The article provides a reflection on the crucial role of the Italian health authorities and their management dealing with the Covid-19 emergency. The article puts a particular attention to the strong operational impact of the measures adopted, which have represented an extraordinary challenge for the management, and the great relevance given to the managerial autonomy of the healthcare organizations, progressively built up over the last two decades, in order to guarantee an high flexibility and providing a response and a great capacity for the compliance. This reflection starts from a brief description of what happened in Lazio Region. One of the lessons learned in almost three months of the Covid emergency is the importance of management handling a change and the need to strengthen a "management of health system", in order to attain the ability at regional level to share strategies and actions implementing, at local level, with the health authorities, and therefore acting with a more cohesive and coherent approach.
Keywords: Flexibility, challenge, decision- making autonomy, responsibility, cooperation, system governance.