Dozens of senior positions look set to be disestablished as the Southern District Health Board restructures to form a single service arm.
The "provider arm", the part of the board that delivers services, had a budget of about $327.3 million in 2010-11 and 3147 full-time equivalent (FTE) staff.
It is proposed scores of senior staff next month reapply for their jobs, with successful applicants announced in July, a document for staff feedback released by the board this week says.
Feedback could change the final structure, which would be announced on June 10.
Proposals include a single chief operating officer.
In Southland, the chief operating officer's role is at present combined with that of deputy chief executive officer.
The chief operating officer would live in Dunedin or Invercargill, and be required to have a presence at hospitals across the DHB.
A single chief medical officer, assisted by a deputy, is proposed, with one person based in Dunedin and the other in Invercargill. A third of the chief medical officer's time would be devoted to clinical work.
The position would be supported by a chief medical officer's assistant.
It is proposed the regional chief nursing and midwifery officer remain in place, with minor changes.
Eight clinical and service groupings in the Otago and Southland arms (four apiece) would become six "directorates".
Head staff would be trimmed from 28 to 18 by the switch to directorates.
Each directorate included a manager, medical director and nurse director, with a midwifery director in women's and children's health.
Under the proposal, positions would be offered to incumbents in certain circumstances, for example when the corresponding role in the other DHB was vacant, or when a new role was similar to an existing one.
Staff offered jobs which had changed significantly had the right to refuse redeployment.
Positions would, in the first instance, be advertised internally, with preference given to affected staff.
A wider review of the provider arm - including executive-level secretarial services and extending to individual wards and units - is expected after the top-level structure is in place in July.
Chief executive Brian Rousseau, in the document's preamble, says it is important the new provider arm structure is in place as soon as possible, to provide leadership and support.
"The Ministry of Health has also told DHBs not to increase the number of managers and administration staff so that funding can be targeted to frontline patient care."
The board could not rely on continuing deficit top-ups and had to cut costs.
Change would also improve services.
"We also face issues of clinical sustainability if we do not do things differently in our provider arm services."
The model of care driving the changes was the concept of "one service, many sites", Mr Rousseau said.
