The Southern District Health Board has made a public apology to patients who have waited too long for treatment and is pledging to do things better.
"We sincerely apologise to those whose wait for treatment has been too long, and acknowledge the impact this has on your lives," commissioners said in the apology published in the Otago Daily Times.
Poor funding and an ageing hospital in Dunedin were blamed, but some work practices need overhauling.
Earlier in the week, chief executive Chris Fleming addressed issues the DHB was drawing flack for in a blog post to staff.
He said some media reports were inaccurate. The DHB was doing good work and he urged staff to remain positive.
However, he did acknowledge a number of problems which were being worked on.
"Over years, this organisation has failed to take actions to address many significant issues and we now find ourselves in the position of having huge challenges," he said.
Surgical waiting times were variable between the former Otago and Southland DHB catchments and steps needed to be taken to address that.
The DHB was limited by the availability of theatre space and surgeons had also not necessarily been provided with adequate theatre time.
"This goes back over many years and I am at a loss to understand how this practice has been allowed to occur," Mr Fleming said.
There was no evidence to support the suggestion that patients are dying because their cardiac surgery was delayed by constraint in intensive care unit beds, he said.
However, delays for elective surgery had resulted in some patients needing to be treated acutely, which was unacceptable, he said.
The DHB was spending millions on a new high-dependency/intensive care unit, which would increase capacity.
It was also carrying out a review of its urology service.
"Processes and practices across the service are variable, and there is concern as to whether we have invested adequately in the service in recent years," Mr Fleming said.