Down East Community Hospital (DECH) in Machias is buzzing with activity these days, with an over $5 million emergency department expansion completed in 2017 and a recent Leapfrog award as one of the top 100 rural hospitals recognized for excellence. "It's huge," says DECH CEO Dennis Welsh. Three years ago the hospital's overall patient satisfaction rate was about 50%. It's now over 90%. "It's the culture change," explains DECH board Chair David Whitney. "You have to be excellent, and you have to be compassionate," with the hospital's culture of service and care.
     It wasn't always so. The culture shift took hard work. Just about exactly nine years ago, in 2009, DECH was placed in a court‑ordered receivership to Eastern Maine Healthcare Systems (EMHS) after the hospital's management team failed to meet corrective actions set out in a plan created by the Department of Health and Human Services (DHHS) on behalf of the Centers for Medicare and Medicaid Services. CEO Wayne Dodwell and Robin Popp, vice president of fundraising and marketing, were "separated from" the organization, and DECH's long‑term contract for management and other services with Quorum Health Resources was ended. Not only did the hospital need to meet the specific steps of the corrective action plan, but community trust needed to be rebuilt. As a part of the receivership process a new board of directors was selected by EMHS, and Whitney was one of those appointed.
     Whitney is in the last round of the maximum allowable third of three‑year terms. "Just before I came on board, we had a dismal reputation," he says. Turning the hospital around, creating transparency for and trust from the community and building a strong staff culture took concerted and sustained effort. For the first three or so years of Whitney's tenure the 15‑member board of directors was "extraordinarily involved with governance," he says. While normally that might be seen as micro-management, at the time it was necessary. Now, the board has pulled back to its more traditional function, with Welsh and senior leadership attending board meetings.
Welsh says, "We work very closely on strategy. It's always good to work with the board," because of the wide range of experience and skill sets represented in each director.
     Board members can take three years or so to become fully literate in the complexity of healthcare management finances. "They are very different from business finances," Whitney says. Every year the Maine Hospital Association holds educational sessions that board members are encouraged to attend. In addition, every board meeting has an educational component so that directors continue to develop their skills.
     Board members themselves bring a wide range of skill sets, a strategy that benefits the senior leadership staff team. "There is strength in having different areas," Whitney adds, and he lists board members as a retired CEO of a general practice, an insurance expert, a retired DECH CEO, attorneys, two practicing physicians, retired physicians, a retired nuclear submarine commander, business people and an information technology expert. Not every board member resides in Washington County. While that's the preference, sometimes looking beyond the border is necessary.
     Whitney and the board he works with have no experience working with Quorum Health Services, which provides management and other services to Calais Regional Hospital (CRH) and had provided services to DECH for many years prior to 2009. "None of us were here," during that time, he explains. When the new board of directors was formed in 2009, it was their responsibility to hire the CEO and management team. With the help of EMHS they did so and haven't looked back since.
     Another benefit of Quorum's services is bulk purchasing power, but Welsh explains that DECH has a bulk purchasing arrangement through its relationship with EMHS. He also is responsible for hiring the senior leadership team, although the board is consulted.
     The CEO has been noticing a welcome trend. "It's always a challenge in rural areas" to find staff to fill about 350 positions, including some 20 physicians. DECH's high quality scores and recognition have begun to garner interest from healthcare practitioners looking for the rural quality of life that the Downeast region offers. Welsh is such a person himself, having spent most of his 30‑year professional life in Philadelphia. Now starting his fourth year with DECH, he says, "I love it here. I love the lifestyle."
     Welsh is thrilled to point to an ear, nose and throat specialist who will be adding to the hospital's services with one or two visits per month. As a specialist based in Connecticut who loves Maine, it's a win for everyone. "We could never support this full‑time, so this works well," Welsh says. The senior team is constantly assessing how to fill the "gaps and holes," and their ability to do so is because of the change in the hospital's culture, he adds.
     The hospital's culture has "far exceeded our expectations," says Whitney. But resting on laurels is not an option. Continuously assessing the hospital's existing services, expanding them in a fiscally responsible manner and attracting patients are all part of the day's work. Employees work together on their engagement and satisfaction and on the hospital's mission and core values during "State of the Hospital" events, with half of the event dedicated to questions and answers. The mission evolves over the years, "but it's what you do to support the mission," Whitney posits, that polishes the culture. "We live it every day" with the work being done, he adds.
     DECH's affiliation with EMHS and its range of partners allows the hospital's staff to access services that would otherwise be prohibitive if not impossible to support at a rural location. Through Eastern Maine Medical Center, patients can access Northeast Cardiology's services. Behavioral health needs are met with Acadia Hospital in Bangor. DECH has begun a collaboration with Cancer Care of Maine for an infusion clinic for anemia management and some other services. Welsh says, "We're at the beginning of the relationship. We're talking about cancer care services in the future."
     DECH has also partnered with CRH to provide some obstetrics and gynecology services at the Calais location. Welsh and Whitney strongly believe that the health of CRH is important both to Calais and to the county. "There's a place in Washington County for two hospitals," Welsh adds.
     Of DECH's relationship with the EMHS partners, "There's a lot of expertise there that a small hospital wouldn't have otherwise," Welsh explains. "It's a collegial relationship. We're all people trying to help others."