Introduction As hospices face challenges, there is a need to balance the economic cost and the demands placed upon the services we provide, leading to new ways of working and changes within the organisation.

Change can be difficult and can often be seen as being “done to” as opposed to being “part of “the process.

Aims The aim was to find a simple tool to use within teams to engage them in the change process and to illicit issues that where pertinent to them in the future development of the service, and to identify areas in which efficiencies could be made.

Method We devised a simple tool which enabled staff to state what they wanted to “Stop, Start and Keep” within the services they provided.

Discussion This tool was used in an “away day” style environment, the whole team where engaged in the process and the use of the tool elicited themes from the team in relation to the questions asked, and enabled the team to develop a plan for future developments and discuss key areas of concern.

There was an over arching theme related to maintaining quality which underpinned all such developments and a desire to ensure the quality of care patients received was not adversely affected. The use of the tool acted as a bench mark to where we are now and where we wanted to be, and enables the team to review progress, its impact and celebrate success.

Conclusion The use of this tool enabled the team to feel engaged and contribute to the development of new ideas and ways of working in challenging times. The process is fluid and enables teams the opportunity to revisit and review and address issues and developments.