We are delighted that this systems approach, co-developed with, systems engineers, health and care professionals, improvement experts and patient representatives can be applied to an important systems challenge such as discharge in mental health.

Professor John Clarkson, Director of the Engineering Design Centre

The Health Care Design Group in the Department's Engineering Design Centre, are part of the MINDS research team, led by the Norfolk and Suffolk Foundation Trust in partnership with leading academics from across the UK, mental health trusts, service users and carers. The team are working together to develop a new approach to discharge from mental health hospitals, informed by a systems understanding. The project is funded by the National Institute for Health Research (NIHR)

Around 50,000 people leave mental healthcare hospitals every year. However, a national survey from the mental health charity Mind found that 40% of people leaving mental health hospitals have no plan in place to support them after they leave.

The idea is to adopt industry tools to understand and adapt the discharge process from the point of view of the people involved. This will include why discharges are sometimes not well planned and what people feel they need to stay well after leaving hospital.

Engineers routinely use a systems approach to address challenging problems in complex projects. This allows them to work through the implications of each change or decision they make for the project as a whole. They consider the layout of the system, defining all the elements and interconnections, to ensure that the whole system performs as required.

The Health Care Design Group have co-produced a report ‘Engineering Better Care’ working alongside clinicians, and healthcare leaders, to explore how an engineering approach could be applied in health and social care to develop systems that meet the needs of patients, carers and NHS staff. The report then led to the development of the ‘Improving Improvement Toolkit’ providing practical guidance and resources to facilitate the application of a rigorous systems approach to health and care improvement. The toolkit is intended for improvers of all levels of experience and for challenges of all levels of complexity, and has the potential to have a transformative effect on health and care, with benefits for patients, service users, and providers. 

“We are delighted that this systems approach, co-developed with, systems engineers, health and care professionals, improvement experts and patient representatives can be applied to an important systems challenge such as discharge in mental health.” 

Professor John Clarkson, Director of the Cambridge Engineering Design Centre at the University of Cambridge.

Dr Alexander Komashie, senior Research Associate in the Health Care Design Group and a Postdoctoral Interdisciplinary Fellow of The Healthcare Improvement Studies (THIS) Institute will co-lead the systems design component of the study. He explains; 

“Discharge from mental health hospitals​ takes place within a system, so it is appropriate that we take a systems approach to making discharge a better experience for service users. We will seek to understand the context of discharge, work with a range of stakeholders to define what ‘good’ looks like and translate that understanding into a process that is fit-for-purpose.”  

Dr Corinna Hackmann, co-investigator on the MINDS project says, “The National Institute for Health and Care Excellence (NICE) guidelines state that discharge planning should include staff working together with service users.

"We know that mental health workers want to create a positive experience for those leaving hospital. However there are many complicated factors that can disrupt this. The aim of MINDS is to combine the expertise of people who have accessed mental health services, clinicians, researchers, engineers, commissioners and managers to develop solutions.”

“The cutting-edge part of this research is the work we are doing with health care systems engineers at the University of Cambridge. We plan to make a tangible ‘aid’ to help in the discharge process”, explains joint-lead on MINDS Consultant Psychiatrist, Jon Wilson.

Sarah Rae is a mental health service user who has experienced difficulties when discharged from mental health wards in the past. She has advised on various projects in the Engineering Design Centre for about ten years and will Co-Lead this research, working alongside researchers at Norfolk and Suffolk NHS Foundation Trust (NSFT). Sarah is determined to use her lived experience to improve services.

“I have had two long stay admissions. On the first occasion I was discharged at very short notice. During a more recent admission I became institutionalised after spending 8 months on the ward. I was terrified of going back into the community. This fear was made worse by the fact that staff did not try to understand my worries or offer any coping strategies. There was no collaborative discharge planning before leaving hospital. The knock-on effect on my well-being and recovery was huge.

"When I approached Corinna Hackmann and Jon Wilson at NSFT research they were both enthusiastic about my idea for a research project. They regarded my lived experience to be of equal value to their academic skills. We had a shared vision from the outset. They recognised how service users could benefit from research into how discharge processes could be improved.”