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Presents a case study in systems modelling for product improvement in a large manufacturing company. Summarizes the background to and purpose of systems modelling as a change management tool as a prelude to introducing the case and its use in understanding a particular paradox.

Care planning is important in the provision of good‐quality care and serves a variety of functions, including acting as a communication tool. An accessible format for care plans is therefore important. The National Minimum Care Standards in England now require that all residents in care homes have a service user plan. This study examined the format and content of 117 blank care plan documents used in Manchester and Cheshire care homes in 2001/02. Sixty‐eight per cent of homes used a problem‐orientated care plan document, 25% used a problem‐orientated care plan with assessment domains defined, 15% used standard care plans and five per cent used daily care plans. Although the government has stressed the importance of involving the user in the care planning process, only 16% of homes had a care plan that specifically asked for a resident's signature or agreement. There were also differences in content of care plans by home type, which may reflect the professional background and training of staff in nursing homes. The variety in types and format of care plans suggests that the interpretation and recording of care planning may not be uniform across homes and there is a need for further detailed work in this area using interviews or observational approaches.