Scrutiny of NHS chief executive officers (CEOs) has tended to focus on the generally short tenure of their position. Whilst the implications of high turnover have been assessed conceptually and empirically, there has been limited inquiry into those CEOs who remain in post for long periods, whether in the same organisations or in multiple ones. This study draws on interview data collected in 2019 with 10 long serving CEOs in the English NHS (with an average tenure of 17 years). Whilst heterogeneity was achieved in relation to CEO backgrounds, different types of trusts which they led, geographical location and balance of
genders, we note the limitations of an interview study of an atypical sample. We frame the study in terms of an organisational lens, focusing on organisation renewal and networked governance, and a personal lens, focusing on strategic competence and political astuteness.