Urgent improvements need to be made at Dunedin Hospital, where demoralised staff are struggling to provide safe services, following a damning review of the hospital's systems.

A National Health Board review says dedicated, committed and passionate staff are hampered by management and leadership structures, entrenched negative behaviours, and poor decision-making processes, the Otago Daily Times reported.

The assessment team said it was clear the "dedication of staff allows the hospital to function better than it should with these impediments".

Managers were unclear about their obligations and roles, and respond to issues in an ad-hoc, reactive, short-term and expensive way, it said, and it calls for the development and delivery of a properly aligned vision and strategy to support the health needs of the community across the whole board area.

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Southern District Health Board chairman Joe Butterfield and board chief executive Brian Rousseau refused to comment, saying they had only just received the report, but board member Richard Thomson said it was a "little unfair" the report did not acknowledge funding constraints.

The report does not address the board's funding issues, despite mentioning several times the effect of cost-cutting measures on services and behaviour.

It said a robust and well-understood patient safety and quality framework, and networks to ensure a safer hospital, should be put in place immediately.

It contains four broad recommendations and 45 specific actions, 26 of them to be completed by the end of this year, including a revamp of the board's overall management and clinical leadership structure.

The review team leader, National Health Board service improvement manager Jill Lane, said a steering group, led by an outside clinical leader, would oversee the recommendations over the next 18 months.

She said that if the hospital had continued as it was, it "wouldn't be a particularly happy place".

The organisation had the opportunity to use the report as a "launching pad for the future", she said.

Health Minister Tony Ryall said he was confident the board would address the problems.

- NZPA