Overcoming hospital resistance in an international innovation co-creation

The health sector is very specific and difficult market for firms to access and deal with. The main reasons for this is that the healthcare systems are in continuous change, the co-creation processes in hospitals are complicated involving many different actors which also affects on firms commercialization and internationalization ap-proaches. However, there is a growing demand of health services and the sector is growing also due to the COVID situation, that has been dramatically speeding up the digitalization of the healthcare services in the hospital settings. Approaching international hospital markets is, however, challenging for the start-up companies. On their journey they are facing a resistance, that they have to overcome in many different ways. The aim of this paper is to increase understanding how a start-up can overcome hospital resistance in an international innovation co-creation process. The results of are based on in depth case study in which the data collection was done over the four years of data gathering. The paper highlights how start-up companies can overcome the resistance in the international innovation co-creation in the hospital markets. It shows the importance of different activities, actors, capabilities and international activities in different phases of the in-ternational innovation co-creation journey.