In the Middle East it would be called “the point of the dagger,” the position 600 Eastern Maine Healthcare corporators find themselves in. First, to choose between two slates of eminently qualified nominees for directorships on the EMHC and Eastern Maine Medical Center boards. Second, to resolve the contention around whether EMHC of the future is best managed by a corporate or collaborative style, a case study right out of the Harvard Business Review. Third, there’s “the vision thing,” that is, where is it all going. To reach consensus on the vision thing is where it all should start. The rest will follow.

In 1981, my family moved to Anchorage, Alaska, where I was to head up an entrepreneurship center. Upon arrival I went to visit the head of the center’s advisory council, one Wally Hickel, former governor and secretary of the interior. Gov. Hickel walked to his window, looked out across Cook Inlet at Mount McKinley and mused, “You know, young man, if we built a tunnel under the Bering Straits we could run unit trains from London to New York.” Fresh from Bangor, I felt a rush and said to myself, “now that’s vision.” So, what should be EMHC’s vision thing?

Given our region’s demographics and fragmented economic base, EMHC is one of our few large-scale potential engines for economic growth. This isn’t to talk about more vertical, horizontal, and geographic diversification that seemingly will end up with EMHC getting the only certificate of need issued because EMHC is all we need. Nor is it to replace one quality slate of nominees for the board with another. No, to be a true engine for economic growth, EMHC would need to become a destination for people and dollars from away.

The challenge would be reframed as a question: “If an icy, isolated northern rural city not unlike Bangor can have a magnet hospital why can’t we.” That city, of course, is Rochester, Minn., the magnet, the Mayo Clinic. We might choose to be more like Hanover and Dartmouth Medical Center or whatever. But, what we as a community and state should most consider is, how can we leverage our EMHC asset of today into a spearhead for making Bangor a significant health care destination.

The agenda now changes. No longer is capturing local market share and all the associated conflicts of primary interest a focus. The challenge for physicians then becomes the rising bar of expectations not an issue of who holds the bar.

Serving on the Governor’s Blue Ribbon Commission on Maine Healthcare Costs, it became clear that Maine was not out of line in either hospital cost or physician cost effectiveness. Rather, the northern and eastern Maine dilemma is that young healthy people are leaving the state, the population is aging, income per capita is 30 percent below southern Maine and 50 percent below much of the northeastern United States. For the hospital and doctors to confront each other in this context is about as useful as for docs and hospitals to play “musical chairs on the Titanic” where their focus is on who gets the ever fewer chairs.

It seems the best solution for the dilemma of having two slates of nominees is for a few of the nominees to voluntarily withdraw their nominations. They would be held in high esteem and everyone would win. As for management style, while both the corporate/hierarchical and collaborative styles have merit, the Harvard Business Review notes that it is easier to evolve from a corporate to collaborative style then the other way around. That’s what Jack Welch did at General Electric and that’s what seems to be happening at EMHC. As for the vision, that issue alone should be on the point of the dagger.

William Beardsley is president of Husson College and a corporator of EMHC.