The Southern District Health Board proposes establishing a "director of patient services", instead of two chief operating officers.
Designed to put decision-making on a regional basis, a proposal to restructure the executive management team is out for staff consultation.
The patient services director would also be deputy chief executive.
Deputy patient services directors would be based in Southland and Otago.
The other big change was a single chief medical officer (CMO), with deputies in Invercargill and Dunedin.
At present, Dunedin and Invercargill had their own CMOs.
At 0.8 full-time equivalent, the new CMO was bigger than in other DHBs, and would be reviewed after two years.
The deputy CMO roles would be 0.3 full-time in Invercargill, and 0.4 full-time in Dunedin.
The chief nursing and midwifery officer, which was already an Otago-Southland role, would take on responsibility for patient safety, quality, and improvement.
A new finance role, "director of finance and funding", would be more "strategic" in outlook than the present finance and funding general manager.
To assist the finance director, a "planning and contracting general manager" was proposed.
The proposal reshuffles some other roles, with job title and reporting-line changes.
In her preamble, chief executive Carole Heatly said the current set-up "perpetuates the perception, functioning, and culture of two separate DHBs, and contributes to cumbersome decision-making processes".
Association of Salaried Medical Specialists executive director Ian Powell said the proposed set-up would work if it was properly resourced, concern over which was why the union fiercely resisted similar changes in 2010.
He had yet to consider fully Ms Heatly's proposal, but it seemed "well intentioned".
"The test will be on where decision-making will rest, and the resourcing of decision-making."
Ms Heatly seemed to have a "good head on her shoulders", and had learned from the mistakes of her predecessor, Brian Rousseau.
The DHB's vast geographical size remained an issue, about which there now seemed greater understanding.
"If there were still two DHBs now, I don't believe they'd be looking for a merger," Mr Powell said.
Submissions close on May 14.
The proposal is expected to be followed by other changes to create a functioning single DHB structure.
