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.



James Shannon

Nursing Leader | Quality Leader | Healthcare Attorney

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