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Table 2 Coding tree/analytical framework

From: Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial

Category

Theme

Data (Codes)

The challenges of working in rehabilitation units

1. The complex nature of the client group

- Patients’ relationships with staff

- Difficulties engaging patients

2. Impact of inappropriate referrals of patients prematurely transferred or with longer term needs

- Difficult to motivate patients

- Lack of support for staff

- Referrals of chronic patients

3. Inadequate rehabilitation-focused leadership and staffing

- Lack of formal structures

- Management

- Resources

- Workload

- Staff held views on activity

Impact of the GetREAL intervention

1. Planning and reflection

- Provided structure and direction

- Time management

- Coordinate and organise activities

2. External and alternative perspectives

- Taking interest in patients

- Insight into patients

- Interaction with patients

- New ideas, tools and practices

3. Dissolving role boundaries

- Changed work practices

- Culture of rehabilitation

- Flexibility

- attitudes

4. Collective working and responsibility

- Team working

- Shared responsibility

- Change in ward atmosphere

5. Motivation

- Staff confidence

- Accountability

- Prioritising activity

Barriers to Sustainability

Intervention-related:

- lack of information

1. Insufficient preparation

- practicalities

2. Brevity of engagement with the intervention team

- Length of intervention

- Top-up session

- Lack of follow up

3. Misunderstanding of the aims of the intervention

- Accountability

- Staff focused versus patient focused intervention

- Not sustaining changed practices

Contextual issues:

- Workload

4. resources

- Staffing

5. Role boundaries

- management

- rigidity

- Permission

- Defending roles and responsibilities

6. Leadership

- Lack of rehabilitation focus

- Paperwork driven

- Lack of formal structures

7. Competing priorities

- Low importance of activity in organisation

- External targets

  1. Note: Codes overlap between themes and are inter-related