The service at West Herts Community Respiratory Service
have been a part of the PRSAS programme for several years and they were awarded
accreditation in July 2022. We’ve talked to their service lead, Louise Holt,
and specialist community respiratory physiotherapist Carolina Uribe to hear
about their experience through the accreditation process. They talk through
some barriers they have experienced and give their advice to services going
through the accreditation process.
Where did you first hear of the PRSAS programme?
Louise: That was back in 2018, and I am fairly
certain we would have heard about them from either NACAP (now NRAP) or ACPRC.
Carolina: Yes, the first time was when we attended a
QI workshop. When I joined the PR team, I was asked to coordinate the project
and we started from there!
So, coming from that that perspective, it sounds like you
saw the PRSAS programme as a QI project?
Louise: Yes, I think it’s like any new national drive
or piece of work that is rolled out and you want to get involved. You want to
always do the best for your patients, and you want to offer the best that you
possibly can. Why wouldn’t you want to get involved in that!
How did you find the process of introducing the PR
programme to the team and presenting the idea of doing the self-assessment?
Louise: From a managerial point of view, whatever you
are trying to instil must come from a positive approach. If I moan about it and
say it’s going to be hard work and draining on everybody, then nobody is going
to get involved in it. If instead you sell it as a positive experience - quite
rightly it is - then I think that’s what you get back from your staff.
Carolina: Yes, we were always working as a team; we
would have team meetings and share tasks, study the guidelines, watch the
videos on the PRSAS website and get everyone involved. During that time, we
allocated a domain for each member of staff, so everyone was engaged and
responsible for a specific domain. There was constant communication and
feedback.
How did your relationship with senior management hep you
complete your self-assessment?
Louise: We have a great relationship with the CCG and
with our ICB, along with our whole wider respiratory team, not just pulmonary
rehab. The CCG was very happy to support us in providing the best services. We
always had full engagement from not just the senior leadership team, but also
the other support services within the division and the trust which was
absolutely imperative.
When you came to submit your assessment request, how were
you feeling?
Carolina: I felt nervous! I think the whole team were
very nervous and hoping for the best, we did a huge amount of work and
improvement. It felt like a relief that we managed to get to this point where
we prepared as much as we could for submission and welcomed feedback from the
assessors.
What was the service response stage of the assessment
like for you? How did you find the communication with assessors?
The service response stage is the two weeks in the lead
up to assessment when services upload any additional evidence requested to help
the assessment team.
Louise: I think it was manageable because you’ve
already worked so hard in the first evidence upload. There was a huge amount of
anticipation on what the outcome was going to be. In terms of communication
with the Royal College of Physicians, that has always been fantastic, with
timely responses.
How did you find going through the deferral period, and
putting into action the key recommendations that the assessors gave you?
Louise: I think we kind of expected to defer - you
are never going to be perfect the first time around, and there is always going to
be something to work on, even now. Nobody has the perfect service and there is
always something you can do to improve. So, we didn’t really feel upset by it, it
was just the next hurdle to try and get over and the feedback we were given was
very comprehensive and felt like we could achieve it.
Would you say going through the accreditation pathway has
helped you develop your service?
Louise: Yes, I would say so. I think that due to the
time pressures of the accreditation processes it forces you forward, in all the
usual aspects of quality, including patient feedback, staff feedback, patients
experience and safety.
It has also given us the chance to review the operational
side of what we do. We now have a better data-driven process for the data we
collect, not just at the start when patients are referred into the service, but
the data we collect afterwards as well.
Which new processes have you embedded into your
day-to-day after going through the accreditation process?
Louise: It has put in place rigorous framework for us
in our team meetings, so it’s clear the direction we’re travelling in; our
vision, purpose and goals for the next year. It feels like it’s now all
consolidated in one place.
Carolina: The classes have changed a little bit to
improve outcome measures on the patient. We have the patient feedback survey,
as well as the staff feedback. We got into the habit of doing QI projects to
support service changes, which is something to back up improvement.
We need to evidence all we do to support accreditation, so
we maintain high quality standards for the documents that we develop in the service,
so we now do a lot of document management control.
Are there are parts of the process that you did find
challenging?
Carolina: Time management is a huge thing, trying to
accommodate and block out time to work. Sometimes clinical priorities come in
and we have to cancel so it remains a challenge trying to allocate time. I
think as long as we remain consistent, and ensure the documents are saved
correctly and have the quality standards, then the goal is clear.
Louise: I definitely think that having protected time
works better because you can get things done. Hopefully, that’s something that
NHS England can push on the agenda throughout different ICBs, so that we can
allocate sufficient resources. It is not just time, it’s resources to be able
to fulfil what’s required.
Congratulations on being accredited! How did the team
feel when you received that final tick mark?
Carolina: It was that feeling of achievement, and
relief! I feel confident that the service that we offer follow the best
practices and meet with the high-quality standards. I feel proud of all of the
people I work with, the service leads, and the leadership team.
Do you have anything else you want to mention to services
going through the accreditation process?
Carolina: Just as general advice for everyone, don’t
put barriers in your mind, it is a huge project, like any other project at the
beginning, but it is possible, just be flexible, open minded and kind to the
people you are working with.
Louise: Yes, it is definitely all about that. Looking
at what the barriers are and finding a way around them, don’t let that barrier
stop you in your tracks. Making them bite-size steps - rather than looking at
the whole picture and becoming overwhelmed, just break it down and use
everybody around you to support you.
Thanks to Louise and Carolina for sharing their experience
going through the PRSAS process with us!
If you want to learn more please visit https://www.prsas.org/about-accreditation or get in touch with us via pulmrehab@rcp.ac.uk