Background The Carer Support Needs Assessment Tool (CSNAT) intervention comprises an evidence based comprehensive support needs assessment tool incorporated into a five stage person centred process. Together they enable a systematic process of assessment and support that is carer led. This ‘CSNAT Approach’ represents a change from existing informal practitioner led practice.

Aim To identify aspects of organisational preparedness needed to accommodate implementation of the CSNAT as a carer-led process of assessment and support within palliative care organisations.

Method Design: mixed methods case study of one large hospice organisation using a planned process to implement The CSNAT Approach. Data collection: field notes at site visits, document review, interviews, focus groups and survey of practitioners using the CSNAT Approach. Participants in interviews/focus groups: 28 staff (one clinical services director, three implementation project leads, 24 practitioners including departmental CSNAT champions); qualitative thematic analysis. Forty-four members of staff took part in the survey (response rate of 51%); descriptive statistics used to summarise survey data.

Results Three key strategies contributed to the successful implementation of the CSNAT Approach in practice:

1. a dedicated planning process: involving a core team to lead on implementation, senior management support/overview, and an intense pre-implementation planning period providing the ‘groundwork’ to support/sustain the process;

2. project leads’ investment in CSNAT departmental champions: including stakeholder analysis to identify key staff with relevant skills, involving them in the planning process;

3. a process of two-way communication about progress with implementation: including development of an ‘issues log’ to ensure implementation concerns of CSNAT users were heard and acted upon.

Conclusions These key strategies have enhanced practitioner engagement with CSNAT implementation and have potential to sustain embedding of The CSNAT Approach in practice in the longer term. These findings were used to inform aspects of the CSNAT implementation toolkit.