Some of the Southern District Health Board's (SDHB) top staff may have to reapply for their jobs in a review of the board's new provider arm.
Two provider arms - the part of the board which provides services - are to be restructured after becoming a single entity under the new board.
The Otago and Southland boards merged on May 1 to form the new board.
The top-level review may see some staff reapplying for their jobs.
SDHB chief executive Brian Rousseau would not comment in detail until a consultation document was released on Monday for feedback.
He did not wish to pre-empt the review's outcome, but job losses were possible.
Cutting costs was one goal, but the changes should result in the most efficient way of providing services across the new DHB.
The aim was to deliver a single service at different sites, he said.
Mr Rousseau declined to put a figure on projected savings, or say exactly how many staff were affected.
It was a worrying time for staff at all levels of the provider arm, he said.
After the top-level review, a broader provider-arm review would start.
An email sent to hospital staff on Monday outlined what was under review:Retaining two CEOs or combining the role.
Retaining two chief medical officers or combining the role.
Whether the single regional chief nursing and midwifery officer role will continue.
Whether clinical leadership roles should involve seeing patients.
How many divisions, such as medicine and surgery, there should be.
Whether service managers can oversee two sites.
How staff will work together from different sites.
Association of Salaried Medical Specialists executive director Ian Powell, who attended a meeting about the review in Dunedin on Friday, described it as well-intentioned, with some good points raised, but a "dog's breakfast".
The review seemed to lack a sense of direction and a clear objective, he said.
The proposals risked putting the board's structure ahead of clinical relationships.
Having a single chief medical officer would concern Mr Powell as it seemed likely the incumbent would drop their clinical work.
Decision-making could be slower, and Dunedin and Southland hospitals would have less autonomy.
However, much would depend on how the role was set up and what support and powers of delegation it received.
In response, Mr Rousseau defended the review, saying change could not happen in a "vacuum", and needed a firm framework, which the review would provide.
He agreed it would be difficult for a single chief medical officer to operate across both regions.
Mr Rousseau said he personally found the travel involved in his role challenging, and staff needed support if their job encompassed both regions.
Public Service Association Dunedin organiser Julie Morton said she was satisfied the review was well run and sensible.
However, members were eyeing it with caution as a first step in the broader provider-arm review.
Health staff were anticipating cuts, but it was difficult to know where they would emerge as the board could not cut services, Ms Morton said.
New Zealand Nurses Organisation Otago Southland organiser Mike Yeats, who attended the meeting, was unavailable for comment.
The new structure is expected to be in place by the end of July.
