Black swans are making headlines again (and no, I'm not referring to movies about paranoid, emaciated ballerinas). The term, coined by Nassim Nicholas Taleb and more recently referenced in Strategy+Business magazine, refers to a "high-magnitude, low-frequency" event, the kind that can't be predicted because its very existence is outside normal expectations. The 9/11 attacks, the March earthquake in Japan and the current drug shortage are considered black swans.

Reform is not a black swan, however stressful and impactful it may feel. We may not have predicted every aspect of the legislation and its ramifications, but we were well aware that the current model was not sustainable, that cost, quality and access were on a collision course unless something major changed.

In this issue's cover story on strategic planning under the pressure of reform, consultant Larry Walker acknowledges the temptation to hold off on preparing for a to-be-determined future. "But I don't think that is the right way to go," he notes. So how can boards get ready for this known unknown? Our experts advise redoubling efforts to understand payment, physician alignment and quality to enable quicker decision-making.

But don't forget about the black swans. They, too, have a place in the strategic plan. Amid discussions of declining reimbursement, physician employment and accountable care organizations, don't lose sight of elements that are essential in any event, be it a black swan or bundled payment: excellent leaders, dedicated clinicians and staff, adequate supplies and a value-driven culture. If that big dark bird lands on your doorstep, your organization will be as prepared as it is possible to be.