More than 100 people standing on one corner in Machias, demanding the community have a greater role in Down East Community Hospital, while 40 hospital staff and board members stand on the opposite corner in a counter protest, is not a symptom of a healthy relationship. But that is where the greater Machias area and its hospital find themselves. The most effective balm for such a wounded relationship is communication.

In many communities larger than Machias, the local hospital has either been absorbed by a larger, regional institution, or it hangs on as little more than a trauma clinic. We can be thankful Maine’s rural hospitals have largely avoided those fates. But it often comes at a price.

In Machias, Down East Community Hospital, facing dire financial straits in 2002, brought in Quorum Health Services, a national health care management group to manage the facility back to black ink. Quorum succeeded, but many physicians, nurses, staff and the community itself are left believing the cure was worse than the disease.

Quorum contracts with about 160 hospitals nationwide, including six in Maine. Typically, it provides a CEO and CFO to a struggling hospital. The executives are on Quorum’s payroll, but answer to the local board of trustees. In the Machias hospital, Quorum sent in Wayne Dodwell to serve as the hospital’s president and CEO.

In addition to the on-site managers, Quorum provides group purchasing of supplies, training and consulting services.

The problems at DECH may have been ignited by the removal of some long-time medical staff. But it may also be that the inevitable – and necessary – changes that came with Quorum’s management were implemented in a heavy-handed manner, with little understanding for and sensitivity to how change is managed in a small, insular community.

Hospital CEOs must have an open door policy with staff and community leaders, and they must have a finger on the pulse of both, a hospital administrator in another Maine town said. Grumbling, whether justified or not, often can be headed off with communicative leadership and an approach that assures people that their concerns at least have been heard.

Another essential component to a healthy hospital, the administrator said, is a strong board of trustees. The board must be perceived as independent and responsive to community concerns, and not afraid of using a firm hand to steer the outside CEO in a different direction when needed.

The situation at DECH has deteriorated so far that a Citizens Challenging DECH group has formed to demand changes. Dr. James Whalen, with whom DECH cut ties recently, suggested the two sides submit to six months of mediation. A more practical cure would be to have the citizen group nominate five people to serve on a community advisory committee, which could then meet with trustees to discuss concerns.

Much of the bad blood will not be able to be aired in public, prevented by privacy laws on personnel matters. But some resolution should be possible, if trustees are committed to taking the good fiscal management that Quorum has provided while also seeing where it has failed to win community goodwill.