Aherne Michael, Pereira José
Initiative Development +, The Pallium Project, Edmonton, Canada.
Int J Health Care Qual Assur Inc Leadersh Health Serv. 2005;18(1):iii-xxi. doi: 10.1108/13660750510578394.
This paper situates a large-scale learning and service development capacity-building initiative for hospice palliative care services within the current Canadian policy context for use by international readers.
DESIGN/METHODOLOGY/APPROACH: In 2000 a national initiative using action research as its design was crafted to support continuing professional development and knowledge management in primary-health care environments.
The Canadian health policy context is complex and requires innovative solutions to achieve desired changes in response to emerging population health demands for quality end-of-life care. Employment of educational and social science constructs, including complexity theory, communities of practice, transformative learning theory, and workplace learning methods, has proven helpful in supporting the creation of national capacity for hospice palliative care.
RESEARCH LIMITATIONS/IMPLICATIONS: There is a significant contribution for social scientists to make in aiding a better understanding of the complexity in health systems. At the same time, an aging population in industrial countries demands more active engagement of legal and bioethical scholars in a range of emerging policy and legislative questions about quality end-of-life care. Educational research is also required to understand better and reform curricula to prepare an emerging generation of health science practitioners for the demands of an aging population.
Changing health service delivery environments demand rethinking of the knowledge and skills leaders require to influence desired change. A broader understanding of where and how learning takes place is essential for enhancing the quality of patient care.
ORIGINALITY/VALUE: The Pallium Project represents a generative response to facilitating learning and building longer-term system capacity. The journey of project development to date illustrates some important lessons that can be adopted from hospice palliative care to inform other primary-health care initiatives, including, potentially, mental health, cardiology, diabetes, geriatrics, where productive change can result from productively linking specialists and primary-care colleagues.
本文将临终关怀姑息治疗服务的大规模学习与服务发展能力建设倡议置于当前加拿大政策背景下，供国际读者参考。
设计/方法/途径：2000年，一项以行动研究为设计的全国性倡议应运而生，旨在支持初级卫生保健环境中的持续专业发展和知识管理。
加拿大的卫生政策背景复杂，需要创新解决方案，以应对新出现的人口健康对优质临终关怀的需求，从而实现预期变革。事实证明，运用教育和社会科学理念，包括复杂性理论、实践社区、变革性学习理论和职场学习方法，有助于建立全国性的临终关怀姑息治疗能力。
研究局限/影响：社会科学家在帮助更好理解卫生系统的复杂性方面可做出重大贡献。与此同时，工业化国家的老龄化人口要求法律和生物伦理学者更积极地参与一系列有关优质临终关怀的新出现的政策和立法问题。还需要开展教育研究，以更好地理解和改革课程，使新一代健康科学从业者能够满足老龄化人口的需求。
不断变化的卫生服务提供环境要求重新思考领导者为影响预期变革所需的知识和技能。更广泛地了解学习发生的地点和方式对于提高患者护理质量至关重要。
原创性/价值：帕利姆项目是促进学习和建立长期系统能力的一种创造性回应。迄今为止项目发展的历程说明了一些重要经验教训，这些经验教训可从临终关怀姑息治疗中借鉴，为其他初级卫生保健倡议提供参考，包括可能的心理健康、心脏病学、糖尿病、老年医学等领域，通过有效地将专科医生和初级保健同事联系起来，可实现富有成效的变革。
