Building Specialized Palliative Care for the Czech Republic: A Fifteen-Year Leadership Journey in a Developing Country.

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 7 years in only 20 years. However, polymorbidity and multicausality have now become topics of concern. In some ways they are products of our success. Yet, the health system and social system were not designed for these patients nor are health care professionals trained and willing to assess and address clinical needs of fragile, chronically ill, and incurable patients. This is true in much of the developing world where initial improvements have led to this new population-based challenge. In that sense, the Czech Republic is an example of what needs to happen in developing countries. Inpatient hospice care, which has been developing in the Czech Republic since 1993, 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 is 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. This article seeks to describe the leadership steps of this systemic change in the Czech Republic with the objective of helping others make the same journey.