title: System-level change in mental health services in North Wales: An observational study using systems thinking.
abstract: OBJECTIVE
  To describe changes to mental health services using systems thinking.
  
  
  METHODS
  Structured standardized quality of life assessment (Manchester Short Quality of Life Assessment: MANSA) was used to establish service user priorities for changes to service provision (part of a process known as check in systems thinking). Current service performance in these priority areas was identified, and changes to service arrangements were planned, implemented and monitored by task and finish (T&F) groups (making use of a process known as flow in systems thinking).
  
  
  RESULTS
  81 MANSA assessments were completed at the check stage (by NM). Work finances and leisure activities emerged as service user priority areas for change, and T&F groups were established with representation of all sectors and service users. Ways to make improvements were observed, planned and implemented by T&F groups (the flow stage).
  
  
  CONCLUSIONS
  The systems approach reveals how services and quality of life have been changed for patients in Wrexham. Further generalizable research is needed into the potential benefits of using systems thinking in mental health service evaluation.
authors.affiliation: Mental Health Research Team, Swansea University, UK S.Evans@swansea.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.affiliation: Mental Health Research Team, Swansea University, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Huxley
authors.affiliation: Mental Health Research Team, Swansea University, UK.
authors.forename: N
authors.initials: N
authors.lastname: Maxwell
authors.affiliation: Cardiff University Business School, Cardiff University, UK.
authors.forename: K L S
authors.initials: KL
authors.lastname: Huxley
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D009936:Organizational Innovation; D010358:Patient Participation; D017060:Patient Satisfaction; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D014852:Wales
keywords: MANSA; Systems thinking; mental health services; system-level change