COVID-19 infection is very new for the world and it impose a global threat in a manner that we faced for prolonged time worldwide. This study mainly focuses on Centre of excellence in COVID-19 unit’s service operational flow of the NABH accredited tertiary level Hospital in Gujarat. From setting up of an isolation ward to day to day routine trouble shooting was worth having learning. The main purpose behind choosing this organization is to know about how the reputed tertiary level Hospital in western India established infection control policy and facility design in place in order to keep both staff and patients safe and protected; as well as learn the complexities of Healthcare Service Operation management during this worldwide COVID-19 pandemic. During this study period lots of new challenges in terms of communication between patient and relative, transportation of equipments and Hospital staff have been faced. Increasing demand for IPD beds and trained human resources were major issues. Oxygen demand, medication scarcity & high COVID-19 infection rate in the society were our prime issues to address. It was exploratory study where tried to portrait all experienced ground level challenges and the variables of decision making process.