"We're doing it this way because we've always done it this way" is a quick and bulletproof answer to many questions, whether it's how to hire a new CEO or how to cook the Thanksgiving turkey. It's comfortable and habit-forming and reminds people that they are but one very small part of a larger institution, community or holiday tradition.

The trouble is, "we've always done it this way" usually puts an end to the conversation. It shuts down creative ideas, radically different approaches and productive dissent. Get too comfortable in the cozy armchair of the tried and true and you might miss the scenery changing all around you. You might miss a growing problem, a fantastic opportunity or a promising leader.

This issue's cover story explores the value of out-of-towner board members. Whether they are recruited for a specific aspect of health care expertise or more general business acumen, these nonlocal trustees can bring a wealth of new perspectives to the board. They have the freedom to make tough decisions not because they don't care about the community but because they aren't compromised by the threat of repercussions in the form of business boycotts or bad press. Without the baggage of—or perhaps even knowledge of—the board's social hierarchy, they are more likely to question the trustee who considers herself infallible and challenge the senior executive who glosses over complex data. And while they may pull their own "we've always done it this way" out of their suitcase, chances are excellent it's different from your board's usual solutions.

"Getting experiences from other systems and markets is probably more valuable than it's ever been," Presbyterian Health Services CEO Jim Hinton says. I would add that getting experience from those outside the usual pool of trustee prospects—whether it's the chamber of commerce, country club or church—is essential, too.