Italian universities are currently facing tough changes and financial difficulties and, in some cases, action to restore (turn around) economic and financial balance has been needed. Ex-ternal and internal factors have contributed to this state of affairs. Global crisis, an overall reduction in public funding, radical organizational reforms, on one hand, and inadequate in-ternal management and control system, on the other, are the main challenges which Italian universities are currently coping with. This chapter focuses on the University of Siena, a medium-sized, centuries-old institution founded in 1240 with an excellent reputation. By the 1990s this University had been growing and expanding for many years (new faculties, more courses, inc...