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P-250  Leading transformation in a perfect storm: testing the theories through a lived experience
  1. Tina Swani
  1. Birmingham St Mary’s Hospice, Birmingham, UK


The presentation delivers a lived experience over 15 months from a point where three significant risks simultaneously materialised in November 2014, to a position where eight service redesign projects were launched by April 2016 with recognised impact on larger systems transformation. The financial position shifted from an anticipated deficit of £1m to a surplus of almost £0.5m.

The presentation relates and reframes culture, coaching, change and marketing theory whilst delivering learning from mistakes and successes; how change was accelerated once the shift from fear to possibility was achieved; and how the focus on dignity, experience and confidence of patients, families and carers has extended reach as a result.

In November 2014 three events occurred:

  • Legacy income had not materialised during September, October and November

  • Three Clinical Commissioning Groups initiated a procurement process for End of Life Care

  • The Fundraising teams were in the middle of a major uplift with an anticipated decline in income trajectory on the previous year

Whilst each risk had been anticipated in isolation, together, this created a perfect storm.

The author delivers a real story, illustrating how change was accelerated through self-directing teams that have transformed working practice to enter new market space with a tested target to double reach and demonstrate sustainability through the Hospice’s Case for Change.

The Case for Change has already achieved significant financial investment (including CCG and major donor investment); early review to the CCG demonstrates some evidence of larger system transformation.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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