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When and where do social innovations emerge? We address this question using comparative and historical analyses of organizing for palliative care in India. Although palliative care made in-roads into different parts of India in the 1980s, it evolved as a vibrant sector only in the state of Kerala, through a novel community-based approach. By examining historical and social conditions, we reveal how poisedness, and particularly political poisedness, of time and place manifests in the genesis and propagation of a social innovation. We contribute to the literature on macro-foundations of social innovations by illustrating how an array of organizations and individuals create the very conditions of poisedness that are thereafter leveraged by institutional actors for the construction of novelty and propagation. Moreover, we specify the conditions of poisedness that are conducive to propagation, thereby contributing to conversations on distinct phases of emergence.