BENNINGTON -- Hospital systems need to change, and that will require a lot of talking amongst people who are not directly involved in health care.

That was one item that Tom Dee, president and chief executive officer of Southwestern Vermont Health Care, took away from a conversation held Wednesday at Bennington College that involved both locals and high-level state and national health care officials.

The meeting was attended by Richard J. Umbdenstock, president and CEO of the American Hospital Association, M. Beatrice Grause, president and CEO of the Vermont Association of Hospitals and Health Systems, and Dr. Harry Chen, the Vermont Commissioner of Health, among others, including Hoosick Falls, New York, Mayor David Borge and Jim Sullivan, director of the Bennington County Regional Commission.

The gathering was one of five being held across the county, said Umbdenstock. One was held in Colorado last week.

After the meetings are complete, the information will be distilled and sent out to members of the American Hospital Association, who will discuss it more. Where the talks will lead is unclear, but gone are the days when health care providers and those involved with the system can act alone.

"The thing I took out of this, was that hospitals across the country, especially here, need to be collaborative," said Dee. "We're looking to transform the system, and hospitals are looking to be a leader, but they have to be one voice of many."

Making those changes will involve "lots of talking," said Grause. There will be more meetings in different locations and involving many different people.

"In order to do something for the community, you have to work with the community," said David Meiselman, president of the SVHC Board of Trustees.

SVHC is the parent company of Southwestern Vermont Medical Center. Two years ago the hospital's doctors formed Dartmouth-Hitchcock Putnam Physicians and became employees of Dartmouth-Hitchcock, based in Lebanon, New Hampshire. This improved SVMC's ability to attract specialists and secured access to Dartmouth-Hitchcock's technical information.

"Leaving here today we have to think about what actions we would take to give power to the words," said Meiselman.

Dee said the changes that need to be made are the sorts of things that will happen over years, not a few months. In the past Dee has talked about hospitals moving away from the traditional fee-for-service model and toward something based off keeping people healthy and out of the hospital.

"All of the different health entities in the community are organized separately and paid separately, regulated separately, it's hard enough to figure out your own segment, and it's really easy to stay inside that segment," said Umbdenstock. "It's really hard to collaborate across segments, especially when a lot of us are hooked into public financing and there's pressure on that public financing."

Umbdenstock said that before his position at the American Hospital Association, he worked for a health care system and found that competing with other providers was often easier to manage than collaborating with them.

"You've got to get everybody to a collaborative state, and you've got to be willing to sit down and talk, and talk honestly about what investments are, and we've not been used to doing that," he said. "We've all had our own methods, we swam in our own swim lanes."

Making collaboration hard has been the fact that providers are usually competing for money, said Grause. "You're collaborating on producing change in the community, but you're actually competing for the dollars to do that," she said.

Chen said the move toward healthy communities will involve schools

"From Vermont's perspective, if we want to get Vermonters healthier, this is kind of conversation, and acting on it, is what we need to do," said Chen.

SVHC spokesman Kevin Robinson said during the three-hour meeting it was brought up that health care only accounts for about 10 percent of a person's health, the rest are social and environmental factors. "Essentially there's a very small piece of which the health system that (Dee) oversees, or that Dr. Chen oversees, can influence," he said. "So, how do we build a health system that begins to address the 90 percent that's outside of what we think about when we think about health care today?"

Dee said the hospital is required to complete a needs assessment on an annual basis, and this meeting may provide a model on how to do that better by bringing in other elements in the community.

Contact Keith Whitcomb Jr. at kwhitcomb@benningtonbanner.com or follow him on Twitter @KWhitcombjr.