Managing continuing professional development palliative care education as a social enterprise: Balancing mission, margin and impact

Palliative care continuing professional development (CPD) is often delivered within constrained funding environments, prompting interest in social enterprise models – mission-led approaches that use revenue-generating activities and partnerships to sustain and reinvest to advance a social purpose—as a path to long-term sustainability. Using three illustrative exemplars, one specifically from the Palliative Care sector (Pallium Canada) and two from other, but related, sectors (Advanced Gerontological Education (AGE) Inc. and Saint Elizabeth Health Care (SEHC)), the paper describes how organizations structure revenue models, define operational safeguards, and manage risks related to legitimacy, access, and quality. We describe recurring tensions, including financial myopia, mission drift, legitimacy concerns, capacity strain, inequitable access, and competing stakeholder demands. These tensions, while difficult to eliminate entirely, are inherent trade-offs that require ongoing management. We outline practical safeguards employed by social enterprises, including multi-criteria performance dashboards, strategic decision checklists, and disciplined portfolio and partnership strategies. Particular attention is given to the “fallacy of free” in CPD and the implications of funding structures for equity and sustainability. The authors believe that a social enterprise model can be a viable mechanism for sustaining palliative care CPD, but only when financial practices are transparently aligned with mission and supported by robust governance. We conclude that the legitimacy of the social enterprise model in palliative care CPD depends on their ability to build and maintain trust, ensuring that revenue is generated in service of the ethical foundations of palliative care.