Central Maine Healthcare has been ailing for some time. The question is whether Jeff Brickman, the CEO hired two years ago to lead the financially troubled system to solvency and sustainability, is curing its problems or aggravating them.

It’s impossible for an outsider like myself to accurately assess the situation at CMHC, but the highly publicized rumblings against Brickman from present and former staff members call to mind the controversial career of the late Robert McNamara, executive and ultimately CEO at Ford Motor Company (1946-1960), U.S. Secretary of Defense during the Vietnam War (1961-1968), and president of the World Bank (1968-1981).

McNamara, a brilliant administrator in the realms of business, government and non-governmental organizations, became the most renowned practitioner of the management system known variously as “financial control,” “management control,” “statistical control,” and “control accounting.” Pioneered at E.I. du Pont and General Motors in the early 1900s, the system entailed the use of detailed financial reporting to enable managers perched atop the hierarchies of sprawling corporations to make decisions about cost-cutting, capital investment, operational spending and product selection.

Under this “rational” system, figures alone controlled decisions, and both access to the figures and the decision-making power that flowed from such access belonged to a very small group at the pinnacle of a bureaucratic pyramid, typically housed in an executive suite on the upper floors of a towering office building. The know-how, experience and opinions of line workers, foremen and low-level supervisors counted for little, if anything, in this calculus.

In her brilliant 1993 biography of McNamara, entitled “Promise and Power,” Deborah Shapley analyzed how McNamara’s obsession with management control led to both extraordinary successes and stunning failures.

McNamara was able to use his mastery of figures and forceful personality to steer vast, balky bureaucracies through a whirlwind of change. He rescued Ford from near certain financial collapse in the late 1940s and 1950s and introduced the compact car and safety features into the narrow-minded Detroit automotive culture. As Secretary of Defense, he modernized weapons procurement, eliminated wasteful inter-service rivalry, developed a credible system of nuclear deterrence, and built up the country’s conventional military capacity. As World Bank president, he converted it from a conservative, clubby institution into a powerful cutting-edge social force by lending for rural development projects in the world’s most impoverished countries.

Yet, McNamara’s overreliance on numerical data and arrogant refusal to listen to voices of caution and dissent from below led to some notable disasters — including the failure of the auto industry to focus on quality control, a prolonged, bloody stalemate in Vietnam, and the accumulation of crushing debt loads by Third-World countries.

Brickman, a seasoned hospital administrator with four decades of experience, certainly had his work cut out for him upon his arrival at CMHC. His immediate predecessors were empire builders, focused on beating local rival St. Mary’s Medical Center and attaining the top-tier status of Portland’s Maine Medical Center.

As a result, CMHC has become a behemoth, which, according to its website, now employs over 3,500 health care professionals and serves 400,000 people in the central, western and mid-coast regions of the state. The campus of Central Maine Medical Center in Lewiston, its flagship, has sprouted large new buildings and expansions of existing structures. It operates rural hospitals in Bridgton and Rumford, has acquired primary and specialty care practices in 15 communities, and has established cancer, cardiac care and trauma centers.

All this expansion spells high overhead. In the fast changing economic climate of health care — decreases in the number of patients covered by private insurance plans, static levels of reimbursement under MaineCare and Medicare, and the ever increasing costs of technology and services — revenues have not kept pace. As a result, CMHC is facing substantial red ink.

To bring down costs, Brickman hired outside consultants, scrapped plans for a sports medicine, physical-occupational therapy and weight management facility at Bates Mill 5, closed down an acute care clinic in Auburn, and discontinued a fitness and wellness center. He has also reportedly cut staff and shortened times for patient appointments, thereby increasing provider patient loads.

Though Brickman touts his “collaborative” approach to change, his critics claim his attitude towards staff is harsh, that he dictates, more than listens, to providers, and that he emphasizes quantity, rather than quality, of health care. The physician turnover rate at CMHC in the past year has reached 27.1 percent, and the medical staffs of all three of its hospitals have voted no confidence in the CEO. Reporting by the Sun Journal’s Lindsay Tice, published Aug. 12, detailed widespread dissatisfaction among CMHC employees with Brickman’s leadership.

Periodic organizational change, though necessary, is inevitably painful and anxiety- provoking for those caught up in it. The lesson learned from the career of Robert McNamara is that change, while usually initiated from the top, must, in order to be truly effective, occur in close partnership with those below.

Whether Brickman takes this lesson to heart will determine whether he can not only bring CMHC back from the brink but guide it towards a successful future.

Elliott Epstein is a trial lawyer with Andrucki & King in Lewiston. His Rearview Mirror column, which has appeared in the Sun Journal for 10 years, analyzes current events in an historical context. He is also the author of “Lucifer’s Child,” a book about the notorious 1984 child murder of Angela Palmer. He may be contacted at epsteinel@yahoo.com

Elliott Epstein

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