The National Health Board has issued a highly critical report on the management of Dunedin Hospital.
In July this year, the Southern District Health Board admitted deep failures in patient systems and the standard of buildings.
The national agency has spent three months reviewing the hospital's systems after identifying problems with Emergency Department waiting times, inconsistent booking processes and access to colonoscopy procedures.
The report issued on Friday confirms major problems in these areas, saying they all stem from a disconnect between the board of the Southern DHB and the hospital's clinicians, and poor decision-making processes.
It says this means managers are unclear about their obligations and roles, and respond in ad-hoc, short-term and expensive ways.
The report says the full merger of the Otago and Southland DHBs must be completed urgently.
The Southern DHB says it will not comment for two weeks.