Figure 1

A conceptual model of the evolution of hospice palliative care in Canada. The path through which HPC is provided in Canada is depicted in this figure. Due to existing inheritances, which include: (1) foundational health policies; (2) service structures; and (3) planning and health systems decisions, provision of HPC services is surmised to flow in four separate ways. The first route is the most direct, which involves providing HPC in strict adherence to the inheritances. Indirect paths are illustrated through the three forms of circumventions: (1) new alternative structures; (2) interventions to shift the system; and (3) service innovations. As shown, new alternative structures completely bypass the inheritances, and as such do not have to adhere to the policies outlined by the inheritances. Interventions to shift the system work within the confines of the system to promote the need to change or amend the inheritances. Finally, service innovations can be understood to use the inheritances as a foundation upon which to build new HPC approaches and models