Currently, the health care industry is in the midst of a structural revolution that is reshaping the financing and delivery of health services, driven largely by a shift in market power to external constituencies such as government agencies and large businesses. Thus, the emphasis on business skills is now centered on external surveillance and internal efficiency assessment along with strategy formation and planning. Even though external surveillance and internal assessment issues are becoming the predominant concern of health care administrators, the management tools utilized by these professionals have not kept pace. For instance, less than half of the hospitals currently using strategic planning conduct any form of environmental analysis, fewer than one in five do general consumer surveys, and only 27 percent include budget and resource allocation processes in their strategic planning practices.