China is managing major health system reforms against a background of rapid economic and institutional change. In doing so it is developing a learning approach to transition management and institution-building. This approach includes testing innovations at local level, encouraging learning from success, and then gradually building institutions that support new ways of doing things. Chinese policymakers and analysts are also developing strategies for drawing on international experience. Analysts from other countries and officials in organisations that support international health need to understand this approach if they are to strengthen mutual learning with their Chinese counterparts.