Mr Cumming, who has been employed until the end of the year by the Southern District Health Board as facilitator on the " Putting the Patient First" project, was formerly general manager of the quality improvement unit at Middlemore Hospital.
The project is designed to improve patients' journey through Dunedin Hospital services.
Mr Cumming is familiar with Dunedin Hospital, having worked in a variety of roles there between 1978 and 1999, including as a senior manager.
Ironically, one of the areas of concern today is the hospital's cramped emergency department, which was state of the art when he oversaw its development in the 1990s.
He readily conceded much had changed in the field of emergency care since then, including more people with complex conditions arriving at EDs.
Several years ago, Middlemore had a worse record than Dunedin Hospital for the length of stay for emergency department patients, but it has been transformed through lean thinking, problem solving and quality-improvement processes.
Mr Cumming said having quality improvement "on every agenda at every meeting at the top table" was important if gains were to be made in improving patient safety, and he supported the proposal for a quality-improvement unit.
The key to solving problems was encouraging frontline staff, who had real understanding of the problems, to spell out the problems and provide the solution.
But at the same time, leadership from the top of the organisation was important, because staff needed to know that senior staff, both clinicians and management, saw it as a priority.
He knew from his own management experience that often, when managers tried to fix a problem, they could make it worse or end up fixing the wrong thing because they did not properly understand the problem.
Toyota had a philosophy that when solving problems, there should be no pressure to decide what the problem was, but it should be fixed quickly once it was understood.
In his fourth week on the job, Mr Cumming said progress had been made in identifying problems and data was being checked to see if it backed people's perceptions.
At Middlemore, some issues people identified as problems "were not actually that serious", while others turned out to be major.
Mr Cumming emphasised that he was not in the hospital telling people what to do, and it was not sensible to import solutions from other places.
One of the problems identified was people staying in the emergency department when they were not actually receiving treatment, but were waiting for a bed or for test results.
It was not appropriate to have them in the corridors and ways would have to be found to deal with that in the time before the observation unit was built.
It might, however, require some short-term investment or "bridging" money to allow people to "cope with things while you are doing other things".
In Middlemore, a temporary ward had been set up to " declutter" the ED, which had cost money in the short term.
Mr Cumming said that at Middlemore, it was estimated that quality improvements had saved the hospital more than $10 million last year, and he was confident that savings at Dunedin would also be significant.
Evidence from overseas suggested that "if you really focus on patient safety and improving quality, you can save about 2% of your budget every year".
Mr Cumming said he did not "really buy into" the idea that people were resistant to change.
Once people were able to step back and look at what they were doing from the patient's point of view, they could see issues in a new light.
As a quality improvement adviser told him once, if resistance to change was inherent, nobody would choose to change their lives by having children, and yet people did it "all the time".
As an older-than-usual father of a 5-year-old, he could relate to that.
