With last week's departure of chief executive Joseph Stewart, the landscape at Butler Memorial Hospital has changed. But more change will be necessary to restore relations between the community and the hospital as its leaders move toward a $150 million investment for which they will probably come to the community for financial support.

Relations between the hospital and the community have deteriorated in recent years, beginning with the attempt by the hospital in late 2003 and early 2004 to buy land, known as the Robinson Property, for a new hospital. The half-dozen public meetings held across the county at that time gave voice to many questions, challenges and objections to early plans for a new hospital.

The challenging questions and pockets of opposition no doubt made some hospital board members and administrators uncomfortable, but it was appropriate to involve the community. However, once those public meetings ended, communication between the hospital and the community was reduced to sporadic press releases and subsequent hospital planning was mostly shrouded in secrecy.

Mutltiple studies were conducted by different consultants, but little information was shared with the public, leaving rumors to fill the information void. An adversarial attitude developed and soon the hospital was at the heart of an us-versus- them situation.

It is that lack of open communication with the public, more than anything else, that needs to change as the board of trustees and hospitaladministrators move forward with plans for either a totally new hospital or a major renovation project at the existing location.

A community hospital is a unique institution in terms of the public's sense of ownership — and open communication, transparency and good stewardship are essential to maintain that special relationship.

If the public will be asked to contribute, as it has been in the past, it is reasonable for the public to know more about the hospital's administration than it now knows. People contributing to a major new project should have confidence that the hospital has been spending or will be spending money prudently.

The law regulating the hospital is outlined in the state's Nonprofit Corporation Act of 1988, but when it comes to communicating with the public and transparency of operations, a community hospital ought to go beyond the minimum that the law requires.

The required single public board meeting each year and the annual filing of a Form 990 with the U.S. Treasury are not enough.

The public would applaud a move by the board to open its regular board meetings to the public. Media representatives should be allowed to attend, as well as a limited number of members of the public. Questions or comments would have to be limited so meetings could be conducted efficiently. But, one way or another, it is important for more sunlight to shine on the workings of the hospital and its board of trustees.

The bylaws of the board of trustees might also be a topic for public discussion and board review — especially regarding the status of term limits and the potential for conflict of interest that can exist between doctors who are financially connected with the hospital and also serve on the board of trustees.

Clearly, doctors provide invaluable expertise to the board of trustees, but that expertise could be provided through an advisory committee rather than by way of voting seats on the board. Having a reserved seat on the board for the president of the medical staff of the hospital, and possibly one other medical professional, seems an adequate level of medical representation on the board.

It is important that the board of trustees include a range of people from the community who will provide expertise in terms of finance, management and, perhaps, commercial construction. The hospital board needs strong leadership, but it also needs an atmosphere in which tough questions and open debate are expected, even encouraged.

An atmosphere that permits open discussion and debate is one that promotes well-thought-out and defensible decisions. If that atmosphere is developing on the board now, that will be a positive development.

Two different camps in the community have been at loggerheads over the decision to either build a new hospital complex on a greenfield site or opt for a major renovation with some new construction at the current location. Stewart's departure does not change the options facing the board, but it does change some of the dynamics.

Such a major investment by the hospital is important to this community — and the project has a greater probability of success if it moves forward with broad community support.

By making some changes, the board of trustees can go a long way toward rebuilding the frayed relationship between the hospital and public. Allowing more sunshine and transparency into the operations of the board and hospital administration is a good place to start.

And for something as important as a community hospital making a $150 million investment, that's just what is needed at this time — a new start. Now is the time to begin the process — and the current board of trustees, along with acting president and CEO Ken DeFurio, is in a position to initiate changes to improve community-hospital relations.

Butler Memorial is a good hospital; the vast majority of people praise the care they receive there. More transparency from the board and administration will help make a good hospital even better.