer methodology, sampling adequacy alerts, and a survey cycle calendar. All shipping today in Enterprise and Ultimate.

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Why It Matters

  • On-site surveys on a four-year accreditation cycle
  • Required Organizational Practices (ROPs) carry "Major" and "Minor" tests of compliance
  • Sustained-improvement evidence expected across the cycle, not snapshot at survey time
  • Tracer methodology drives surveyor activity on-site
  • Sampling adequacy per service / unit comes up during tracer activity
  • Health Standards Organization (HSO) standards span clinical, governance, and population health
  • Multi-program organizations need a single source of truth across acute, LTC, mental health, and community services

What's Included

All live in clearPath Enterprise and Ultimate. Each capability is wired into the audit data and dashboards your team already uses — no new collection workflow, no parallel system.

Accreditation Canada Survey Readiness Dashboard

Survey Readiness Dashboard

Per-site and per-service gauges show months of sustained compliance, % above threshold, observation volume vs. sampling adequacy, days until your next on-site survey window, and open Quality Improvement actions. Drops into the same dashboard grid you already use, scoped by the same site / service / time-period filters.

  • Sustained-improvement gauge across the four-year cycle
  • ROP compliance status by service
  • Sampling adequacy flags per service / unit
  • On-site survey-window countdown
  • Open Quality Improvement plan count

Quality Improvement Plans

When a service drops below threshold or an ROP test of compliance is missed, an action item opens automatically. Capture interventions, assign owners, and link the re-audit results that close the loop — mapping cleanly to the leadership and quality-improvement standards Accreditation Canada surveys against.

  • Auto-create from threshold drops or ROP gaps
  • Assign owner, target date, intervention type
  • Link the re-audit that proves closure
  • Status, age, and overdue indicators in the list
Quality Improvement plan list
Survey Evidence Packet

Survey Evidence Packet Generator

One-click PDF or Excel binder for any date range and standard set: compliance trends, sampled observations, Quality Improvement closures, role and permission attestations, and a sampling adequacy summary. Builds the binder your accreditation lead would otherwise spend a week assembling.

  • Custom date range and standard-set scope (ROP / HSO / Qmentum Global)
  • Compliance trends + sampled observations
  • Quality Improvement plan closures included
  • PDF or Excel output, surveyor-ready

Tracer Methodology

Pick a client, encounter, service, or window and clearPath surfaces every related observation and custom-audit response in a surveyor-style tracer view. Run mock tracers between on-site surveys to spot drift, capture the trail, and export the result alongside the evidence packet.

  • Tracer subjects scoped by client, service, or window
  • Pulls observations + custom audits in chronological view
  • FHIR Patient / Encounter / Location for inbound subjects
  • Export tracer packet inline with evidence binder
Tracer subject list
ROP and Qmentum template library

ROP and Qmentum Template Library

Pre-built custom audits aligned to Accreditation Canada's Required Organizational Practices and Qmentum Global standard sets, organised by service area: acute care, long-term care, mental health, and community-based services. Standards tagging on every question lets reports filter by ROP, HSO standard, or Quality Dimension.

  • Pre-built templates for acute, LTC, mental health, and community services
  • Standards tagging at the question level (ROP / HSO / Qmentum Global)
  • Customise scope, evidence sources, and review checklist
  • Re-run any template against the latest data window

Plus

ROP & HSO Standards Coverage

Hand Hygiene Education, Antimicrobial Stewardship, Information Transfer at Care Transitions, Medication Reconciliation, Falls Prevention, Patient Safety Incident Disclosure — the audit templates your services need, tagged at the question level so reports filter by ROP, HSO standard, or Quality Dimension.

Sampling Adequacy Alerts

Configurable thresholds flag services with thin observation counts before a surveyor notices. Fix data gaps across the accreditation cycle, not the morning of the on-site survey. Adequacy status surfaces inline on the readiness dashboard.

Survey Cycle Calendar

Enter your last on-site survey date. clearPath projects the next survey window across the four-year cycle and reminds you about self-assessment deadlines, mock tracer rounds, and Quality Improvement plan checkpoints.

How It Maps to Accreditation Canada Standards

  • Hand Hygiene Education ROP — observation-driven compliance with WHO Five Moments: core platform capability, surfaced on the readiness dashboard.
  • Antimicrobial Stewardship & Infection Prevention — tagged audit templates in the acute care and LTC packs.
  • Quality Improvement & Leadership — closed-loop Quality Improvement plans tied to threshold drops and ROP gaps.
  • Sustained improvement — multi-month compliance trend above threshold: surfaced as a dedicated gauge on the readiness dashboard.
  • Tracer methodology — observation-level data scoped by client, service, or window; pulls into the evidence packet on demand.
  • Quality Dimensions — Safety, Accessibility, Appropriateness, Client-centred services, Continuity, Efficiency, Population focus, and Worklife — reportable filters across every dashboard and audit.

Built on the Platform You Already Use

Accreditation Canada Readiness doesn't introduce a parallel data store or a separate workflow. It's a layer of survey-prep tooling sitting on top of the same audit sessions, custom audits, dashboards, and security model your team uses every day.

  • Time-stamped, observer-attributed audit trail per session
  • WHO Five Moments + HCP type + technique + attributes per observation
  • Custom audits for any compliance topic, with standards tagging
  • Two-factor authentication, role-based permissions, LDAP / Active Directory
  • FHIR R4 publish-out for BI and EHR integration

Direct Observation Custom Audits FHIR R4

Built for the Canadian Healthcare Sectors You Operate In

Acute Care & Regional Health Authorities

Hand Hygiene Education ROP, infection prevention and control standards, environmental rounds, medication reconciliation. Auditor Groups roll units into programs of care so the readiness dashboard and evidence packets match the way infection prevention and quality teams actually operate.

Long-Term Care & Continuing Care

The LTC pack ships with falls prevention, pressure injury prevention, medication reconciliation, and resident-care ROPs — same time-stamped, observer-attributed evidence trail as hand hygiene, same one-click evidence packet at survey time.

Mental Health & Community Services

The mental health and community-services packs map to client-safety and care-transition standards: suicide-risk re-assessment, ligature-risk environmental scans, information transfer at care transitions. Sampling adequacy alerts and the evidence packet generator do the work the accreditation coordinator doesn't have hours for.

See Accreditation Canada Readiness in Your Data

Show us your site hierarchy and survey timeline; we'll walk you through what your readiness dashboard looks like and how the evidence packet would render for your last 12 months of compliance data.

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