The "Putting the patient first" document from a governance group within the board pulled no punches about the lack of cohesion among services, the need for better facilities and the frustrating bottlenecks in the services.
It called for an integrated, patient-focused service where ongoing quality improvement was practised as a matter of course.
Asked about the response from staff so far, group chairwoman Otago chief operating officer Vivian Blake said there had been much support from staff, but some had been surprised by the openness, honesty and "frank nature" of the report.
Asked if there had been any feeling some in the governance group had been involved long enough to have already addressed some of the issues, Mrs Blake said some had said they would have liked to have seen a report like this years ago.
It set out clearly the restraints the hospital was working under, she said.
"One of the things I want to make very clear is that staff do a great job. Patients do, on the whole, receive good care, but what we are saying is that we do have a lot of waste in the system and we certainly can do things better."
The governance group would meet again at the end of this week to consider what process it would follow, but any changes would have to be aligned with the National Health Board review of hospital systems, which is not due out until next month.
In a memo to staff calling for feedback, Mrs Blake and one of the group's clinician members, Mike Hunter, said considerable investment needed to be made, particularly in Dunedin Hospital facilities and in staff in some areas.
However, this alone would not solve the problems faced.
Changes in processes were also needed, "although at present many of these are thwarted by lack of people or poor facilities".
They said they believed a clearly stated vision based on sound principles needed to be endorsed and supported by all staff, the executive and the board.
"It needs to say something that is substantial, that is ethical, that is relevant; and then it needs to be enacted."
Everyone from the board down had to be accountable to it.
"We believe we are on the threshold of a significant change of direction and emphasis in our hospital, and we need a strong sense of common purpose if this is to be successful."
Mrs Blake and Mr Hunter said they had been asked why Southland Hospital was not included, but the group considered that "we in Dunedin needed to get our own house in order first".
That was a "big enough chunk to bite off in the first instance".
This did not preclude the vision being extended across the board at a later time, but it would be presumptuous to assume this at this point, they said.
Largely, the focus would be on where most of the problems were - in the medical, surgical and emergency groups.
