Acting regional directors John Bacon and Ruth Carnall have been appointed to take up substantive posts in London and the South East.
The announcements on Friday were broadly welcomed, although HSJ sources warned that the appointments - to succeed Nigel Crisp and Barbara Stocking - would herald 'a big change in style' of management for the regions.
Mr Bacon - formerly director of finance and performance management - has been described as 'playing bad cop to Nigel's good cop', while Mr Crisp was director of London region.
Sources said there was 'nothing very fluffy' about his management style, which had won respect, and that he was seen as 'an enforcer' with 'a very firm grasp' on the detail. His background in performance could mean his 'enthusiasm for targets' and financial stability was likely to override other issues, some sources suggested.
But Mr Bacon said: 'I think we have got a very strong performance and financial regime. . . our finances are pretty stable. . . [but] unless we have got that stable base we can't get going on the agenda, however exciting. '
He said difficulties recruiting staff and the cost of living were extra challenges in 'an intense period of change' for the capital's NHS.
'London in a sense shapes the way things happen in the rest of the country. My job is to bring some shape and coherence to the work. '
Both former NHS chief executive Sir Alan Langlands and current chief executive Mr Crisp went from regional jobs in London to lead the NHS.
But Mr Bacon, aged 50, insisted that his latest promotion, after 18 years working for the NHS, was 'the pinnacle of my career'.
'I do not think It is a natural progression. It just happens that the last two [NHS chief executives] were from London.
'As far as I am concerned this is the pinnacle of my career. '
Mrs Carnall, chief executive of West Kent health authority, has been acting director of South East region since December, following the departure of Ms Stocking to be shadow director of the Modernisation Agency and then to lead charity Oxfam.
She rebutted any suggestion that the South East regional office was 'leading the way' on equal opportunities by appointing two women in a row as directors.
'No, I think That is nonsense, ' she said. 'Barbara and I are like chalk and cheese, our backgrounds are quite different, too. . . I do not think anyone thought, 'Oh my God, We have got to have another woman, stick another one in. ''' Mrs Carnall, 44, said that one of the main pressures she would face heading South East region was improving access to care: 'We have got more trolley waits than anyone else, ' she said, flagging up bed-blocking problems exacerbated by a paucity of care home places and pressures on social services.
'We have got an awful lot of relatively small district general hospitals which are not secure and viable in the long term, ' she added.
Mrs Carnall began her career in the NHS in finance and was chief executive of West Kent HA from 1994.