Although the success of social innovation relies on civic engagement and involvement in a vast array of interests, the scaling process of the top-down renewal of the health governance have received little attention in literature. Considering as crucial to understand the structural effects of these process, which is linked to the institutionalization of any reform paths and to the warrant of the "publicness" of the collective goods (i.e. health) and service (i.e. healthcare), this article aims to focus on an effective scaling process (adopted by Tuscany Region). The qualitative research path is driven by the Sewell’s theory of structure, which considers the structure as composed simultaneously of schemas (virtual) and of resources (actual) in their recursive relation. This approach allows to identify the effective possibilities for a structural change within a specific milieu.
Keywords: Social innovation, sistema sanitario, teoria della struttura, Sewell, studio di ca-so, schemi e risorse.