It's always interesting when something moves from optional to essential, from the nice-to-have category to the must-have category. Mobile phones made this jump rather swiftly, and brought free ubiquitous WiFi with them. Armed with these new essentials, we wonder how we ever got along without them. In governance, the new necessity is the outside board member.

In a presentation on care systems of the future at the recent Center for Healthcare Governance Symposium, consultant Barry Bader asked attendees if their boards could find trustees with the necessary competencies, diversity and independence if recruitment is limited to their community. Those traits are non-negotiable as hospitals embrace value-driven care. An outside expert in quality, medicine or finance not only educates the board, he or she can bring a clear-eyed perspective on what's best for a community's health without the burdens of history or local connections. Board members who attended the groundbreaking of a facility or celebrated the first patient in a new service line may unconsciously refuse to read the writing on the wall while an outsider can raise tough questions about their viability.

"People fall in love with buildings and programs," noted Jim Hinton, CEO of Presbyterian Healthcare Services and AHA chair-elect, in a later session. Presbyterian's board has two members from outside of its home state of New Mexico, and he said that they are the most important drivers of the board's self-assessment.

It's fair to wonder how community members will accept the idea of an outsider's leading one of their most important assets, but the justification — that they are there to help keep health care local for generations to come — ought to be pretty persuasive.