Ten-year tenure as a physician CEO at a Nordic university hospital: five lessons learnt

Background I was a 42-year-old neurosurgeon with experience as department head when I took chair as chief executive officer (CEO) at the University Hospital of North Norway to lead a comprehensive organisational and financial restructuring. This article aims to develop lessons learnt during my 10-year tenure. Methods I restructured the organisation and hired a new executive team. We developed a new strategy and measures to implement it. I describe the results, a strategic disagreement that developed and my resignment, and reflect critically over my actions as a leader. Results Measures of safety and quality in clinical processes, cost-effectiveness and financial equity improved. We expedited investments in medical equipment, information technology and hospital facilities. Patient satisfaction was stable, but employees' job satisfaction decreased. After 9 years, a politicised strategic disagreement with superior authorities developed. I was criticised for attempting to influence inappropriately, and resigned. Lessons learnt (1) Data-driven improvement works, but comes at a cost. Healthcare organisations should consider to prioritise resilience over efficiency. (2) It is inherently difficult to recognise when and how an issue changes from a professional to a political logic. I should have used contacts in politics and surveilled local media better. (3) During conflict, role clarity is crucial. (4) CEOs should be prepared to resign when strategically unaligned with superior authorities. (5) A CEO tenure should not last more than 10 years. Conclusion My experiences as a physician CEO was intense and immensely interesting, but some of the lessons were painfully learnt.