As my colleague Simon Hopkins says, no one entered the charity sector to cut services and reduce impact. Yet for many hospice leaders, that is the reality they face. 

But there is remarkably little information — let alone formal training — on how to navigate an organisational turnaround effectively.  For most, it’s a matter of learning on the job. Which makes a bloody difficult job even harder.

Simon and I have been working on a project for Hospice UK to develop a practical toolkit on organisational turnaround, designed to fill exactly this gap. It brings together Simon's decades of experience in the field with insights from hospices that have recently been through the process. 

We will be sharing our findings at a Hospice UK Big Conversation event on 24th June. If you want to attend - Register here. We also plan to update the toolkit over time on the back of feedback from hospices.

But ahead of the session, I wanted to share a few comments from hospice CEOs that have really hit home.

"It's never too early to start preparing for a turnaround." When facing a deteriorating financial position, the temptation to delay action is very real. The hope that something will turn up may sound naïve — but as human beings, we can sometimes convince ourselves it is plausible.

A clear reserves policy that defines objectively when remedial action is required — and ideally what that action will be — removes that temptation. To quote one CEO, "If you think you might need to start doing something soon, you probably should have started months ago."

"The values-driven culture that makes us so good at what we do also makes us resistant to change in a period of crisis." Change is never easy. But in organisations where people rightly receive enormous praise for their work, accepting the need for radical transformation can be even harder. 

Many CEOs reflected on the challenge of helping staff and stakeholders understand why difficult decisions were necessary. For some people, the realisation that a hospice is subject to the same financial realities as a business seemed unfathomable.

"Some people can be understandably unkind." A masterpiece of empathetic understatement. In times of crisis, the CEO can become a lightning rod for anger and blame. And people can be very unpleasant, often hiding behind the cloak of social media to launch vicious attacks. The importance of a unified board and leadership team, a strong personal support network, and genuine resilience cannot be overstated.

"Countering a simple lie with the complex truth is not easy." More than one hospice encountered a critical local media, unwilling or unable to engage with the real complexities of their situation. Clear, consistent messaging is essential — but so is accepting that some people will choose not to listen, regardless of the evidence.

"If you don't move on, no one else will." Every CEO acknowledged that mistakes had been made and lessons learned — and recognised that this was inevitable. But none regretted embarking on the journey. Many also reported genuine green shoots: improved financial results, better staff survey scores, and a move to a culture of ‘let’s get on with it now.’

There comes a point when turnaround gives way to stability. It won't happen on a single day. But it is important to recognise when that change happens — and to start looking forwards, focusing on what gets you up in the morning, rather than what has been keeping you up at night.