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Led by the University of Otago's Centre for Health Systems in Dunedin, the national survey released in Wellington on Thursday is believed to be the largest carried out in the health sector.
Southern was ranked 49% for ''clinical governance'' behind other low-ranked boards, Whanganui, Bay of Plenty and West Coast.
Best-performing were North Island boards Counties Manukau (highest-ranked, 65%), Wairarapa, Tairawhiti (Gisborne), Hawkes Bay, Northland, and Taranaki.
Southern health workers were least likely to say they involved patients and families in care; least likely to say their DHB supported clinical leadership; least likely to agree the DHB had established partnerships between managers and clinicians. Speaking at the national survey's release, Health Minister Tony Ryall said the Government had directed boards to restore clinical staff to positions of influence.
''Cast your mind back four years, and there was significant disengagement between clinicians and managers. You read it in the newspapers almost every day.''
Commissioned by the National Health Board (NHB) and the Health Quality and Safety Commission, the project gauged progress since the In Good Hands clinical leadership report of 2009.
There had been progress, but more work was needed, Mr Ryall said.
Association of Salaried Medical Specialists executive director Ian Powell was disappointed, but not surprised, to see the southern board ranked lowest.
Significant changes called for in last year's systems review of Dunedin Hospital had not eventuated, he said.
The board placed its faith in restructuring to effect a change in culture, which had not worked.
''There's a big disconnect,'' Mr Powell said.
Southern board chief medical officer Dr David Tulloch said in a statement recent restructuring to merge Dunedin and Invercargill clinical departments increased clinicians' influence.
A new decision-making model put them on an equal footing with managers, and ''once they are properly in place, I would expect a vastly improved response''.
NHB national director Chai Chuah said boards had made considerable progress developing clinical leadership: ''DHBs need to accelerate and increase these activities. The challenges of the health sector can be met as clinicians are fully engaged, lead changes, and provide clinical governance over the triple aims of quality, access, and remaining within existing resources.''
The survey drew 10,303 responses - a 25% response rate. The survey targeted doctors, nurses, midwives and allied health workers.
The quakes-affected Canterbury DHB was left out.