Adopting and adapting foreign innovations in health service delivery: a case study in elderly care in Suzhou, China

Background: One of the shared challenges faced by societies worldwide is aging, which started in high-income countries and has gradually been prevalent in middle- and low-income countries. International exchange of innovations has been encouraged to address global challenges. However, transferring innovations in service delivery across different health systems has been found challenging and influenced by various factors. There remains a shortage of empirical studies that focus on how the adoption and adaption of innovations originating from high-income Western countries in low- and middle-income contexts such as China have taken place. Methods: To deepen the understanding of the process of international transfer of innovations an exploratory case study was conducted at Suzhou Social Welfare Institution, located in Suzhou City, Jiangsu Province, China, July 2022 -January 2023. This case study focuses on the organization’s journey of adopting and adapting innovations in elderly care from the Netherlands over 20 years. With a qualitative design, we conducted 5 one-to-one semi-structured interviews with Dutch respondents and 3 group interviews, each comprising 8 Chinese respondents. Additionally, we analyzed 10 documents. Results: Four key characteristics were identified which influence the processes of adopting and adapting Dutch innovations in elderly care in the Chinese context. First, the fact that the Chinese government uses governmental-designated pilot organizations like SSWI to support the diffusion of innovations in elderly care. Second, the hybrid top-down and bottom-up approach used in Chinese organizations to manage innovations. Third, the differences between the values of the Chinese context and the values embedded in the innovation. Fourth, the trust and informal relationships build with foreign experts based on long-term cooperation. Conclusion: It may take considerable time to adopt and adapt innovations in health service delivery, especially when there are discrepancies between values embedded in innovations and the contextual values. To facilitate the process, taking an incremental approach and establishing a long-term collaboration between experts involved in the countries of origin and implementation may be beneficial. This message may shed a light for other middle- and low-income countries to transfer innovations in service delivery from high-income countries.