Working with Conway's Law

By: Eric Schulze

      In order to fully realize the benefit of process and risk management, we need to understand Conway’s Law to design better systems and processes.  ​If you were familiar with Conway’s Law, it might appear that healthcare is stuck in a viscous cycle, so how would we begin? 
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       If you are not familiar with this term, let’s first define Conway’s Law.   Melvin Edward Conway is a computer scientist, computer programmer, and hacker who coined what's now known as Conway’s Law: "Organizations which design systems are constrained to produce designs which are copies of the communication structures of these organizations." In other words, our communication structure of our hospital constrains our ability to design better systems and processes.  I would say the Conway’s Law is applicable to our profession of healthcare.
 
     Let’s unpack this concept to discuss.  Our communication structure conveys a lot about our organizational culture.  If information flows freely between all disciplines and levels in the hospital, we are more “aware” and likely working together diligently to meet our objectives, mission, vision, etc.  If our communication structure is one that does not effectively share information, etc., we see more siloes and, therefore, less cohesion.  More communication is more stewardship; we all realize that we have a common goal and we all work together to achieve that common goal.  If this open communication structure is institutionalized and part of our culture, we achieve optimal results.  The opposite is also true. 
 
     The constraints experienced by a poor communication structure prohibit a hospital from reaching peak efficiency, possibly even effectiveness.  Effective communication is the key to managing critical and complex healthcare processes.  Managing the interfaces or “hand-offs” in a process or between processes is likely the most difficult and often the most important step.   Wasn’t it about 15 years ago that TJC implemented a standard for the nursing/clinical “hand-off” process?
 
      If our communication structure is average, do we therefore design average processes? Robust communication structures actually affect more than just process and system design.  Walk through a hospital with an effective communication structure and you will find sustainable processes producing intended results by employees that are aware of how their specific job/task affect the bigger picture.  Hospitals are tough on change.  Historically, we survived our shifts by mastering “work arounds”.  Work arounds do not exist in a well-designed process; we trust the process and the process works.  It is reliable.
 
     The most difficult components to change are the culture and communication.   Enhance communication and you enhance awareness.  Enhance awareness and you have created a platform for culture change and innovation. Process reliability is ensured through a robust process design.  The benefits to your hospital and your patients will be realized when both components are achieved.