Purpose - The aim of this paper is to understand whether and how the Italian healthcare context has embraced the practice of sustainability accounting and reporting, by checking if the specific sector has developed institutional pressures that move organizations towards the adoption of sustainability disclosure. Design/methodology/approach – Document analysis was adopted as a qualitative research method of data collection and analysis. A total of 80 documents were included in the exploratory analysis, 10 related to regional programming phase and 70 related to the monitoring corporate phase. Findings – Italian organizations are lagging in adopting sustainability documents. Documents do not refer to SDGs as they are filled in according to a law that was designed far before the introduction of SDGs. The lack of pressures across public sector organizations has not fostered the culture of sustainability reporting in the public healthcare sector. Originality/value – The contribution of this research can be seen from a practical level: (1) this paper contributes to the accounting and reporting literature by studying the availability of accounting and sustainability reporting practices in the public sector; from a theoretical level (2) this paper analyzed the development and role of institutional pressures for sustainability reporting in Italian Public Hospitals.