His comments came at the Otago District Health Board's monthly meeting on Thursday during discussion of a letter from Health Minister Tony Ryall advising that future funding track money (FFT), which makes adjustments to boards' funding to allow for overall price and wage increases, could be about 2% next year, or even lower.
Half a percent of this will also be withheld as an " efficiency adjustor" if boards do not meet efficiency requirements.
Regional chief financial officer Robert Mackway-Jones said the FFT prediction was "quite significant" given the board in its planning had forecast 3% (this year it is 3.1%) for each of the two years ahead.
It would mean $5 million less for the board in each of those years.
He pointed out that the board was still trying to reduce this year's deficit to $7 million as required by Mr Ryall and was expected to break even over three years, a point which had not been reached in the board's planning.
Board member Dr Malcolm Macpherson said the board could not save its way to success and needed to make sure it was not doing "bad, better".
Chief executive Brian Rousseau said there were several areas which needed to be looked at, including the way community health care was provided, how services could be moved from the hospital to the community, who held budgets and who was accountable.
There was, for instance, no direct link in the community between the person who wrote a prescription and the place the money came from.
There needed to be such relationships if the board was going to live within its means.
Mr Thomson, who chairs the hospital advisory committee, said work had started with a range of senior doctors, nursing staff, other health staff and management looking further at the lean thinking process trialled in the emergency department recently and how it might be more widely introduced.
The process, which is based on that used in Toyota vehicle manufacturing, encourages staff to identify waste in the system and find their own solutions to removing it.
Mr Thomson emphasised that it was early days in the process, which should not be rushed because the board needed the front-line staff to be involved and to work through the issues.
Historically, one of the issues which had got in the way of change was the difference between the way management and clinicians saw the budget.
Clinicians had tended to see the budget as the management's responsibility and theirs to treat the patients.
"If we can't reconcile those two statements, we can't go anywhere. If we can't get joint agreement around some shared principles, we're doomed," Mr Thomson said.
People needed to have time to think beyond day-to-day survival, which dictated the way things were done when working in a system.
