The new chief executive in charge of St Albans City Hospital has described its buildings as "unfit for purpose".
Samantha Jones officially took over the role of chief executive of West Hertfordshire Hospitals NHS Trust on February 4.
Ms Jones has worked in the NHS for more than 20 years, starting life as a paediatric and general nurse in Great Ormond Street and Bromley hospitals before taking part in a management training scheme.
She was previously the chief executive of Epsom and St Helier Hospitals NHS Trust, before taking up the directorship of Care UK, a private-sector healthcare provider.
Ms Jones said: "We have a fantastic workforce and I have been overwhelmed by the commitment of the staff.
"The trust has its challenges. Clearly the infrastructure concerns me. We provide very good care, but in buildings that are just not fit for purpose.
"What’s helpful being new is that you see things through the patients’ and families’ eyes.
"There is enough to do here, what I hope to bring is leadership and clarity."
West Hertfordshire Hospitals NHS Trust is at a period of great change, with a hopeful foundation status bid, which will bring with it more independence and financial flexibility.
Ms Jones said: "It is an outcome, not a reason for being. Whether you’re an NHS organisation or a foundation trust, you have the right system and processes in place.
"At the moment I’m not confident we have a clinical strategy strong enough, so we are revising it, and from that we will know what our commissioners want from this organisation.
"We will then know what the size and shape is for the future and within a few months we’ll have outlined a timetable to get to foundation trust."
The most recent financial report said the trust was operating at a deficit of £1.6million in December 2012.
It had hoped to finish this financial year with a £3.1million surplus, but later revealed it was just aiming to break even.
Ms Jones said next financial year, senior medical staff would be brought into the early stages of a patient’s treatment, in order to make the service more efficient.
She added: "The finances are an outcome of how we deliver our clinical services, if we approach everything around the highest quality of care for patients, our finances will follow.
"We’ve had a significant increase in emergency admissions, and there is a cost to delivering that. We also haven’t delivered what we said we would from a savings perspective."
The city’s minor injuries unit was plagued by closures in 2012, to allow staff to be transferred to Watford General Hospital.
Ms Jones said: "The minor injuries unit has been closed due to a lack of staffing, and people have had to come over to Watford.
"We need to do a better job of communicating when that happens. We do notify our GPs and put it on the website.
"I also need to understand when and why it happens. At the moment my understanding is that it has been down to sickness in the staff working in St Albans and Watford.
"If we’re clear about what services we should be providing, we will know where and what type our emergency patients are."