Background Isabel Hospice provides care for a population of 350,000 across eastern Hertfordshire. To enable the hospice to meet the challenge of an increasing demand for community services at a time of financial constraint, we utilised the NHS Institute for Innovation and Improvement ‘Thinking Differently’ programme. This provides a range of practical approaches and tools which enable fundamental rethinking of pathways of care and service delivery.

Aims To think creatively about how we give people nearing the end of their life, and their family/carers, the best possible support and care in the place of their choice.

Methods The ‘Thinking Differently’ three part process was adopted: Stop before you start – an initial focus group for hospice staff to reframe our challenge and consider it from a number of different perspectives. Generating ideas – four focus groups for stakeholders across our catchment area which used divergent thinking techniques to produce a large quantity of innovative ideas. Selecting and testing ideas – a final focus group for senior hospice staff using convergent thinking techniques to identify the ideas most likely to make a difference.

Results A total of seven focus groups were held, three for hospice staff and four for external stakeholders, including patients, carers and a range of health and social care professionals. From over 30 innovative ideas generated, four projects have been identified for further development: ‘Isabel Urgent Care’ – a rapid response hospice @ home service ‘Hospice Direct’ – an enhanced 24/7 advice line for patients and professionals ‘Living Well With Isabel’ – a Patient and Carer Self-Management Programme ‘The Mobile MDT’ – Multi-professional community clinics.

Conclusion Using the ‘Thinking Differently’ toolkit enabled the hospice to undertake a robust consultation process with our key stakeholders and identify approaches to transform the services we provide.