The failure to restructure senior positions at the Southern District Health Board has been described as a huge waste of time by a Public Service Association official.
Last week, the board backed down on a proposal to reduce the number of top managers, leaving separate Dunedin and Invercargill hierarchies in place.
Organiser Julie Morton said she could not see where a "double bureaucracy" could produce efficiencies or improve services.
The idea that staff from both Otago and Southland should work together to reach consensus would only mean more time taken with bureaucracy and meetings, with nothing achieved.
"There's no leadership; nobody carrying the can; nobody saying `right, this is what we need to do to make a particular service work across these two regions'.
"If you don't have a regional structure, how can you realign services to be regional services? It doesn't make any sense."
Her view is at odds with that of Ian Powell, executive director of the Association of Salaried Medical Specialists, who said the proposal had been too radical.
Senior doctors were pleased their concerns had been heeded, he said.
Mr Powell, who had previously described the original proposal as well-intentioned but like a "dog's breakfast", said the association had had some constructive discussions "below the radar" with chief executive Brian Rousseau on its issues.
The association had been particularly concerned about the clinical leadership structure which was not consistent with the approach to developing regional services.
The best configuration within each service was what was needed and this could vary from service to service across the region.
Working with the existing structure and adopting a more evolutionary approach was more likely to produce financially and clinically sustainable services, Mr Powell said.
The new board would still have plenty of challenges, because of the sheer size of the region and the distance between the two major hospitals.
The board received 167 submissions on the restructuring proposal from staff and some organisations.
While the submissions have not yet been released, a summary was included in Mr Rousseau's announcement to staff last week.
While there was support for the principles behind offering one service from many sites, there was little enthusiasm for the structure he proposed.
Evolution not revolution was supported, with many saying development should come from within the services.
Staff across the two areas had to have time to develop relationships.
Leading positions in the directorates were considered to be too large, particularly when travel was taken into account.
There was also concern that people would not be on the appropriate site to deal with issues as they arose.
Travel was a dominant theme, with some staff expressing concern the personal circumstances of some competent managers and clinical leaders would prevent them seeking senior positions if they had to travel too much.
New Zealand Nurses Organisation Otago organiser Lorraine Lobb said Mr Rousseau was "wise" to retain nursing expertise at each of the main hospitals.
Ms Lobb said NZNO's main concern was the proposed regional nursing directors whose expertise would be shared by both Dunedin and Southland.
Nursing already had an over-arching chief, regional chief nursing and midwifery officer Leanne Samuel, and that had worked well, supported by a deputy, Ms Lobb said.
However, it was the next tier down which caused concern.
Health Minister Tony Ryall declined to comment.
