Dr Ladislav Kabelka, Home hospice care sv. Zdislavy Trebic, Vysocina region, Czech Republic, Czech Society for Palliative Medicine, explains the background to his longer article just published in ‘Journal of Palliative Medicine’. The article seeks to describe the leadership steps of a systemic change in the Czech Republic with the objective of helping others make the same journey.
The success of the development and establishment of specialized palliative care in the Czech Republic is due to many years of political, educational, and often voluntary work of many health professionals. I have been on this journey since 2003.
Since its creation, the Czech Republic has developed an advanced health system and social system. Life expectancy at birth has increased by an average of seven years in only 20 years. However, polymorbidity and multicausality have now became topics of concern. In some ways they are products of our success.
Inpatient hospice care, which has been developing in the Czech Republic since 1993, was (is) not the answer to this problem. Rather, approaches to ensure that the early introduction of palliative care in the course of serious illness care, personalized medicine and a multidisciplinary approach in the system are required. Focusing only on terminal illness care is insufficient. Beginning in 2005-2006, we have worked to create a system of education and clinical services in specialized palliative care in the health and social system.
In 2009, I was a founding member, and then served eight years as chairman, of the Czech Society for Palliative Medicine, Czech Medical Association of Jan Evangelista Purkyně (CSPM CLS JEP). In the 15 years, from 2005 to 2019 specialized palliative care has become an established part of Czech health care because of the work with professional societies, the public, government ministries, politics, regions of the country, and insurance companies.
I have recognized the importance of collaboration with colleagues. Not only physicians, or other healthcare professionals, but also politicians; for example, I believe that it is essential to demonstrate respect and dialogue. I can remember firmly disagreeing over some issues. I could advocate strongly, yet I needed to listen, receive feedback, and change my position. That ability opened doors. The path to success could be summarized as “not only divide and rule but also prepare-motivate-delegate-help-finish”. That path has lasted almost 10 years for me.
I can now see a number of up-and-coming, hopeful professionals around me who can develop palliative care effectively. They must travel a similar path; they will have doubts and make mistakes. I feel obliged to help in this without preventing them from learning their own lessons. After leaving the role of chairman of CSPM CLS JEP in spring 2017, it was not easy for me to see some of my mistakes repeated by others. Yet, I understand this is inevitable for professional growth.
And for those who of us who have already been on the long journey to establish palliative care, our role is now is to continue that journey with respect and support for our new colleagues.
This post relates to the longer article,Building Specialized Palliative Care for the Czech Republic: A Fifteen-Year Leadership Journey in a Developing Country by Ladislav Kabelka, published online ahead of print in Journal of Palliative Medicine, 23 January 2020; https://doi.org/10.1089/jpm.2019.0662
(EAPC members are eligible for a substantial discount on the personal online subscription to Journal of Palliative Medicine. More information here.)
More about the author
Dr Ladislav Kabelka, MD, PhD, worked for six years in a geriatric clinic, then for 12 years in the largest Czech hospice in Rajhrad near Brno, as a doctor, then head physician and director. He was the founder, and subsequently chairman of the Czech Society of Palliative Medicine (ČLS JEP) for eight years. Dr Kabelka has been involved in health policy for many years and is an initiator and guarantor of the concept of multi-level palliative care in regions, now mainly in the Vysočina region.