The role of cultural values and norms in the adoption and implementation of foreign innovations in health service delivery in China.

Background: In pursuit of the ambitious and large scale 2009 national health reform objectives, China has turned to the introduction and implementation of foreign best practices in health service delivery. While it is well known that cultural differences may significantly impact the adoption and implementation of innovations, there is little specific knowledge on how these impact foreign health service innovations adopted in China. Our aim is therefore to identify which cultural norms and values affect the adoption and implementation of foreign innovations in health service delivery in the Chinese context and how.

Methods: We interviewed a variety of respondents (government officials, directors, doctors, consultants, researchers) involved in the adoption and implementation of foreign health service delivery organizations from China (n = 10) and from The Netherlands (n = 9), with which China has built long-standing cooperation on exchanging innovations in health service delivery. A semi-structured interview guide was used. The interviews were transcribed verbatim, translated (Chinese into English) and coded, using both thematic and open codes.

Results: Identified values and norms related to health and care, health services and professionals, and organizational dynamics respectively. Some act as potential barriers to the adoption of innovations (e.g., the body must be treated with respect), some play a facilitating role (e.g., eagerness to learn from other cultures), and some can be either a facilitator or a barrier depending on the circumstances or the views of our respondents (e.g., filial piety, longevity is valued over quality of life).

Conclusions: Innovations in primary and elderly care that are nurse-led and focus on new service concepts emphasizing personalized care, experience cultural barriers in China. Meanwhile more structural and technical innovations especially in a hospital setting are strongly facilitated by Chinese cultural characteristics. While the national culture has a significant impact on foreign innovations in China, the interactions of those innovations with the local cultural context at meso- and micro- levels additionally plays an important role.