Background We are a family support team of 4.68 WTE paid staff made up of counsellors, a social worker, spiritual care co-ordinator, administrator and 25 volunteers. A new manager was appointed in late 2017 and found a team struggling under a long waiting list. Feedback from other teams in the hospice was frustration that family support was slow and unresponsive.

Aims Following a team away day in January 2018 we decided to re-focus our work to be:

• timely and appropriate;

• rehabilitative and empowering;

• efficiently supported and evaluated.

We had no specific numeric goals at this point, only to reduce our waiting list and become more responsive.

Method Taking a whole-system approach devised a plan which included major changes to:

• Team ethos;

• Assessment and referral processes;

• Communication and roles;

• Our counselling/service model;

• Recruitment and training;

• Evaluation and data collection.

Results After a year we achieved and have maintained:

• The elimination of our waiting list; clients are now allocated within days of being assessed unless they have very limited available time slots;

• Response to tasks and requests within two working days, usually within 24 hours;

• Positive outcomes demonstrated in self–reported evaluation and improved Core 10 scores.

Conclusion

• A whole team/whole system approach fostered a commitment to our aims and acceptance of the changes we needed to make, even when they were difficult;

• A short–term counselling model is appropriate in a hospice setting if supported by theoretical and practical training in how to deliver counselling in this way;

• The no–waiting approach means that the intervention is made when it is needed and can be most effective, and our outcome results show this;

• Our willingness to be flexible in the way we work with individual cases where specific need is demonstrated provides the team with confidence that we remain client centred within a rehabilitative model.