NHS West Midlands has failed to appoint a chief executive despite carrying out interviews.
The strategic health authority is seeking to replace Cynthia Bower, who was appointed Care Quality Commission chief executive in July.
HSJ understands no-one has been appointed from a shortlist of three.
An email to staff from chair Elisabeth Buggins last Thursday states: "As you are aware yesterday we interviewed for the substantive chief executive position but didn't feel ready to make an appointment at this stage."
Ms Buggins has asked interim chief executive Peter Shanahan to stay in the role another six months. It is hoped a permanent appointment will be made next April.
The email praises Mr Shanahan's input and says: "I am very clear that the NHS is undergoing real and fundamental change that requires inspirational leadership, clarity of purpose and drive to achieve service transformation and value for staff, patients and the public."
An NHS West Midlands spokeswoman said no arrangements had been confirmed for further advertising of the post or interviews.