Board member Dr Malcolm Macpherson said he had been contacted by a senior emergency department nurse who had agreed with his recently reported fears that rather than changing, staff were doing "the same old, same old" under another name.
The emergency department took part in a lean-thinking pilot in 2008 but, while some gains were made, project clinical leader Dr Tim Kerruish warned last year it might get bogged down without a change in the hospital culture.
Emergency department staff have recently taken their ongoing concerns to management about the lack of progress in improving conditions in the stretched department.
They say patients are staying there too long and they are worried about the difficulty of providing adequate care for high numbers of patients on beds in corridors.
Dr Macpherson said board members had a moral obligation to take the issue seriously or they would be "letting everyone down, including ourselves".
It was not a matter of doing the "wrong righter" but doing things differently, Dr Macpherson said.
Chairman Errol Millar said the board was "absolutely committed" to introducing lean principles across the hospital, but the "hearts and minds" of people doing the job had to be captured.
Chief executive Brian Rousseau agreed with members who called for a higher profile for lean-thinking methods, but it was a real challenge to do this when management was always "firefighting".
Members of the executive team were playing "catch-up" with such tasks as ensuring increased elective surgery volumes were reached, preparing for strikes and compiling recovery plans for the Ministry of Health.
Member Richard Thomson said there were clinicians who wanted to drive change and the board needed to look at how it could actively work with them. He suggested giving the matter top priority at hospitals' advisory committee meetings.
Member Louise Carr expressed concern about confusing governance with management and suggested it was the board's role to come up with a solution and empower management to implement the vision.
At some stage, the process would reach a point where consensus had been reached and people would have to "agree to disagree, come on board or leave".
Mr Thomson said all of the evidence suggested that without the sort of support he was proposing, lean thinking, which encourages staff to identify waste in the system and work out how to reduce it, would fail.
Mr Rousseau said everybody had to engage with the process and some staff were more willing to be involved than others.
Chief operating officer Vivian Blake assured the meeting much work was going on around a clinically-led "whole-of-systems" approach to change.
She agreed with Mr Rousseau this work had to be combined with a "whole raft" of other things which were going on and it was "not something you can manage in the lunch hour".
She was reluctant to "write it up" yet because work was still being done on it.
When it came to the board, "we may well need to ask for investment. This is a programme which will take at least three to five years." She described it as "probably the biggest thing" she had embarked on in her time with the hospital.
