She sought board advice on whether she should keep focusing on the volume of work done by staff, or increase staff leave.
Managing both was a "near impossibility".
The board, under new chairman Errol Millar, spent much of its almost three-hour public meeting session discussing financial matters.
He said the board, which has a forecast deficit of $12 million this financial year (some $2.6 million over budget), could not continue to be performing worse than budget and needed to work out how to do that.
Former chairman Richard Thomson asked what plans there were to reduce the amount of untaken annual leave.
If the board has large amounts of untaken leave over a long period, it can become expensive because as wages rise, the leave has to be paid at the higher rate.
Leave rates in some areas have been lower than would usually be expected because of short staffing.
Mrs Blake said some staff had 240 hours or more of leave owing.
Areas where there was no strategy for ensuring this was taken were being asked to come up with one.
There was a difficulty for senior medical officers running a two-person or single-person service to manage the work required in that service and still allow for annual leave.
Sometimes, leave was paid out rather than taken, but the board had to be careful about doing that.
In one service staffed by two senior medical officers, this had been done twice.
"The question is, is that really appropriate? Should we not be ensuring that person has their leave?"Being a good employer comes into it."
Mr Thomson said the board did not have enough information to respond to the request for direction from Mrs Blake.
Regional chief financial officer Robert Mackway-Jones said his forecast assumed leave was being taken at the same rate as it was earned, although that clearly was not happening.
Deputy chairwoman Susie Johnstone said the unpaid leave, even though it was "book entry stuff", had the potential to have a huge impact on the end-of-year result.
Board member Peter Barron said it was important elective surgery rates were maintained, so cases did not become acute.
In the current economic climate, a change in expectations about wage increases was also needed.
In the private sector, staff were being told they would be doing more for less, or they were not going to have jobs, he said.
Mr Mackway-Jones said the board's discretionary spending was limited to about 10% of its budget.
One of the areas where the board is looking to save money is in home-based support services, where costs exceed the budget by about $600,000 so far this year.
Regional planning and funding manager David Chrisp told the meeting needs assessors in Otago and Southland were reviewing their practices so more consistent decisions were made about allocating these services.
Concerns that the generic letter of expectations from Health Minister Tony Ryall did not take into account aspects of boards' performances which could be better than average were raised by several members.
Chief executive Brian Rousseau said the board already delivered about 11% more elective surgery, according to its population, than the national average, and staff had been talking to the Ministry of Health about setting appro-priate base rates nationally.
The board also had good cancer treatment waiting times.
Mr Thomson said while he had no difficulty with much of the letter, the minister needed to be clear rising costs were coming from growth in clinical areas, not from administration.
It was agreed a commentary on Mr Ryall's letter, outlining the board position on the various expectations, should be prepared.
The board, along with other South Island boards, expects to receive a share of some $8 million held by South Link Health, related to savings made by that organisation in the 1990s.
The accrued funds will be spent on priority health areas agreed by parties to the arrangement.
