We spoke with Sandra Walsh, an IQILS nurse assessor since 2021, about the challenges and benefits of the accreditation process and her advice to services undergoing assessment.

Sandra Walsh is lead hepatology clinical nurse specialist at Wrexham Maelor Hospital. She began her career in 1990 as a trainee in Chester, initially her focus was care of older people but over time her ward evolved into a gastroenterology unit, where her passion for hepatology began. She worked her way up to ward manager and after holding the role for 4 years, faced a decision on where to take her career next. She ultimately decided to dedicate her future to hepatology and specialist nursing. After waiting 2 years for a liver-specific role to become available, she finally joined the team at Wrexham Maelor. Here she has helped to transform and grow the hepatology service, which now works across three hospital sites. 

'I still love it now, and I'm 20 years in this job' 

After attending an IQILS launch event at the RCP’s Liverpool office in 2017, Sandra thought the programme was a great idea but felt it would be impossible for her service to undertake given their lack of resources – a concern shared by many services. Her wealth of experience made her an ideal candidate to become an assessor and in 2021 she joined the programme. Due to a lack of assessments at the time, Sandra’s training was regrettably brief. However, since completing her first assessment she quickly became one of IQILS’ most trusted nurse assessors.  

While initially worried about the ‘dos and don’ts’ of assessments, her subsequent experience has shown her how important flexibility is when visiting a service, as each one has different challenges and realities. 

'When it comes to evidence, sometimes less is more'

Sandra highlighted several challenges she has faced as an assessor but was keen to point out that these are usually mitigated by the collaborative and enthusiastic teams she encounters.

Simply finding enough time to focus on all the key aspects of an assessment day’s agenda can be a logistical challenge, though it’s assessors and services usually manage together. Working through a service’s evidence online can be difficult, especially when it contains irrelevant material or is more than 12 months old. In more difficult cases she tells us that focusing on key information, such as the service’s operating plan and staff profile, is a good place to start. Equally, failure to provide evidence on the day of an assessment, often despite a request in advance, can waste precious time and delay outcomes. A lack of staff availability for interviews has similar consequences. Sandra highlights that even if a team member is on sick leave, for example, a compromise can always be found if the assessment team is given notice beforehand. Finally, internal politics is something every service will struggle with at times, and while this can sometimes spill over into an assessment, Sandra stresses that she and her fellow assessors do their best to look beyond this and focus on the standards and the service.

'Everybody's having the same problems'

Unfortunately, many services face issues that are not related to the clinical abilities of their team members. Sandra highlighted that a lack of staff/financial resources, sometimes caused by a perceived lack of management support, often stops services beginning the accreditation process at all. Basic prerequisites for an assessment, such as a service website, can feel like a major obstacle if the necessary IT support is not available. Sandra also pointed to a frequent over-reliance on one team member to complete an assessment. This is a high-risk approach if the individual is unavailable or leaves the team; therefore, she suggested maximising collaboration within the team as much as possible. Sandra encouraged services to speak with the office team before ruling IQILS out. The programme’s priority is always to be supportive rather than exclusionary and promotes improvement pathways with evidenced outcomes, which can often be used to increase management/financial support. 

Sandra told us that every service she has visited showed great qualities, evidenced by the fact that they have all gained accreditation. However, she did highlight two examples that stood out to her. During a visit to Derriford Hospital in Plymouth, she learned about the South West Liver Buddies and her fellow assessors felt this was a fantastic programme and, unsurprisingly, patient feedback was outstanding. The second example was from a recent visit to Aintree University Hospital, where the team found the Alcohol Care Team to be a dynamic initiative that continues to develop. 

'(conducting assessments) opens your eyes to what's happening around the country' 

Sandra told us that while teaching and assessing is already a part of her role as a nurse lead, becoming an assessor has given her the experience to review processes on a much broader scale. Seeing what services around the country are succeeding or struggling with has provided her with greater insight, and more confidence in the ways her team are performing well. She has learned that she is a more effective assessor because of her significant experience, and as a result she does not present services with unrealistic targets, rather she tailors her advice to match a service’s capabilities. While some services may have the resources to provide exceptional services, Sandra’s focus during each assessment is whether that service is meeting the standards, rather than making comparisons.

'I think doing anything new is scary, but you shouldn't stagnate either' 

Sandra acknowledged that beginning the accreditation process can be daunting, but her top tips for success were simple and echoed her earlier thoughts: 

She advises that services try to only upload relevant documentation and avoid the urge to include evidence ‘just in case’. Similarly, she suggests that services should work through the standards methodically when uploading evidence, ensuring that all content is up to date. 

When receiving feedback, prompt and continued engagement with the assessors via the assessment dashboard allows the assessment to progress without roadblocks. She emphasised that it is important to show that you are doing the basics, however obvious it may feel. 

Finally she outlined how important continued improvement is to her. There is always room for growth, at every level of service provision. 

Thank you to Sandra for her insight into the accreditation process from an assessor point of view. If you are interested in becoming an IQILS assessor, or you’d like more information about the programme, please get in touch with us: askiqils@rcp.ac.uk.