There is little written about UK hospices as organisations. Given the changing nature of care as hospices increase access significantly beyond cancer, it is important to explore models of change. This research aims to highlight key concepts within institutional theory and change, that may be of interest to hospice leaders in developing and delivering their future strategy. The method was a literature review alongside professional experience which when combined resulted in three key outcomes:

• The introduction of the concept of legitimacy and how this has the potential to be a key factor in hospice organisational change

• The highlighting of a model by Greenwood, Suddaby & Hinings (2001) which provides a framework for institutional change

• The development of a new theoretical model that proposes a way of representing the nature of elements of hospice organisations. The model also outlines three options that explain some of the choices the hospice movement may make in addressing the need for change i) decoupling i.e. the intentional separation of activity from the accepted norms e.g. via a new partnership, ii) deinstitutionalisation followed by reinstitionalisation which is the process described by Greenwood, Suddaby & Hinings (2002) identifying key stages of radically shifting institutional narrative or iii) the development of a new social movement.

The work is part of a larger study that aims to explore organisational factors influencing hospices’ development of services for people with dementia. This first part of that work concludes that there is importance in understanding the nature of hospices as both old and new institutions (Selznick, 1957; Powell & DiMaggio,1991). This theoretical lens provides a refreshing and insightful perspective on many of the challenges hospices are encountering as they face the future.