Several authors note a growing gap between the development of evidence-based innovations from research projects and their implementation in day-to-day clinical and administrative practice on a large scale. One of the reasons for this is a lack of theoretical and methodological knowledge to implement the best clinical, administrative and organizational practices in other places and contexts. Scaling up requires an adaptive approach recognizing the importance of flexibility in design, appreciation of the local context, and a sensitive response to the unique needs of each environment. It requires the use of qualitative methods to examine underlying processes and mechanisms and encourages the adaptation of intervention to fit different contexts. Dissemination and scaling up of major innovations in the healthcare sector requires an approach rooted in complex systems theory which implies considering several plausible scenarios, fine-tuning innovations to local specificities, harmonizing innovation with the realities of receiving environments, and facilitating intra- and inter-organizational interactions.