SUMMARY. Hospice organizations must understand and plan for their position in the proposed and ongoing changes in health care delivery in the United States. This paper proposes that hospice organizations shift their thinking about their role in the health care system. Hospices may view their work as processes which are impacted by many entities within the system of care; measure the outcomes of this work against the needs of patients, families and health care providers; and work to continually improve care. Aspects of this approach, and its implications for hospice organizations, are described. Using this new understanding, hospice organizations can both broaden their impact on care for larger numbers of dying patients, and position themselves to move forward within that system as the financial base and structure of health care change. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com]