The second-largest retailer in the world has no stores," Jim Hinton said last month, referring, of course, to Amazon, once a bookstore, now a purveyor of everything from cereal to snow tires. Then he asked, "Could we have a health care system with no hospitals?" A pause. "Probably not."

Hinton, the president and CEO of Presbyterian Healthcare Services and chairman of the AHA board of trustees, pointed out that hospitals most likely to succeed during this period of transformation are led by boards and executives who have been asking themselves hard questions like this one, as well as: Does our organization deserve to be in a narrow network? Are our patients getting a good value? If our organization closed or didn't exist, would it matter?

These questions could — and should — stop a board meeting in its tracks, which means they should be asked regularly. Let me add a few more to this list:

• Does our board have the right mix of skills and experience to serve and guide our hospital?

• Have we incorporated racial, ethnic, gender, age and socioeconomic diversity into the board and organizational leadership to the best of our ability?

• Would we send our parents, children or spouses here for care?

• Do we tolerate disruptive behavior from physicians because of their revenue-generating potential or their reputation in the field?

• Is every patient and family member treated with respect, regardless of race, ethnicity, age, sexual preference and ability to pay?

Tough questions should spark meaningful governance dialogue about the hospital's place in an increasingly value-oriented, ambulatory-centric care continuum. So, here's one more: Do they?