Thermodynamics and Change Management

en·tro·py /ˈentrəpē/ (n.) Lack of order or predictability; gradual decline into disorder.

According to the Second Theory of Thermodynamics and the concept “Arrow of Time,” as one moves “forward” in time, the entropy of an isolated system — the combination of a subsystem under study and its surroundings — will increase. This means that over time disordered states are significantly more probable than ordered states. “Because there are so many more possible disordered states than ordered ones, a system will almost always be found either in the state of maximum disorder … or moving towards it.”

We in healthcare must accept that no outcome we reach will ever reflect perfection. We can work on perfecting operations for years, but those operations will never be without flaw. Nevertheless, it is essential that we work toward maximizing order in disorder. While efficiency does not equate with perfection, it is attainable through continuous improvement and daily monitoring. We must always look to improve on processes and never permanently settle on one process over another. Settling impliedly assumes constant, continuous order when order of this kind does not exist. If history teaches us one thing, it should be that maintaining the past at the expense of the future is extremely difficult, if not impossible. In health care we must accept changes. In doing so, we must identify ongoing tendencies toward disorder and use our efforts to make the present form of disorder the best for both the patient and employees. A sound understanding of managing through change is as important now as it will ever be. We must be open to new ideas. We must mitigate entropy by working alongside and with time’s ever-evolving ideals and standards.


Hospital Operations and My Love of Healthcare

I love healthcare. More specifically, though, I love hospital operations. Working in healthcare means that I go to work every morning looking to improve in someone’s life. No matter the role, the role of a healthcare worker positively affects the patient. The affect can be direct or attenuated, but from one-to-one care to the casual smile passing by, the smallest human interaction has to ability to transform a patient’s mood. As much as patients need hospitals, hospitals need patients. This is something that a hospital and its employees must always remember.

Transitioning from clinical to operational practice broadened my influence on the patient. As a clinician, my influence was limited primarily to the hands-on care I provided to the patient. It attached to the shift that I worked. When working nights, I influenced the patient at night. When working days, I influenced the patient during the day. While my influence periodically transferred to adjacently scheduled shifts, for the most part it stayed time-specific, focused on my time spent at the bedside. As an operational specialist, things are different. Most notably, I don’t work a shift like I did in the past. I no longer have that specific time of the day when I provide hands-on patient care. A large part of me misses this dedicated time. The corresponding trade-off associated with taking an administration role, however, is worth it. I now see patient care as it moves across the care continuum. I monitor day-to-day interactions between patients and practitioners; practitioners and administration; patients and administration. All of this provides an understanding and appreciation of health care unattainable from the clinician level. My new role gives me a new vision, and it is this new vision gives me the heightened ability to effect improvements in patient-hospital interactions.