Mr Kirwan was widely regarded as the driving force behind the LGH's strong economic performance.

The LGH's loss will be the Tasmanian Royal Flying Doctor Service's gain as he moves to head up that organisation in January.

His resignation leaves all three Tasmanian Health Organisations with acting heads and an uncertain future as the government rolls them into one statewide organisation.

Many Northern Tasmanians working in the health system had hoped he would end up running the state THO.

Whereas the THOs in the South and North-West blew their budgets and were dogged by allegations of nepotism and maladministration, THO North was a relative beacon of stability.

THO South chief executive Jane Holden was sacked and THO North-West chief executive Gavin Austin resigned amid allegations of special deals for friends and family. They both deny the allegations.

The resignation or removal of all three THO bosses in a six-month period will create terrible uncertainty within the Health Department.

Of course there is still a dedicated and smart senior management team at the LGH, but Mr Kirwan was largely seen as a buffer between staff and government.

He had a reputation for arguing the case of the LGH strongly behind the scenes and not being cowed by Hobart-based bureaucrats.

He did the hard economic work so that the health professionals could do their jobs as best as they could.

It is now up to the state government to make clear how the statewide THO will function, who will fill the top role and what budget savings will need to be made.