Bonkers: reflections on time, creativity, and opportunities

On hearing that the role of general secretary for N-QI-CAN (National Quality Improvement inc. Clinical Audit Network) was being advertised, I leapt at the chance, feeling it was bonkers to miss the opportunity.  Elected in December 2019, I paused taking the opportunity to assess, listen, consult, and collaborate before moving forward with priorities to further strengthen N-QI-CAN.  This is an update on my bonkers journey as general secretary to date and reflections. 

It will probably come as no surprise that I reflect on a bonkers year and half, a time of significant change.  One where our professional and personal lives have changed beyond recognition with the pandemic and have challenged us through concern, grief, business continuity, staffing issues, duty of care, quality of care, pride, financial and new ways of working be they distanced, COVID secure or virtual.   

My role as general secretary

In addition to my main role, I work 2 days a month as general secretary and am responsible for ensuring governance arrangements and membership are being followed including ensuring probity, openness, and transparency.  I am also deputy chair and oversee the N-QI-CAN finances. Day-to-day that means I work with our chair (Carl Walker); responding to queries, concerns and celebrating successes. This includes supporting our quarterly meetings, liaising with NHSE and HQIP national audit providers and developmental work for our forward plan including task finish groups with members. 

A bit about my journey to date

I work in an acute emergency university trust and latterly within the Dorset integrated care system and have worked in the NHS since the early 90’s in leadership roles within the golden thread of quality including clinical audit, clinical research, innovation and quality improvement.  I previously chaired the South West Audit Network (SWANs) and am the chair of the Clinical Ethics Group at University Hospitals Dorset (Poole site).  I am a Health Foundation Q Community member and accredited NHSE Quality Service Improvement and Redesign (QSIR) Associate.  I am undertaking a PhD researching improving the quality of patient care through leadership, culture, and communication.  I am also developing a clinical research project reviewing using QI to improve patient care and am delighted to be working on this project with an amazing team including the Picker Institute Europe. 

Common Drive

Why am I involved in N-QI-CAN?  As professionals working within the golden thread of quality be it clinical audit or other quality improvement, clinical research, innovation or wider, we all share a common drive to improve the quality of health and social care outcomes for our service users.  The drive furthermore in clinical audit is to ensure that nationally and locally health and social care is provided in line with proven standards of high-quality care, e.g. Royal College of Physicians.  In my role as previous SWANs chair and now as general secretary, I am proud that through N-QI-CAN and our regional networks we provide practical advice and support to those who are undertaking QI including clinical audit.  This enables health and social care staff to undertake their project in a way that aids understanding where quality of care falls short, reviewing the reasons why and taking the necessary steps to improve and sustain the quality of care.  

N-QI-CAN’s role

As a recognised group within health and social care, we (N-QI-CAN) work collaboratively with NHS England and Improvement (NHSE/I), Healthcare Quality Improvement Partnership (HQIP), national clinical audit providers and other quality improvement bodies.  We provide key governance functionality and undertake workstreams as outlined in our forward plan and agreed with HQIP, NHSE/I.  This includes developing and improving local clinical audit and making recommendations as a unified voice on quality matters and working collaboratively to make improvements.

We act on your behalf to support our members to deliver high-quality projects that help to improve patient care as part of local programmes.  If you are involved or working in clinical audit or wider quality improvement, I would encourage you to sign up to the N-QI-CAN forum and join your regional network.  To find out more visit:   or contact me on the details at the end of this blog.   

Governance arrangements

As part of my new role as general secretary, having paused, assessed, listened, consulted, and collaborated I undertook a review of the N-QI-CAN governance arrangements and having circulated a draft to enable feedback I ran a workshop in Skipton House, London on 4th March 2020 with the N-QI-CAN regional chairs.  We dedicated time to discuss, challenge, tweak and further strengthen the governance document and work on our common purpose and this enabled all chairs to give feedback on behalf of their regional networks.  The time spent was essential, enabling us to further build our working relationships and for us all to have a wider understanding of regional and individual needs and requirements, time I am very grateful that everyone had invested in.  Further consultation and feedback have enabled us to have an agreed common purpose and governance arrangements approved by N-QI-CAN members, NHSE and HQIP.   I also note that it was the last time we were all met together in a room and a time where we spoke of growing concern with the rapidly increasing impact of COVID which ultimately led to the first national lock down on the 23rd March. 

Reflections on bonkers

Reflecting on my time to date as general secretary, its been bonkers particularly with how the pandemic has been and is evolving.  New ways of living and of working have challenged us all.  Staff in quality roles were called to support the unprecedented clinical needs and yet the need to facilitate quality projects and quality of care remained centrally at the core of all we do in our health and social care roles. 

I am proud to reflect that through this bonkers time, we (N-QI-CAN) continued to provide a voice for those in quality roles seeking clarification for organisation requirements for the local or national audit programmes, information regarding support for the evolving COVID-19 hybrid quality projects, national data opt out (to name a few) and ultimately support health and social care staff with concerns, queries and the ability to openly communicate in a safe non-judgmental environment on our Networking and Sharing Forum (NNSF).  In a quieter period for me between Christmas and the New Year, I caught up with some posts on the forum. It makes me smile to see the number of posts where clinical audit professionals are reaching out looking for answers or advice on solving a problem or something they are trying to develop and equally the number of members who openly share and provide support.  We can and do all learn from one another.  

It may be a bonkers time, but the pandemic has meant that we have all needed to work differently and think in more creative innovative ways to minimise the inequalities that the pandemic has caused.  As health and social care staff we are all learning to adapt and improve and that’s what gives us strength through respect, leadership, communication and teamworking.  Now more than ever we need to support our organisations through our quality work to ensure to ensure that we can provide equitable quality health and social care that meets the needs of our users. 

Finally, I reflect on the fact that I believe we all continue to learn every day of our lives.  If there is one thing I would encourage you to do, it is imagine the golden thread of quality, and ask yourself how you fit into the wider quality picture?  and how you are using the creative opportunity that bonkers provides to your advantage to innovatively support improving the quality of care for health and social users?  

Why bonkers? “Breaking free of Bonkers, how to lead in today’s crazy world of organisations” (1) was the book that the amazing Phil Glanfield and colleagues wrote coinciding with an Ashridge NIHR leadership programme I was on.   We explored the research and development agenda with key national figures including the amazing Dr William Van’t Hoff and Professor Chris Witty.  When on behalf of our programme I laughingly presented Chris Witty with the book back in 2017, little did we know how relevant bonkers would remain.  

If you are wondering why I have written this blog, the answer is simple.  I wanted you to hear in my own words a little of what I am doing, my thoughts, reflections, and my encouragement to you. 

Sarah Chessell

General Secretary – National Quality Improvement (including Clinical Audit) Network (N-QI-CAN)

Head of Innovation, University Hospitals Dorset @ChessellSarah

1.Breaking free of Bonkers, how to lead in today’s crazy world of organisations (2017) George Binney Philip Glanfield & Gerhard Wilke

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