Exchange of health service innovations between East and West

In the 21st century, countries worldwide face complex challenges that strain their health systems. The World Health Organization advocates for a global exchange of health innovations to promote learning among countries about solutions to common health system challenges (e.g., increasing health expenditure, aging population). Spreading innovations is like the ripple effect after throwing a pebble into a pond. It is a dynamic, non-linear process influenced by various contextual factors. Diffusion therefore cannot be “off-the-shelf” deals and contextual differences can either facilitate or hinder the process.


Current scientific evidence, however, primarily documented diffusion within Western health systems. Innovation diffusion between contexts with significant differences is under-researched. How innovations diffuse between East and West remains unclear and the same applies to the transnational diffusion process. We therefore need to advance the understanding of the factors and processes of transnational diffusion of health service innovations between health systems in the East and West. With this aim, we conducted a systematic review, semi-structured interviews, and case studies in China (regarding Dutch innovations in elderly care) and The Netherlands (regarding Chinese traditional acupuncture).


This PhD thesis provides novel insights into factors that facilitate and/or hinder the transnational diffusion of health service innovations between health systems in the East and West; and how these factors affect the diffusion process. We found that various factors often interact to affect the transnational diffusion of health service innovations between East and West. The structural and especially cultural fit between the innovation and the system influences transnational diffusion (innovation-system fit). Especially when strongly held norms and values in the context are not compatible with those embedded in the original innovation. When such incompatibility exists, mutual adaptations are often needed. The global journey of innovations can be facilitated by change agents whose knowledge work, culture work, and structural work serve to overcome the innovation-system fit barrier. Trust work may be additionally necessary depending on the perceived trustworthiness of change agents and on whether the innovation is ‘invited’ to the adoption context or not. Trust work may also be needed to establish a long-lasting international social network linking the country from which innovations originated, and the country into which innovations are introduced. Such international social networks are instrumental as a channel to exchange innovations, knowledge, and culture between the East and the West and provide a platform for the diverse tasks of change agents. The transnational diffusion process remains complex, non-linear, and recursive, which requires incremental steps and long-term commitment.