Table 6 Key characteristics of inner setting and exemplar quotes

Culture

Staff

Understanding of ‘normal’ service provision to consider how NROL fits

S03: we have to be careful that it’s not… the icing on the cake therapy, that they are actually increasing the intensity of the overall offer. But then I think it comes back to what's our core business, and are we delivering our core business?

S14: We don't provide maintenance, we provide a block of treatment to improve a patient and then discharge them. But then do we need to actually relook at the model?

NROL requires a shift in culture

S02: To deliver this is requiring a culture shift and a mindset shift in the therapists, and they're not all ready for that yet. So we've only had a few groups running. There's resistance in some places, and there's absolutely enthusiasm in others.

S15: It's just trying to sort of weave NROL into the daily fabric of life rather than feeling like a separate thing. So I think we're getting there, but it’s slow.

Implementation Climate

Staff

Compatibility of NROL within the service with competing priorities and limited capacity

S13: Capacity and the time are the main issues. I think it's been difficult. Trying to… I suppose juggling my daytime job and NROL.

S03: NROL could be a way of reducing waiting lists… but I think we're in a situation where the therapists are so busy they can't see the wood from the trees.

S17: it's been a year of stress at work and outside of work for many reasons…during COVID the stroke team actually started a new service, the early intervention team….so there's just been a mass of things going on, so I think people have just not had the headspace for something else.

NROL enabled collaborative working across teams, caseloads, disciplines

S08: I think the thing that's been good is it’s a stroke and neuro project, not just one or the other …. And I think this is really helped stroke and neuro therapy staff to get to know each other better, work together and have that kind of cross pathway work for our patients.

S11: we probably worked a little bit more collaboratively than I would have done if I was just seeing someone on my own.

Readiness for implementation

Staff

NROL needs leadership commitment from clinicians, management and clinical academics

S01: I mean the people behind it. You've got the therapist themselves, which do an absolutely wonderful job. They’re amazing at it. But you've got people like (clinical academics), who worked tirelessly behind the scenes to try and pull everything together and make sure everything runs smoothly as possible.

S07: I know particularly my operational lead, and service lead as well, has been really positive and really pushing NROL. She really sees the benefit, so we have been supported from that perspective.

Clinical academic partnership and funding from the ‘SameYou’ charity a key enabler for implementing NROL

S03: because we already have this partnership between the UCLan and ELHT …. but without that it just wouldn't have happened. I have a feeling that a lot of it would have just gone on the ‘too difficult’ pile.

S14: I think it's been well supported once we could evidence the impact of it… I think we wouldn't have got it off the floor if we didn't have the charity funding. I don't think we would have got it anywhere near to what it is.