"If I take a look at what is happening in the rest of the world, we have slipped behind in New Zealand.
"I think quality starts at the governance level.The boards need to understand their role in quality and I don't think they do.
"It is not the fault of the boards. That is the kind of system change we need."
The board had been focused on "chasing our tails on a lot of initiatives", but improving quality of care had not been one of them, he said.
Mr Rousseau's comments followed his attendance earlier this month at an international conference in the United States about quality improvement in health care, which was attended by more than 5000 people.
One presentation Mr Rousseau attended, which examined how to get "boards on board" to improve quality and safety, suggested boards should have a quality improvement committee, spend more than 25% of their time on quality issues and invite patients and families to board meetings to share their experiences.
Every board member should be asking questions about patient safety, such as "do we really have an open and fair culture?" and "are we always open when things go wrong?" conference-goers were told.
While change was needed at board level, Mr Rousseau was also critical of his own performance.
As chief executive, it was his role to lead a change of culture in the organisation to a culture focused on quality, he said.
"Probably the biggest problem is lack of time. The reality of a chief executive's job is there are a lot of other things we deal with.
"It is about finding the time to get out of the office and spending time walking around the organisation, talking to people. Finding out more about their roles is a vital step.
"I don't do that enough and it is one of the things I have got to change."
Mr Rousseau said he had "had his nose to the grindstone" and had not been to the annual quality improvement conference run by the Institute for Healthcare Improvement for seven years.
One hospital took quality improvement so seriously it had 25 people at the conference.
The board had made a start on improving quality of care and patient safety with a "putting the patient first" pilot in Dunedin Hospital's emergency department, but needed to go "harder and faster", he said.
Emergency specialist Dr Tim Kerruish, who is leading the pilot project which aims to reduce waste, increase efficiency and improve patient flow, has previously told the board the project could founder in the existing hospital culture.
Mr Rousseau said he would spend his Christmas break reflecting on the issues and "come back with plans" next year.
