Background With escalating demands of the healthcare and social sector, increased regulation and negative press coverage about the role of charities, the need for bold purpose and direction for healthcare charities is paramount for future survival. This paper charts the rapid root and branch transformation of a traditional local hospice into a contemporary palliative care provider: the positive impact of service user input, the challenge of changing an entrenched culture and the dichotomy of leading a local charity against the commercial realities of the sector.

Aim With a significant time imperative the aim was to effect full scale and fast but effective transformation of the hospice in providing it with a new focus, ambition and strategy in order to navigate its way through the challenges of the healthcare economy and future proof its vision and strategy.

Methods and results A significant consultation and perception study was undertaken to involve every form of stakeholder to understand the status of the organisation and how it was viewed by its community. The process and feedback were used to engage the organisation in co-designing its new vision, mission, values, brand and three year strategy. The initial transformation has been completed and was successful, the strategy in its first year of implementation. The cultural change has been fundamental despite being the most challenging aspect and most difficult to measure in the long term.

Conclusions and innovation The listening process, sharing challenging feedback from important stakeholders and authentic and disruptive leadership were the backbone of inspiring and effecting rapid change but there are numerous points of learning or improvement for other organisations considering the same path or elements of it. The impact of the volunteer workforce in a charity setting and the importance of leading the process, not as a project but as a cultural transformation.