Hospital chief executive officers (CEOs) have demanding jobs in which they must, at times, function as if they are potentates of small principalities. Their ability to elicit loyalty and allegiance, hand out discipline and praise, foster alliances with other organizations, and commit the occasional hostile yet (it is hoped) successful foray onto a competitor's turf are skills that must be mastered for success and longevity. We have taken the thoughts and strategies of the Renaissance political master, Niccolo Machiavelli, and applied them to the modern hospital CEO for whom we feel they still hold elements of wisdom and guidance.