Sometimes institutions become so much a part of a community that it’s hard to imagine the community without them. Around here, Grays Harbor Community Hospital is one of those.

But the existence of our hospital is no longer something we can take for granted. It could fold under the weight of a diminished local economy and a failed national health care system. It could simply go away. In the past seven years, about 70 rural hospitals have. A major study by the National Rural Health Association says nearly 700 more are threatened.

The stories are all pretty similar. There aren’t enough patients and most of them don’t have private insurance, meaning the patients they do get either don’t have insurance or have Medicare or Medicaid, which doesn’t reimburse the hospital enough to pay for the cost of service. Patients who have private insurance and the means to seek treatment out of town are prone to taking their money elsewhere.

And recruiting physicians to small towns is hard when they can make more money in the city.

Community Hospital lost more than $8 million last year and millions more in the years before that. That’s not sustainable. The hospital has reserves, but they won’t last and hospital’s that can’t pay their debts close. This one owes about $30 million to Key Bank.

Most of the blame gets directed at the hospital administration, in particular its CEO Tom Jensen.

Jensen seems to know his stuff about the business of running a hospital. About public relations and building trust in the community, not so much. He doesn’t seem to think that’s part of the job description, but if the hospital is going to overcome some of the negative public perceptions that is holding it back, it needs to be.

The hospital has a lot of naysayers. Whether they’re justified is hard to say and can really only be judged on a case by case basis.

Obviously, people sometimes have bad experiences at the hospital — long waits in the emergency room, screwed up bills or whatever the case may be. And sometimes the stakes are much higher, misdiagnosis or inadequate treatment.

Those are the stories that seem to stick and get repeated over and over and Jensen doesn’t put enough emphasis on changing those perceptions. In this day of social media and call-in radio shows, not battling for the sake of your reputation can be fatal.

Now, when the hospital needs all the friends it can get, it could use a few more.

Jensen is working with state legislators on a bill that would increase reimbursement payments for Medicaid patients, which make up an usually large part of the patient mix.

We all need to hope that plan works.

As usual, it will be hard to get the attention of urban lawmakers. We’ll need all six legislators in the 19th and 24th districts Kevin Van de Wege, Steve Tharinger, Mike Chapman, Dean Takko, Brian Blake and Jim Walsh, to be rowing in the same direction.

The hospital is about to introduce a new rebranding campaign and a name change to reflect its regional importance from Quinault to northern Pacific County and from the Ocean to McCleary. Naysayers will see it as a waste of money, but it’s a chance for the hospital to tell its story and create a new narrative.

And it’s the administration’s job to be front and center for that.