We recently spoke with Sundeep ‘Sunny’ Chahal, nurse lead for Wolverhampton’s New Cross Hospital liver service, who provided his insights on the benefits of accreditation and working with IQILS.
Introduction
Sunny has over 13 years of experience working as a nurse in hepatology and gastroenterology. Over the past 6 years, he has worked with colleagues to vastly improve liver services at New Cross Hospital. Their reach now extends beyond the clinic itself, with the team providing vital services to the wider community, including people who are homeless.
He cites IQILS as an essential factor in enabling this progress and growth.
How did you and your team come to be involved with IQILS?
Over his career Sunny has gained valuable experience through varied roles, including a period working to provide liver services in prisons. In 2018, his focus turned to improving the liver services at New Cross Hospital.
Historically, there had been no specific liver pathway at the hospital and services sat under a wider gastroenterology umbrella. In an attempt to change this, Sunny and the team began to carve out an independent, specialised liver service at the hospital, under the initial leadership of Dr Ian Perry, and later Dr Townsend.
In 2019, the service registered with IQILS, with the long-term goal of achieving accreditation.
What benefits do you feel your service has gained from working with IQILS and the accreditation process?
The first benefit that Sunny discussed was expanding the service’s scope through recruitment. For some time, he was effectively working alone as a clinical nurse specialist to provide fairly limited liver services. He describes how IQILS helped the service to identify new pathways and provided an evidenced and attainable vision for development.
In order to deliver these new pathways, the service was granted the resources by its trust to recruit new team members, which in turn gave them the staffing resources to offer even more varied clinics, and so the cycle has continued.
Having only been able to offer hepatitis C clinics initially, the team now offers services for a vast array of liver conditions. These range from hepatitis B to fatty liver disease and even mini-clinics in homeless shelters and drug/alcohol rehab centres.
'All of this came from IQILS … looking at how other teams work and how we could adapt some of those features.'
Sunny describes this growth as resulting from the opportunity to build relationships with and draw from the examples of other IQILS-accredited services. For example, the team is now able to take the ‘Hepatology Bus’ (borrowed from their neighbours at Queen Elizabeth Hospital (QEH) in Birmingham) around Wolverhampton and offer ad hoc services to the public. This is a great way to engage with patients who may otherwise slip through the cracks, such as those who are homeless, and is only possible because of their relationship with QEH.
Additionally, the service soon hopes to introduce advanced nurse practitioner roles, a move inspired by a site assessment that Sunny carried out at another service as an IQILS assessor.
Following patient demand, paracentesis services have returned to New Cross Hospital. Services were moved to Cannock Chase due to COVID restrictions in 2020 and had remained there exclusively. However, in a move to improve patient services as part of the accreditation process, the team now offers paracentesis at New Cross once again. This means that local patients no longer need to travel out of the city and additional appointments are available, which supports patients with reduced mobility and at the end of life in particular.
'Without IQILS, we wouldn’t have been able to show that this would benefit our patients.'
In effect, IQILS has provided New Cross Hospital with evidenced justification for growth and improvement. Before engaging with the IQILS programme, securing funding and permission for necessary improvements proved very difficult. However, since engaging with IQILS and the accreditation process, Sunny reports that this is now much easier. Being able to use the example of other services and present the proven outcomes/benefits of an idea (such as saving money or preventing unnecessary admissions) to his trust has led to much greater support for proposed improvements.
'They’ve got more choice in their care.'
This ultimately benefits patients, which Sunny highlights is the most important thing for his team. He feels that offering a wider range of services in more varied locations has vastly improved ease of access for patients.
How did your team feel after gaining accreditation?
The team celebrated by having a ‘blast of a party’ after being awarded accredited status in 2022. Sunny describes a feeling of validation from seeing all their hard work being recognised.
Sadly, after working so hard in the build-up, Sunny was unable to attend the site assessment or celebrations himself as he was admitted into hospital, and had to rely on his colleagues to oversee the critical visit from the IQILS assessors. While Sunny’s commitment through recurring health issues is highly commendable in itself, the fact that his team could be relied upon in that moment evidences the growth that the service has seen since the days when Sunny was working almost exclusively on his own. This was only possible through continued, successful recruitment, something that Sunny is again keen to note would not have happened without IQILS.
Aside from recognising the team’s hard work, Sunny highlights that being able to show patients that the service is actively working to improve their care has also been satisfying in the long term.
What challenges did the accreditation process present?
While Sunny has been incredibly positive overall, there have inevitably been challenges during the accreditation journey. The service was initially given a deferral following their first site visit, meaning that there were still improvements to be made in order to gain accreditation. However, using the feedback from the assessors, the team made these changes and 2 months later had been reassessed and awarded accredited status.
Permanently maintaining growth is also something that has been difficult at times. Having been able to employ three clinical nurse specialists at one point, Sunny described how a reduction in funding meant that the team had to let one of them go. It was frustrating to be forced into what felt like a step backwards after huge strides over recent years.
Similarly, a recent project to build a dedicated liver ward fell through, again due to a lack of funding. However, the team’s ambition has not been dented and they hope to pick up the project again within the next 2 years.
More generally, keeping to accreditation deadlines can be slightly challenging. Annual reviews, a mandatory requirement for maintaining accreditation, require the submission of up-to-date evidence each year, and Sunny highlights that, inevitably, this is not always collated as promptly as he’d like when relying on several team members.
'The accreditation process is pretty straightforward'
However, he is keen to highlight that, overall, the accreditation process is uncomplicated and, if tackled properly, doesn’t require an amount of time or effort that will be detrimental to your clinical workload.
What advice would you give to a service that is currently working towards accreditation?
Sunny’s advice is simple yet effective: ‘Don’t stress too much, give yourself plenty of time to prepare required evidence and ensure full team involvement.’
Sunny highlights how having weekly meetings has been incredibly useful and the support of the whole team is important to achieve accreditation, and of course to run any successful service.
'There’s plenty of support'
While it can be daunting, Sunny wisely outlines that if something isn’t quite right, it’s ‘not the end of the world’, and there will be opportunities to fix issues, exemplified by New Cross Hospital’s deferral following their initial assessment. He urges services facing any issue at all to communicate with the IQILS team, and highlighted how supported he feels.
'I’ve been emailing Katy (IQILS project manager) this morning and she’s already responded!'
Overall, do you feel that the accreditation process has improved your service?
'Most definitely'
This felt like a leading question after Sunny’s incredibly positive feedback so far, but his response was definitive. Once again, he reaffirmed that IQILS has helped a team of effectively one person develop into an accredited service with a full complement of dedicated staff.
In turn, this growth offers his staff the opportunity to develop their careers, as new roles are being introduced regularly. Simultaneously, the opportunity to have nurse-led clinics has taken pressure off consultants.
Additionally, as a result of gaining accreditation, a specific liver referral pathway has been developed, meaning that patients are seen by the clinic much more quickly.
Sunny concluded by reiterating that the accreditation process is a team effort, and accreditation would not have happened without the contribution of all his colleagues.
Thank you Sundeep Chahal for this valuable insight into the benefits of accreditation and the advice you have provided to services beginning the process.
If you would like to know more about the accreditation pathway and how to get started, click here. To get in touch with the IQILS office, email AskIQILS@rcp.ac.uk