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West Herts Community Respiratory Service
25 August 2023

Louise Holt and Carolina Uribe

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!

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