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Medical disruptive innovation is essential for deepening the reform of health-care system. The theory of general disruptive innovation assumes that innovations can diffuse by benefiting and attracting consumers through observed and objective relative advantages. Yet decision-makers for adoption in health-care settings are safety-sensitive professionals whose cognitions barriers about underperformance in focal attributes will impede further evaluation of innovation's ancillary performance. Existing studies do not answer the question of how such innovations can overcome safety barriers, find early adopters and grow to the early majority. The purpose of this study is to investigate the process, mechanism, and path of early diffusion of medical disruptive innovation.

The authors conduct a longitudinal case study of the diffusion of Enhanced Recovery After Surgery (ERAS) in China during 2011–2018.

The authors find that the diffusion process of medical disruptive innovations can be viewed as a cognitive evolutionary process that sequentially establishes conformity, differentiation and normalization. Cognition reframing of expert, meaning and benefit for professionals is its implicit mechanism. When adoption may trigger cognitive concerns, actors’ very early (dis)adoption is driven by a combination of structural position, innovation attributes and performance perceptions; central actors then play amplifier roles in the development from early adopters to the early majority.

This study proposes a process theoretical framework for the early diffusion of disruptive innovation. By dissecting the key processes and mechanisms from a cognitive perspective, the study offers theoretical contributions and practical insights into the diffusion of disruptive innovation in professional settings.