The healthcare emergency was one of the most severe consequences of the out break of the COVID-19 pandemic that occurred from March 2020 until today, in subse quent waves. In this scenario, the Hospital of Spoleto "San Matteo degli Infermi" (located in the Umbria region, Italy) became a COVID-19 referral centre, therefore having to make organizational changes. This study aims to evaluate the quality of care and the health policies applied during the pandemic time, through interviews and survey results. Twenty-eight referents of Operational Units (OUs) from three Organizational Articulations (OAs) agreed to respond. The questionnaire consisted of 81 items, relating to ten  topics inflected in the first five pandemic waves. Survey results were analyzed by the “SPRIS system”, a tiered decisional matrix already described and applied successfully. In particular, it provides a measure of performance highlighting skills and issues. Findings showed that the individual OUs fluctuated from “good” to “very high” performance in- dex, however “very high” performance range was reached cumulatively. Remarkably, the situation was improved after the first sudden wave, driven by adopting safety measures. In conclusion, this evaluation showed an optimal reaction of Spoleto Hospital during the first five waves, due to approaches taken in response to pandemic challenges.