There was very little point in developing an organisational plan, as recommended in the recent damning report, when gastroenterologists and gastro-intestinal surgeons were ''fighting with each other''.
Both groups had agreed to participate in a process that will begin next month, led by Counties Manukau colorectal surgeon Andrew Connolly, a former chairman of the Medical Council.
In an interview, Mr Fleming said the issues were deep-seated and not just between the surgeons and the gastroenterology department, but within the gastroenterology department.
These relationships needed to improve ''or, frankly, people may need to make decisions about what they want to do''.
He would not be drawn on how long he had given for this process, and conceded attempts to resolve issues in the past had been unsuccessful, but ''we can't be here in a year's time or two years' time with the same problems''.
Everyone he had spoken to about this was focused on improving care for patients and the community, but there would need to be some compromise.
''From what I've seen, compromise and change is required by them all.'' Although he did not like seeing the issues aired so widely and so publicly, ''if it leads to a better outcome overall, then it's the right thing to have happened''.
Now the issues were out in the open, ''if we don't follow through, then we're not doing our job''.
Dr Connolly supported the involvement of an organisation such as the Cognitive Institute to work within the gastroenterology department, Mr Fleming said. This had been recommended in the report into the concerns of Southland Hospital surgeons carried out by Christchurch clinicians, general surgeon Phil Bagshaw and gastroenterologist Steven Ding.
That report, as well as drawing attention to the work culture, said limiting access to colonoscopy had gone too far and had ''adverse consequences for patient care''.
Undue delay in diagnosis or treatment had occurred in 10 out of 20 cases reviewed.
Mr Fleming again rejected Mr Bagshaw's call for a public inquiry into the board's management of colorectal cancer - ''we don't need to have a public inquiry to know we've got problems in the service''.
Once teams were working together, that would be the time to develop an organisational plan that looked at least a decade ahead.
Asked if he was confident about the latest initiative working, Mr Fleming said he was confident it was going to take co-operation, compromise and change by gastroenterologists and surgeons to come up with a solution that worked for the broader community.
Mr Fleming conceded he did not have information about the numbers of patients general practitioners might have wanted to refer for colonoscopy but did not because they knew they would be knocked back.
He had no plans to go out and seek that information, but expected publicity might bring forth some concerns.
It would be worthwhile to get GPs, gastroenterologists and general surgeons ''in the same room'' to make sure ''we are getting the right referrals''.
Mr Fleming was reluctant to discuss the specifics of low colonoscopy rates and why the board went ahead with bowel screening last year when ministry figures showed it had under-delivered its expected colonoscopy volumes in the year to June 2018 by 653.
Questions posed to the board on this last month were transferred to the Ministry of Health, which has now sought to delay its response until August 29 for further unspecified consultation.
Mr Fleming said it was valid to ask why the board had not addressed historical issues sooner, but people who had benefited from the bowel screening programme would have a different outlook on it.
