Mike Hunter, clinical leader of Dunedin Hospital's "6 Hours - It Matters!" project to improve waiting times in the emergency department, said the difficulties could already be seen in the emergency department, which was "physically, a shambles".
The layout of the department meant it was impossible to get good patient flow and he had recently observed an associate charge nurse and a consultant wheeling beds to accommodate patients.
"Why would you employ an ED consultant to wheel beds about? It's not common sense."
An observation unit beside the emergency department, in the area occupied by Muffin Break, is to be built by next July. Work has already started on a new food outlet, which will have street access, beside the main entrance.
Mr Hunter said improving systems could "only go so far" and then there came a time when "facilities stand in the way".
The "Putting the Patient First" governance group, of which Mr Hunter is a member, in its strategic plan produced earlier this year, called for a revisiting of the master site plan for a revamp of services over the Dunedin and Wakari hospital sites.
It was drawn up in the early part of this century and its first stage submitted to the Ministry of Health in 2008.
To date, however, only about half of the first stage has been approved - $24.38 million - which includes relocating the acute mental health ward to Wakari and redevelopment of the neonatal intensive care unit.
Mr Hunter, who is also the clinical leader of the intensive care unit, said the new look at the planning had to consider the relationship between services and future changes to service delivery.
Without a vision of what was likely in the next 25 years, the risk was the board could spend much money making mistakes and then having to reverse them, he said.
In the past, the board had put off plans for rebuilding because of the cost and because they were "politically unpopular".
He suggested acute services had to be located together within the hospital building, but there could be a case for such services as out-patient care, care of the elderly, day surgery, and physiotherapy to be elsewhere.
Areas such as the clinical services block, the Fraser building and the children's pavilion would all be difficult to adapt for modern use and a new building might make more sense.
There was potential to build more at the Wakari Hospital site where one of the advantages was the availability of parking.
Among the issues the existing hospital faces is that some areas such as the intensive care unit were already "under an ultimatum" from the college of intensive care medicine, gaining only temporary accreditation because of the limited facilities.
This could affect the hospital's status as a training organisation.
Recruitment could also become difficult when facilities were below par and this had already happened in the gastroenterology area.
Otago chief operating officer Vivian Blake said the board's collaboration with the University of Otago to develop a gastrointestinal disease centre of excellence had already sparked increased interest by prospective staff.
Mrs Blake said there was an "awful lot of work" to be done before the board could "venture to the bricks and mortar of it".
In its assessment of systems at Dunedin Hospital, the National Health Board recommended that the board complete facility planning and development for Dunedin Hospital in collaboration with the university and considering regional services by June next year.
