Every organization is directly influenced by its external environment; to put it even more emphatically, nearly all large-scale change originates in the external environment. Current health-care reform in the United States, for example, is significantly altering the way hospitals and insurance companies operate. The entire industry is moving away from the “fee for service” model toward new “accountable care” models that bundle treatments, incentivize better health-care performance, and align provider risk and reward under the new laws.