Like any bold idea, the amalgamation of Albury Hospital and Wodonga Regional Health Service had its naysayers.
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There had never been a cross-border health service.
Syncing the legislation of different state governments and harmonising two organisations with individual identities seemed impossible to some when it was floated in the 1990s.
But come 1995, a ministerial taskforce was investigating and in July 2001, the first announcement was made by Victorian and NSW health ministers that a joint public health provision would be a reality.
It was aptly put in The Border Mail's editorial in 2003; "The amount of time taken to formalise the arrangements is a fair indication of just how complicated the situation is", but four years later patience was running out, amid the release of economist Stephen Duckett's report guiding the integration.
The departure of chief executive Andrew Watson from Wodonga after 14 years was reported as "disappointing but understandable".
Finally at the end of 2008 there was a date: July 1, 2009.
Rachael Andrew was working as nurse unit manager at Albury Hospital and her brother David was in the same role across the border.
"Even though there's a small geographical distance between the two hospitals, in a cultural sense they were quite different," she said.
"Albury Hospital was in NSW health and we'd been used to being governed from a distance, whereas Wodonga Hospital was very much a regional health service that had its own board of directors.
"I was managing the beds when the amalgamation happened.
"It was quite challenging ... but we were able to make it happen."
Nicki Melville was one of seven inaugural board directors in 2009 and said Professor Duckett's report was the final hurdle clearing two decades of planning by bureaucrats, clinicians and community leaders.
"The only way forward was to have one health service," she said.
"NSW would say 'Wagga's bigger than Albury so they get the growth', and Victoria would say, 'Shepparton's bigger than Wodonga', but we knew that together, we were the biggest regional centre between here and Sydney.
"The two states came together under the intergovernmental agreement.
"Our first chief executive was Stuart Spring - he came from the Royal North Shore Hospital - and our first chair was Ulf Ericson.
"Unfortunately Ulf's no longer with us, but he and Stuart were the architects in 2009."
Mr Ericson wrote in the first annual report that in light of "extraordinary and sometimes difficult" circumstances around that first year, the accomplishments were "truly inspirational".
The combined presentations to the two emergency wards was more than 61,000, and the obstetrics unit at Wodonga welcomed 1660 babies into the world.
While the dust was still settling on the amalgamation, work began in 2011 on another huge task: planning for a cancer centre.
An operating deficit of $1.1 million in 2010 blew out to nearly $4 million in 2012, as emergency presentations and the elective surgery wait-list continued to grow, and three mental health services were brought together under the AWH banner.
"The most difficult year" for management and budgeting came in 2013 when the board was asked by the Commonwealth to save $1 million in six months, a request later withdrawn.
Despite this the budget was brought a bit closer to the black.
The contributions of Mr Ericson and Dr Spring were recognised in 2014, when Lou Lieberman and Susan O'Neill took over as chairman and chief executive respectively.
The first "people matter" staff survey "highlighted the need to consult and involve staff on the major issues".
Two years later, Leigh McJames took hold of the reins from Ms O'Neill and the 2016 annual report outlined strong commitment within the AWH workforce to patient care, but also "an unacceptable level of bullying in some areas".
Improving that culture was a major priority alongside addressing the health service's financial position.
A major highlight was the Albury Wodonga Regional Cancer Centre opening in September 2016, and nine months later the NSW government announced $30 million for the Albury ED.
Mr Lieberman resigned from his position, and his work and that of his peers was reflected in improvements in the People Matter Survey results and Albury Wodonga Health returning its first positive financial outcome in the 2017-2018 year.
Albury-Wodonga Health is on track to achieving a break-even position again for the 2018-19 year, the second time in its history.
Ms Neville, who became the first chairwoman of the board in taking over the role from Mr Lieberman, said it was a credit to the staff.
"They're under pressure 24/7, yet they're still delivering on time and on budget," she said.
"With slowing down of the housing markets, the states are not getting as much revenue, so we're going to have a tough budget this year.
"That's on top of enormous growth - 6.6 per cent growth in all our ED presentations.
"We'll do everything we can to meet that growth; I can assure our community that what drives us is safety and quality of care for our staff and patients."
Monday will mark 10 years since the integrated Albury Wodonga Health became officially operational.
Compared to 2009, last year there were double the staff, 77 more beds and nearly 3000 additional emergency presentations.
But those numbers don't paint the picture of how much the service has grown.
Their six sites have grown to 17, delivering 80-plus clinical and allied health services such as dental and palliative care.
Across the decade, the Albury and Wodonga emergency departments have treated half a million patients.
Some of those people have been seen by David Andrew, who has been a registered nurse with AWH for 17 years.
Mr Andrew has seen his work at Wodonga's ED change, as more high acuity cases have gone to Borella Road and the Wodonga campus has taken on more sub-acute provision.
"When I first started we used to get all the emergency stuff, but now things like big heart attacks get sent over to Albury - it has changed in that sense," he said.
"We have a very strong team in Wodonga."
David and his siblings, Rachael and Debbie Andrew, represent the varied, integrated operation of Albury Wodonga Health as it is today.
Debbie is an RN in the day procedure unit, while Rachael's substantive role overseeing medicine and acute admitted services has been put aside temporarily as the executive team seeks a new chief executive.
"I've been really fortunate to work in lots of different roles; we've come a long way in 10 years," Ms Andrew said.
"One of the main achievements was getting people to see themselves as one health service."
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There's always room for improvement - a target set in 2016 to ensure patients are transferred from the ED to a mental health unit under eight hours remains relevant today, Ms Andrew said.
"It's definitely a priority for us, because we don't think it's good for any patient to spend an extended period of time in the ED and that's not what it's intended for," she said.
"We've already done quite a bit of capital works in both units to improve them, which is fantastic, and we've got two new nurse unit managers in Kerferd and Nolan House."
"There are three EDs feeding into out two inpatient units for mental health, so that's quite challenging."
Better mental health management remains a key priority for Ms Melville as well.
"Integration of mental health was a lot later than integration of the two hospitals. I'd be the first to admit we've still got some way to go," she said.
"We have 2500 amazing staff who put in every day, supported by over 300 volunteers, and this is the time to thank them."
Ms Melville and the board have this week been interviewing applicants to fill Leigh McJames' role, after he resigned as chief executive in April.
Interim chief executive Janet Chapman said looking to the next 10 years, Albury Wodonga Health would transform again.
"In July the cardiac cath lab is starting up intervention, but over time I expect people will be able to go there for an emergency response," she said.
"As we continue to grow, what we will see is more specialisation, research and services.
"In 10 years' time, we'll have maternity at the Albury campus and a brand new ED and intensive care unit.
"Albury Wodonga Health will achieve its potential as a significant regional health service."
- Read more in today's special 10th anniversary publication, inside Saturday's Border Mail, and in more coverage in Monday's paper.
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