Abstract: This study explores facilitators and barriers to the adoption of an innovative service technology, palliative care, in the complex organization of the hospital. It uses a conceptual model that integrates Hasenfeld's human service organizations framework with innovation diffusion theory to understand interactions between organizational factors, characteristics of the innovation, and the implementation process. I carried out a comparative case study of hospital-based palliative care programs in three healthcare systems that varied by organizational type, specifically financing mechanisms and VA-mandated program versus non-VA voluntary program. I conducted in-person interviews with key players (physicians, nurses, social workers, administrators, and executives, total n = 22), which I analyzed qualitatively coding for themes within and across cases; I supplemented these data with archival material from each program. Variations in palliative care programs were compared and generalized back to theorized relationships with the service technology (interdisciplinary palliative care), organizational environment (healthcare system), and implementation process factors. Integrating palliative care challenges the dominant ideologies and practices of the hospital—because of the emphasis on curative care and saving life, and cultural norms about death and dying. The interdisciplinary nature of palliative care itself challenges established hierarchies, power relations and disciplinary domains in the organizational structure of the hospital. The interdisciplinary team includes role incumbents who communicate, collaborate, and deliver care in ways that transgress traditional hospital boundaries and protocols. Organizations with capitated financing mechanisms have financial incentives to implement palliative care. In addition to innovation champions and executive support, including users in the implementation process and increasing opportunities for observability of outcomes are among the best ways to overcome resistance to palliative care. Implementing hospital-based palliative care requires some reciprocal adaptation to meet these challenges; the technology is redefined and the organization is restructured, to accommodate each other in that process. The conceptual model integrating innovation diffusion theory with Hasenfeld's service organization framework was especially useful in illuminating processes by which particular innovations in health service delivery are implemented and sustained within multiple levels of context.