West Hertfordshire Hospitals trust chief executive David Law has resigned following the trust's poor annual health check performance.
The trust was one of four given a 'double weak' rating for quality of services and use of resources for the second consecutive year.
Mr Law was appointed chief executive in July 2004, having previously been the trust's director of strategic planning.
In a statement he said: 'My time here has been challenging but I think I leave the trust in a better position than I found it. It is only right though that the responsibility for failings identified by the Healthcare Commission falls on the chief executive.'
Deputy chief executive Professor Graham Ramsay, the trust's medical director, is now acting chief executive.
The trust said Mr Law would not be getting severance pay.
'David Law has resigned and as such there is no package attached to his leaving,' said a statement.
The move follows calls for Mr Law's resignation from three local MPs, including Watford Labour MP Claire Ward and Hemel Hempstead Conservative MP Mike Penning.
Mr Penning told HSJ other senior members of the management team should also step down.
'It all very well to tell David to resign and then say "we're bringing in someone new" but the whole structure is still there.'
He said takeover by a high-performing trust was not an option. 'There's no-one in this part of the world that has the management expertise and track record to come in and turn this around,' he said.
The trust has struggled to implement plans to restructure services at three hospitals encumbered by massive debts and in the face of high hospital infection rates.
During Mr Law's term it moved from a£26m debt to a projected£5m surplus this year.
However, local health campaigner Jean Brett said day-to-day patient care had suffered while Mr Law was 'chasing cuts' and pursuing the 'mirage' of a big private finance initiative deal to redevelop Watford General Hospital.
Hertfordshire county councillor Michael Downing (Labour), a member of Hertfordshire's health scrutiny committee, told HSJ: 'David Law's resignation may be what protocol demands but it won't actually solve anything.'
He said the departure had come at a difficult time with consultation on reconfiguration of acute services at a crucial stage.
Last week, HSJ mistakenly listed West Hertfordshire primary care trust as 'double weak' for the second year, instead of West Hertfordshire Hospitals trust. The PCT was rated double weak, but for the first time. Last year the reconfigured PCT was not rated because it did not exist.
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