Yesterday, the board confirmed it was removing eight clinical departments (four each in Dunedin and Invercargill) in favour of five overarching entities.
The aim is to create an Otago-Southland structure focused on delivering a seamless health service for patients, while saving money. At present, there is duplication, and inconsistency, because the two centres did not merge clinical services in the 2010 amalgamation.
The decision sees 29 positions (19.8 full-time equivalent) removed, and 20 (15.5 FTE) created.
Positions affected are medical directors, nursing directors and general managers. Five of the 20 created positions are "allied health" directors, who were not present at this level previously.
Nursing leaders have dropped from nine to five, including the removal of the deputy chief nursing and midwifery officer.
Ms Lobb, when contacted yesterday, said top nurses would be "less accessible" to nursing staff once the changes took effect.
"That's disappointing for nursing."
The Invercargill-based chief of nursing and midwifery, who is unaffected by the restructuring, and her Dunedin-based deputy, whose job is to be removed, had worked well together, Ms Lobb said.
In addition to losing the deputy, there would be five, rather than eight, departmental nursing leaders. The additional travel they would undertake, and the fact they were fewer, meant nurses would see less of them, Ms Lobb said.
"They are not going to be as accessible."
At present, nurse leaders were engaged with many projects, often behind the scenes.
The incumbents were not "sitting around" doing nothing, she said.
The "big unknown" was the shape of further restructuring in a few months, which would affect the next layer of staff.
The head of the senior doctors' union, Ian Powell, of the Association of Salaried Medical Specialists, feared the medical directors (0.5 FTE) would be spread too thinly between the two main hospitals in Dunedin and Invercargill.
This posed a "high risk".
Detail was needed about the administrative support the medical directors could expect.
He did not feel reassured by the "mushy" document released by the board explaining its decision. The decision document said the board was going ahead with a shared decision-making model at the senior management level between clinicians and managers, despite submitters' concerns it would mean too many issues escalated to executives, due to disagreements.
The changes helped "develop district-wide systems and processes through a greater focus on patient safety, continuum of care and value-for-money programmes".
It would "provide improved reporting, accountability and decision-making supported at the appropriate level, to lead financial improvement." The new entities were medical (approximate budget - $103 million, 730 full-time equivalent staff); surgical ($107 million, 690 FTE); mental health, addictions, and intellectual disability ($59 million, 620 FTE); women's, children's and public health ($71 million, 670 FTE); older persons' health, clinical support and community ($58 million, 570 FTE).
Health and safety concerns about additional travel concerned "many" submitters, although the document does not spell out how many of the 145 submissions raised it.
"There were many suggestions around railcars, buses, planes etc to ensure this [difficulty of travel] was minimised.
"The concerns raised are valid and work is currently being undertaken on the issue of travel across the district."
Some submitters were concerned about the scope andsize of the new roles.
"It is intended that these leadership roles will have a presence on each site and will need to ensure that they are accessible to their teams."
Submitters persuaded the DHB to retain the title "general manager", rather than the "patient services division leaders" proposed initially.
New appointments will be announced from next month, and implementation will be staged from October to December, to minimise disruption.
Interviews start on Thursday, and existing staff will be given preference.
Asked about travel, patient services executive director Lexie O'Shea said the DHB was working to reduce the burden with technology links, car-pooling, and flights. However, travel was an unavoidable component of the new roles.
She believed the number of senior nurses was adequate.
Mrs O'Shea declined to say how much the reduction in senior staff saved in the restructuring, saying that was not its purpose.
"Patients are at the centre of all we do ... Creating a high-performance organisation with a focus on quality and becoming financially and clinically sustainable unified DHB."
The 2011-12 unaudited financial result was a deficit of $13.2 million, the board meeting this month heard.
