The department is taking part in a pilot project to reduce waste, increase efficiency and improve patient flow, using the lean thinking method used by car manufacturer Toyota.
Emergency specialist and clinician on the project team Dr Tim Kerruish said the project had the potential to begin transforming the hospital from dinosaur to dynamic, although the process could take about five years.
"We have great staff here. There is no reason why we couldn't be a world-class hospital that people would be proud to work in and the community could be proud of."
The idea behind the project is that by working together to lessen waste, which is anything which uses time or equipment without benefit to the patient, staff will have more time to spend with patients.
The plan is for the department to begin the process before it is introduced to the rest of the hospital.
The emergency department has been dogged by reports about short-staffing, overcrowding, staff turnover and staff bullying in recent times and Dr Kerruish readily admitted staff morale was low, in what could be a frustrating place to work.
It was the processes being used which were problematic, rather than the people.
People accepted the way things had been done for years and did not stop to ask "What are we doing, why do we do it and is there a better way?"As ways of treating patients changed, extra procedures were added, but nothing was ever taken away, in what he calls a layering process.
He hoped that by all staff working together to come up with solutions to problems which they had identified, frustration would be lessened and staff morale would go up.
Most importantly, patient care would be improved.
He did not accept that overcrowding was caused by patients coming to the department inappropriately.
It was a matter of getting patients to wards in a timely way.
Nationally the project, which is being trialled by 11 district health boards in a variety of hospital settings, is known as Optimising the Patient Journey, but Otago has decided to call it "Putting Our Patients First" combined with a Ghandi quote " Be the Change You Want to See".
Knowledge management and transfer consultant Darran Allen, who has been contracted by the Ministry of Health to advise district health boards on the project, said he expected the level of wastage in the department to be about 20%.
Mr Allen , who spoke to hospital staff this week, said at the Counties Manukau emergency department so much stock was being held that centralising it freed up four rooms.
Some items were almost 20 years past their use-by date and instruments no-one could identify a use for were found in bakelite cases.
Dr Kerruish would not be surprised to find similar items in the department's stock room.
The difficulty with over-stocking was that there was so much material staff spent much of their time "treasure hunting" trying to find things.
At Mr Allen's presentation, a staff member suggested the concept sounded like "packaging common sense and selling it back to us".
