CIO Bradd Busick on Managing Entropy, Trust, and Culture in Health IT

MultiCare Health System’s technology leader reflects on leadership, burnout, and the hidden forces that drive organizational decay.

In an era where technology drives healthcare delivery, leaders like Bradd Busick, SVP and CIO at MultiCare Health System, are increasingly focused on less visible forces: organizational entropy, emotional debt, and the fragility of trust within complex IT environments. For Busick, entropy—a term borrowed from physics—serves as a metaphor for what happens when cultural disorder goes unchecked.

“Entropy in this world, particularly in healthcare IT, is the idea that most things without course correction will glide toward disorder,” Busick said. “And that is 100% true in our space.”

With a team of over 500 and oversight of 13 hospitals and 48 community providers across the Pacific Northwest, Busick approaches his CIO role as both strategist and steward—calibrating leadership, culture, and execution in real time.

Culture Decay and the Weight of Inaction

Busick’s concern with entropy began in an unlikely place: a Las Vegas vacation with his teenage son. After watching a Penn & Teller show that referenced the concept, Busick found himself reflecting on how entropy applies to health IT operations. That insight evolved into a blog post and sparked direct messages from CIOs around the country.

p style=”font-weight: 400;”>“The number of leaders who reached out privately, saying, ‘It’s like you’re reading our mail,’ was astounding,” he recalled. “No one wants to admit their culture is a disaster, but many know something’s off.”

Left unmanaged, Busick said, entropy manifests in organizational stagnation—siloed thinking, disengagement, unaddressed interpersonal conflicts, and high turnover. He emphasized the danger of leaders who avoid tough decisions and allow problems to fester.

He also draws parallels between institutional decay and technical debt—arguing that unresolved relational or emotional debt between colleagues is just as corrosive. Whether it’s a broken promise or a missed deliverable, those failures accumulate over time.

Busick urges leaders to actively monitor the relational dynamics within their teams, and not spare self-evaluation in the process. He recalled mapping emotional debt with a mentor at the Gates Foundation by quantifying the trust level across key relationships. The exercise was revelatory. “If you’ve got debt with a ton of people,” he said, “maybe the problem isn’t them. Maybe it’s you.”

Trust, Burnout, and Leadership Blind Spots

One of Busick’s more striking observations is that poor leadership behaviors—such as issuing arbitrary directives or allowing ambiguity in responsibilities—are often accepted as normal in IT departments. The result is not just confusion, but broken trust.

“When leaders don’t circle back after shifting priorities, they don’t just waste time—they damage credibility,” he said. “And when trust is broken, staff learn to wait for the third ask before they act. That’s wildly inefficient.” Busick said he knows people in other organizations who have developed rules for interpreting leader requests—waiting until the third time something is asked before acting on it, just to ensure the request is serious.

The link between entropy and burnout is, in Busick’s view, “wildly high.” He monitors not just attrition but also indicators like declining work quality, rising cynicism, and the prevalence of irony over authenticity in communication. “To me, sarcasm and irony are symptoms of burnout,” he said. “When those start to displace authenticity, you know something’s wrong.”

Preventing burnout, in his framework, means cultivating truth-telling across the organization. He described a rare and valuable relationship with his boss, now MultiCare’s president and former CIO, who frequently challenges him on whether he’s living his stated values.