The Santa Maria della Misericordia Hospital in Perugia, with 780 beds and over 2,800 staff members, is the main hospital of the Umbrian Regional Health Service. In collaboration with the University of Perugia, the hospital integrates clinical care with research and training. Following the renewal of employment contracts in November 2022 for the Comparto and in January 2024 for the Dirigenza, the hospital initiated a significant process of personnel enhancement. This article describes the comprehensive review of managerial and professional career paths within the hospital, incorporating a new organizational design. The intervention was an opportunity to strengthen the managerial dimension and distinctive professional skills. The process involved a major change management action based on transparency, fairness, and the enhancement of the professional skills present in the organization.