St. James's is a pilot site for the introduction of organisational change initiatives in the health service. In this context, the prime Clinical and Clinical Services at the Hospital have been organised into 10 Clinical Directorates. These Directorates are now the basic business blocks through which core services of the Hospital are planned and delivered
- This directorate specialises in Cardiology, Respiratory Medicine, Cardiothoracic Surgery, Palliative Care, Pharmacology and Therapeutics & Vascular Surgery.
- Diagnostic Imaging (X-Ray).
- This directorate comprises the Emergency Department, Emergency Observation Ward and Chest Pain Assessment Unit.
GEMS - This directorate specialises in Gastro Intestinal Medicine and Surgery, General Medicine including Hepatology, Renal Medicine, Urology and General Surgery.
HOPE - The directorate encompasses Haematology, Medical and Radiation Oncology, National Centre for Adult Bone Marrow Transplantation and the National Centre for Hereditary Coagulation Disorders.
- This directorate encompasses Histopathology, Haematology (including Molecular Diagnostics and Transfusion Medicine), Microbiology (including the MRSA and TB reference Laboratories), Immunology and Biochemistry including Endocrinology.
- This directorate specialises in Medicne for the Elderly.
ORIAN -This direcorate comprises Operating Rooms, General Intensive Care Unit, High Dependency Unit, Day Surgical Unit, Laser Unit, Endovascular Unit, Sterile Supplies Unit & Anaesthetics.
Omega - This directorate compriseses Plastic & Reconstructive Surgery, The Burns Unit, Maxillofacial Surgery, Orthodontic and Cleft Unit and Orthopaedic Surgery.
SAMS - This directorate specialises in Dermatolgy, Endocrinology, Genito-Urinary Medicine and Infectious Diseases (GUIDE), Gynaecology, Neurology, Opthalmology, Rheumatology, Clinical Neurophysiology and ENT.