Table 5 Initial themes from the qualitative analysis of the case study data

Reception of GetREAL

Lack of prior information and engagement that involved all staff

Delay in staff engaging with the short term intervention

Only short term changes

Maintaining initial enthusiasm

Looking afresh and starting new activities

Stimulating strong enthusiasm and seeing service users respond positively

Carrying on new activities long term

The training was interesting and collaborative

Felt engaged, listened to and supported

Short term changes

Lack of equipment and staff time

Service user disappointed because they were not able to continue activities they liked.

New activities stopped

Impact of GetREAL

GetREAL featured: Predisposing meeting to engage managers and senior staff;

Enabling stage with trainers working alongside each unit team for 5 weeks to deliver a tailored programme

Staff felt energised and motivated; more confident and empowering, and that they knew patients better.

More collaborative working, improved staff skills in the short term.

GetREAL featured: Modelling ways to involve service users in developing the service

Service users started having a voice more, and giving positive feedback on the increased activities, which pleased staff.

Wider variety of activities offered to service users and their involvement was encouraged in the short term

The Legacy of GetREAL

Involvement of all staff

Staff engagement in activities was set as a norm.

The evidence for a long-term legacy following the GetREAL training was mixed.

Some new activities continued long term

Positive feedback from service users

Services users enjoyed the activities and were happy to keep them continue.

Regular review of the action plan.

Joint planning and working

Lack of staff available to support a range of activities and staff being too busy to extend their job roles.

No role flexibility