Responding to comments by Association of Medical Specialists executive director Ian Powell, suggesting management had been in denial about the issue of lengthy stays in the department, Mr Rousseau said there was a willingness of management and other clinical leaders to listen to and work with the department to improve the situation.
What was now required was for ED leadership to "engage in the process and be open to exploring all possible solutions".
He did not accept that management was in denial , saying that Mr Powell had been kept aware of the work being done to try to improve the situation. Emergency Department clinical leader Dr John Chambers has said he supports all the ongoing project work under way at Dunedin Hospital using "lean thinking" to analyse processes and streamline work practices.
However , he did not believe the department would make adequate progress until there was a multimillion-dollar investment, involving both physical redevelopment and extra staff.
Mr Rousseau, in turn, has made it clear that the board, with its district annual plan showing a $14.9 million deficit still not approved by Health Minister Tony Ryall, is in no position to make a special case for the department.
"Solving this problem requires leadership, both clinical and management."
While it might also require investment, that was a last resort in "this constrained environment".
It could not be the first solution because "if we were to take that approach, we would need to take the money away from some other clinical area and that will have consequences".
He released an email from chief operating officer (Otago) Vivian Blake, dated September 27, sent following a meeting of senior clinicians and managers ( including Dr Chambers ), to identify some of the short- and medium-term issues which needed to be dealt with to support shorter stays in the department.
The Government's health targets require that 95% of patients spend no longer than six hours in the department before they are either discharged or transferred to a hospital ward.
The quarter to the end of June showed that Dunedin Hospital had the poorest results for this in the country with just under three-quarters of patients meeting the target.
Mrs Blake's email showed that a high-level group was being established to oversee possible improvements.
Seven areas of work had been identified and leaders found for them.
These included work on the accuracy and sharing of data, consideration of the effectiveness of the ED consultants' roster ( to be led by Dr Chambers), looking at nursing resources required at night, how the proposal for a specialist medical admitting registrar would work and " after hours" patient management.
Those leading the various areas of work were expected to co-opt and consult other staff, report on progress and seek advice on matters of significant impact or importance.
