University Hospitals Birmingham (UHB) recently became the 50th service to achieve PRSAS accreditation. We spoke with Gemma Atkins, Pulmonary Rehabilitation Lead, about the service's accreditation journey, the challenges they faced, and the impact accreditation has had on both staff and patients.

Can you tell us a little about your service and the patients you support?

Gemma: We're quite a large service. We have programmes running across three hospitals, two community wellbeing centres and we also offer a virtual programme. Being based in Birmingham, we support a very diverse population. We tend to see a more deprived cohort of patients than you might see nationally, and we also work with a very ethnically diverse group of patients.

We support patients with COPD, bronchiectasis, interstitial lung disease, asthma and pulmonary hypertension.

What motivated your service to begin the accreditation journey?

Gemma: We signed up for accreditation in 2022. The initial drive came from within the team, but it was also something that our ICB wanted us to pursue. For us, the main motivation was quality improvement. We wanted to improve the quality of the service we were delivering and accreditation provided a really clear framework to help us do that.

What were the biggest challenges you faced along the way?

Gemma: When we started, we didn't really have the management structure or capacity needed to undertake a project of this size. We had several Band 7 staff who were very clinically focused, but nobody had dedicated time to do the work involved. There was a real willingness within the team to move things forward, but rewriting SOPs, reviewing waiting lists and aligning processes with accreditation standards all take time. The turning point came when the Trust created a Pulmonary Rehabilitation Lead role with protected time to focus on service development, quality improvement and accreditation. Once that happened, it only took around 12 months for us to be ready for submission.

If there's one thing I'd stress to other services, it's that protected time is absolutely essential.

Did anything about the accreditation process surprise you?

Gemma: I think we were surprised by just how much work was needed to align the service with the quality standards. There were a lot of processes that we didn't realise weren't fully in place until we started working through the domains. We had to think carefully about how we were collecting data, how we were evidencing it and how we could demonstrate compliance.

At the start, that felt like a big hurdle. Looking back now, it's actually been one of the most positive outcomes because we're much better at collecting and using data than we were before.

What changes have had the greatest impact on your service?

Gemma: One of the biggest pieces of work was completely rewriting our main SOP. It's now much more user friendly and new staff tell us that it really helps them understand how the service operates.

We've also created a central system that tracks everything from SOP review dates and audits to staff training requirements. It's made it much easier to identify gaps, monitor progress and ensure things are completed on time.

The accreditation process also encouraged us to think much more strategically about service development and quality improvement. As a result, we're now undertaking more quality improvement work, reviewing it more effectively and seeing tangible results. For the first time ever, we're seeing our waiting lists come down, which is hugely positive for both the service and our patients.

How did you engage your team throughout the process?

Gemma: It was definitely a team effort; We broke the accreditation standards down into individual tasks across each domain and shared them across the team. Accreditation became a standing item at our team meetings, which take place twice a month, and we reviewed progress regularly. Keeping it on the agenda every two weeks helped keep everyone engaged and ensured that accreditation remained a shared responsibility rather than sitting with one person.

What role did senior leaders and stakeholders play?

Gemma: We already had fairly good relationships with the ICB and we used our regular meetings to provide accreditation updates. Our senior leadership team were also very supportive. We had regular updates with managers and therapy leads, and accreditation became a key discussion point during annual reviews and quarterly reporting.

Did accreditation strengthen those relationships?

Gemma: Absolutely – before accreditation, we didn't have the same level of engagement with the ICB, senior managers or executive teams. Through the accreditation process, those relationships have developed significantly. We've had opportunities to speak at Trust-wide events, share updates with patient groups and engage with senior leaders much more regularly.

I'd say accreditation has completely transformed our relationship with senior managers.

Looking back now, is there anything you would do differently?

Gemma: I wish we'd thought about the amount of administrative and transformation time that would be needed much earlier. For quite a long period, we didn't make as much progress as we wanted because nobody had dedicated time to lead the work.

If you're just starting out, I'd recommend identifying who is going to steer the project and making sure they have the time and support they need to do it.

How will you maintain accreditation going forward?

Gemma: For us, it's about continuing the processes we've put in place. We'll continue to engage regularly with senior leaders and stakeholders, maintain our annual reviews and keep quality improvement at the centre of what we do. The new systems we've created mean it's now very easy to see when SOPs need reviewing, when audits are due and where there may be training gaps. Those processes will help us maintain the standards we've worked so hard to achieve."

Finally, how does it feel to be PRSAS's 50th accredited service?

Gemma: We're absolutely delighted. It's a really special achievement for the team and something we're very proud to celebrate."

The accreditation process has completely transformed our service. It's made us fit for the future, given us a much clearer structure for development and improved the way we work together as a team.

I genuinely think our staff are happier within the service as a result. Everybody has a better understanding of their role and where it fits within the wider team. And when staff feel supported and engaged, patients benefit too.

It's a lot of work, but it's absolutely worth it. For any service beginning the journey, I'd encourage them to make use of all the resources available through PRSAS. The portal resources, online meetings and accreditation events were incredibly valuable for us and made a real difference throughout the process.

Thanks to Gemma for sharing her accreditation journey with, and congratulations to the entire UHB pulmonary rehabilitation team on this achievement.