The recent announcement by Dartmouth Health regarding the elimination of employee positions and the cancelation of hundreds of vacant positions has left many people in the Upper Valley asking difficult questions.
The issue is not simply whether a large healthcare organization facing financial difficulties has the right to reduce its workforce. Sometimes difficult financial decisions may be necessary. The deeper concern is how those decisions are made and — most importantly — how the people affected are treated.
When employees are suddenly told that their positions have been eliminated, with little or no warning, the impact goes far beyond a number on a spreadsheet. These are people with families, mortgages or rents to pay, responsibilities, and years of service to an institution they believed was part of their community.
There is a human being behind every position that is eliminated.
This raises a very important question: Could this process have been handled with greater transparency, communication, compassion and respect for the people whose lives were being affected?
Dartmouth Health is not simply another corporation. Its history is deeply connected to the Upper Valley. Mary Hitchcock Memorial Hospital began in Hanover in 1893. In 1991, the hospital moved to its current Lebanon campus, and over the years Dartmouth Health has continued to grow, bringing together hospitals, clinics, and healthcare organizations throughout New Hampshire and Vermont.
That expansion has provided important medical services to communities that depend on them. The growth of Dartmouth Health has also transformed it into one of the largest and most influential healthcare systems in the region.
But with growth comes responsibility.
Dartmouth Health has recently reported a significant financial deficit. The organization has explained that increasing operating costs — including labor, medications, supplies, and other expenses — have contributed to the situation.
Those numbers deserve serious consideration. But so does another question:
Has the rapid growth and expansion of the system created financial and operational pressures that now require employees and local communities to bear the consequences?
If an organization expands because it expects that greater size, integration, and patient volume will strengthen its financial position, the community deserves to understand what happened when the financial reality did not develop as expected.
This is especially important in the Upper Valley, where we already face serious challenges involving housing, the cost of rent, wages and the ability to retain essential workers. Many people who work in healthcare and other critical services struggle to find affordable housing close to their jobs. When people lose employment suddenly, the consequences can affect entire families and communities.
That is why the manner in which these reductions were carried out matters. Did management consider the individual employees and the contributions those employees had made over many years? On what information did they make their decisions? What criteria were used and how were individual positions and departments evaluated?
Were the employees who were affected given an opportunity to explain the importance of their work? Were alternative solutions considered? Were the long-term consequences for patients, employees and the community fully examined?
These are not unreasonable questions. They are questions of accountability and transparency.
A hospital is ultimately made up of people. Doctors, nurses, technicians, therapists, administrative staff, environmental-services workers, food-service workers, maintenance employees, researchers and many others are the people who make healthcare possible.
Patients do not experience a hospital as a financial statement. They experience it through the people who care for them.
Dartmouth Health has been an important part of this community for more than a century. With that position comes a responsibility that extends beyond financial sustainability. It includes responsibility to the employees who have dedicated years of their lives to the institution, to the patients who depend upon it, and to the communities that have supported its growth.
Financial sustainability is important. But so are transparency, accountability, communication, compassion, and human dignity.
I am speaking out because I believe Dartmouth Health belongs to the community it serves— not only as an institution, but as a neighbor and a major employer.
The people affected by these decisions deserve more than a notification. They deserve to be treated with dignity and respect.
And the community deserves an honest conversation about how Dartmouth Health reached this point and where it intends to go from here.
The question should not simply be:
“How do we reduce costs?”
We should also be asking:
“How do we build a healthcare system that is financially sustainable without losing sight of the people and communities it was created to serve?”
That is a conversation that deserves to happen openly, respectfully and honestly.
Esperanza Martinez lives in Lebanon.