New Santa Chiara Hospital in Cisanello is under construction as part of Pisa University Hospital (Aoup). The 1000 beds and 5.000 employees Hospital (currently on two distant pavilion facilities) will find in 2026 a unique location in Cisanello, through the expansion of hospital buildings. The project aims structural and technological innovation and deep development of the organization. New responsibilities, new roles, new care delivery, organizational models and new logistics will be needed in new spaces. Our approach to change management is setting up future through bottom-up engagement and participation. In the meanwhile, we are working on a strong smart hospital design for buildings, users, care and hospital governance. New spaces are shared and care settings homogeneous, beyond our known borders: this is a cultural challenge we have been dealing with for two years. Currently, we are studying the corporate organizational culture and nursing care delivery model through research, engaging front-line nursing staff and nursing management, planning future organization and designing future hospital life. Smart Hospital Project involves analysis of needs in digitization, connection of processes and adoption of new tools that can allow better use of resources, increase patient safety and costs reduction. Research, change management and Smart Hospital are our change drivers. This can be replicated to other realities facing challenge like us, with resilient approach and shared construction of organizational change.