Introduction High standards of care, compassion, communication, competence, and commitment are characteristics which are regularly highlighted in service user feedback to hospices recorded using the 'I Want Great Care' friends and family test. Described along with courage as the6 Cs in nursing that are required for effective patient care this presentation considers the risk of hospice staff developing attitudes and behaviours which could fit an alternative version of this model.

Aim The aim of the presentation is to challenge hospice providers to consider the impact of positive service user feedback to staff over a prolonged period of time, considering views from international business leaders in terms of the impact and risk of 'success' and translating this risk into the perspective of care delivery.

Approach used The presentation considers the role of education and training in raising the awareness of staff and of hospice trustees to the potential risks we faceand the strategies we might adopt tominimise the risk.

Outcomes The focus on a quality improvement model of challenge, changeand continuous improvement not purely in clinical knowledge and skills but also in behavioursand attitudes within the team along with the benefits of considering an alternative 6 Cs before problems arise in practice.

Conclusions and application to practice The project in termsof education and training and the presentations delivered, challenged staff and trustees alike to be aware and react to attitudinal risks in practice. Having sharedthis workbeyond our own organisation through the executive clinical leads group, identified similar challenges in other organisations, in some cases resulting ina direct impact on practice and the experience of care for patients and families.

This feedback from colleagues has highlighted that this is a topic which needs to be exploredwith a wider audience.

The alternative 6 Cs Culture, Conditional, Canonisation, Control, Conformity, and Complacency other equally worrying traits and behaviours are available.