Purpose: The purpose of this in-depth case study was to better understand how practices, policies, and structures contributed to a large health care organization's track record of hiring, training, and retaining persons with disabilities (PWDs). Method: We conducted in-depth interviews with 63 key informants across four hospitals in the hospital system. Within each site, we recruited participants from multiple-levels of the organization to understand the complexity of employment practices. Content analysis was used to analyze participant response to open-ended questions. Results: Providing appropriate supports, including clearly defined job roles that are aligned with employee abilities, ongoing coaching and support, and purposeful efforts to integrate PWDs into the broader organization, are important elements of ongoing success. Invested leadership, alignment across organizational structures, and building partnerships with organizations with knowledge and skill in supporting PWDs are additional critical success factors. Conclusions: Findings indicate that it is imperative for organizations wishing to strengthen their hiring practices for PWDs to develop a culture that embraces a person-first approach. As evidenced here, in an environment where all employees feel supported, valued, and as if there is room for growth, there is opportunity for employees with disabilities to be viewed through a positive, developmental, and generous lens.