There are many challenges in running a large hopital department. I have been head of department for a year and wanted to share my experiences with colleagues in similar situations. During the first year It has been a kind of a rebirth of a large academic department at a university hospital and we have during the first year especially struggled with a lot of economical problems. Numerous changes were implemented, and we came out of 2012 for the first time in more than 10 years with black numbers on the bottom line instead of red numbers. This has only been possible because many things have been changed simultaneously and the staff has all been aware of the strategy and in agreement with the plans. Everybody has worked very hard to achieve this fantastic goal and we are now able to look ahead and to develop plans for changes in patient care, research and education. I would have loved a year ago to be able to read a book like this in order to get some tips and tricks, and I hope that the book can be helpful for new leaders of big departments where there are similar problems.