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Application of operations management in healthcare is particularly promising to improve the overall organisational performance, although the Italian system is behind in introducing related techniques and methods. One of the recent experiments in healthcare is the implementation of “Lean Thinking”. The purpose of this paper is to investigate which exogenous forces are driving knowledge transfer on Lean, both in the private and public healthcare sectors.

Informed by institutional sociology (DiMaggio and Powell, 1983; Powell and DiMaggio, 1991), the paper builds on the case study methodology (Yin, 2013) to elucidate the environmental pressures that are encouraging the adoption of Lean thinking by Italian hospitals and Local Health Authorities.

The study highlights the economic, coercive, mimetic and normative pressures that are triggering the adoption of Lean thinking in the Italian National Health System (INHS). At the same time, the authors reveal the pivotal importance and innovative roles played by diverse prominent key-actors in the different organisations investigated.

Considering that little is known to date regarding which exogenous forces are driving the transfer of knowledge on Lean, especially in the public healthcare sector, the paper allows scholars to focus on patterns of isomorphic change and will facilitate managers and policy makers to understand exogenous factors stimulating the transfer of Lean thinking and the subsequent innovation within health organisations and systems.

This paper presents the results of exploratory research aimed at understanding how firms operating in regional clusters use the clusters' collective identity in their external communication and combine it with the communication of their individual identity. In particular, the paper aims to detect different behaviors among different types of firms.

A quantitative exploratory content analysis is performed on the websites of the wineries of the Franciacorta wine cluster (Italy). A two‐step cluster analysis is used to identify differences in identity communications.

The results suggest the existence of two groups manifesting different patterns of identity communication. Larger firms communicate their individual identity through symbols, but they consistently communicate collective values. The other group (on average smaller firms, but including some of the biggest) seems to exploit collective identity symbols, without giving prominence to collective values.

This study provides an understanding of how companies communicate collective symbols and values promoted by cooperative institutions; this understanding can be beneficial for future developments of collective branding projects.

This research contributes to broadening the debate on cluster identity as a strategic resource by adopting a communication perspective as well as providing empirical data on how different types of clusters' firms actually combine a collective cluster's identity and their firm's identity to shape their external image.