Table 1.

Catalogue of changes made during the MHC in one case study site on issues relating to service user involvement

Before	After
Service users were not routinely involved in  the organization of their care	A patient‐held record is now being developed to support  patients in making their own records about care they receive
Patients were not routinely asked to become  involved in the design of their care plans,  or to sign them	Patient signatures now required on care plans, and a  record made of their involvement/understanding
Changes to organization of therapeutic  activity require information from service users	Questionnaire sent to recently discharged service users  asking for their views regarding the activities that would be  most helpful to them. Responses aid the reorganization process
Patients requested more regular discussion  regarding ward issues, with the nursing team	Regular community meetings are now held on the ward.  All patients invited to attend. Patients decide agenda for each meeting
Difficulty assessing patient's experiences  relating to the collaborative improvement  measures	All patients now invited to complete questionnaire relating to MHC  improvement measures. Opportunity made for postal returns.  Responses demonstrated service user satisfaction with the changes
Difficulty effectively communicating with patients  regarding the aims of the project,  changes made and current plans	MHC newsletter now given to all patients to explain project, detail  changes made and provide overview of planned changes