HSE hospitals' chief Dr Tony O'Connell, who announced he is quitting his post this week, also made a surprise resignation from his job as director general of Queensland Health in Australia in 2013.
Dr O'Connell, a native Australian, who was appointed to the HSE job of Director of Acute Hospitals last May, is returning home after his wife was offered an academic post in Queensland.
In August 2013 he also caused surprise when he stepped down from the Queensland job - a role which he held for more than two years.
Dr O'Connell, a former intensive care specialist, joined Queensland Health in 2009 as the chief executive of the department's centre for healthcare improvement. He said he was leaving to pursue private sector opportunities.
"Dr O'Connell leaves on agreed terms, after four years with Queensland Health and two at the helm, driving the biggest and most successful reform programme yet seen in health administration in Australia," it was announced.
Queensland had the shortest median waiting time for elective surgery, and the hospital emergency department was delivering the best performance ever at the time of his exit.
Dr O'Connell was seen as playing a key role in devolving responsibility for health to 17 hospital and health service boards more than a year ago across the Australia state.
In a special broadcast to staff he said he left Queensland Health in the best financial position it had been in.
His experience in Ireland was very different, with hospitals sinking further into the red in 2014.
At the same time public waiting lists to see a specialist and have an operation soared.