Table 8.

Impact of co-designed changes

Priority	Improvement	Impact
Space – “Restrictions to activity posed by the stroke unit environment”	Space previously used to store wheelchairs was transformed into a new social space, for shared meals, groups activities and meeting with visitors	“We had a gentleman who wouldn't really engage in therapy, but I gave him the job of watering the plants [in the new social area] every day and he started doing that and apparently he did better in therapy after the engagement sessions”. (Staff, Site 4, post).
Activity – “Limited opportunities for patients to be active outside of therapy”	Activity boxes were provided for every four-bedded bay – items were chosen and boxes put together by co-design groups	“We have huge gaps in the day where your patient’s doing nothing, they’re bored, they become institutionalised, so with these extras, like your volunteers coming in, you’ve got various groups, you’ve got your cooking group, your breakfast club, your lunch club, it just makes for a, well it’s a more positive experience.” (Staff, site 2, post)
Communication – “Driven by structures and routines not enabling to activity”	A new webpage, information leaflet and posters were co-designed to emphasize activity and the importance of bringing in familiar and stimulating items from home, e.g. photos, games, electronic devices	“I think the information leaflet’s quite good because it says, it tells you things like where the day room is and that you can go into the garden and things like that.…”. (Carer, site 4, post)

Note: Space, Activity and Communication were priority areas agreed by patients, carers and staff at joint events. Quotes illustrate the impact of changes taken from interview and ethnographic observational data post implementation.