Why Lean Programs Don’t Work

While reading a Knowledge@Wharton article on the subject of why employee wellness programs don’t work, I found myself thinking about why lean programs don’t always seem to work. Management professor Iwan Barnakay found, “Wellness programs have become a $50 billion industry, but companies aren’t getting much bang for the buck.” The article cites research that more than 80% of large employers have a wellness program and offer free health screenings and other incentives, yet these attempts at employee behavior change don’t seem to work.

We bring a good idea to intelligent, reasonable, well-meaning people with whom we share broad goals. And yet somehow they fail to adopt proven practices that are for their own benefit. Where have we heard this before? What the article does well is illustrate the importance of getting to the “why” of non-engagement with wellness programs.

How to Be Lean

The way to be lean is to limit inputs and keep it moving. This is the same for building a fit management system and for achieving human health and wellness. In lean, we call it flow. In wellness, we call it diet and exercise. It’s not complicated. Costs must be lower than revenues. Calories consumed must be equal to or less than calories burned. But it can’t be that simple. Clearly, there is more to it than this.

Another thing that bodies have in common with our business operations is that they deteriorate over time, in the normal course of their use. Entropy is a fact, natural deterioration can’t be avoided. But most of us are guilty of something called forced deterioration, in which we accelerate the process by abusing our bodies with substandard inputs, excess burdens, or exposure to harsh environments.

Listening to Our Machines

“What we need to do is listen to our employees. We have to talk to them to understand what their barriers are to start engaging,” Barankay says. As part of the lean practice of TPM, or Total Productive Maintenance, we listen to our machines. This is both literal and figurative. During the initial cleaning step of Autonomous Maintenance, we not only listen to our machines, we see, feel and even smell them, in order to detect abnormal conditions. During later Planned Maintenance activities, we use predictive maintenance technologies to monitor equipment vital signs, detecting signs of wear that signal an oncoming failure event.

An advantage of flow-oriented lean, whether it be manual work or information flow, is that it’s relatively easy to get started without asking technical questions about the physics and chemistry of specific machine functions. However, this is also a weakness. We can see that in asset-oriented lean, when we ask machines the right questions, they give us answers. When the researchers in the article asked people, “What’s preventing you from using the wellness benefits?” such as going to the gym or health screenings, they learned a few interesting things.

For Wellness or for Lean, Start with Stabilization

First, it’s easier to flow when the equipment isn’t broken down. This may seem obvious, but it’s a point missed by many and the cause of lean program failures. We batch to hide unreliable equipment, poor quality, lack of cross-training, material shortages, or other problems. On the one hand, flow exposes them and allows us to address these problems. On the other hand, when these support systems are thoroughly broken, attempting to flow results in things shutting down.

When a process is capable of flowing, lean is easy. It’s just a matter of some initial math, redesign, and continuous improvement. This is in part what’s happening with wellness programs, according to Barankay, the employees who benefit the most from wellness programs are the ones who are already healthy. They exercise regularly and see a doctor, so getting a voucher for the gym just rewards them for what they are doing anyway. 

When we have the energy to exercise, the time and inclination to prepare healthy meals, and a lack of worries eroding our sleep, it’s easy to go to the gym or take advantage of other wellness perks. If we’re experiencing forced deterioration, no amount of encouragement to “keep it moving” will help, until we remove some burden and create stability and space to improve.

What if it’s None of Our Business?

There are many reasons lean programs don’t work. On the whole, it’s because we were unable to face up to and do something necessary but difficult to make it work. Some people don’t like the math. Others fear public speaking. There are people who are intimidated by the terminology. Working with machines can be intimidating. So can working with people. Others are comfortable with all of this, but simply not with doing things in a way different than how they’ve always done it.

Machines are complex. When we listen to machines, it’s necessary to know their language. But learning how machines work, the names of components, systems, and interactions is easy relative to understanding people. People’s lives are far more complicated. According to the article, “When you are poor in America, when you have comorbidities, this is such a big cognitive burden that the idea of adding more routines is really, really difficult.” If our lives are burdened or unstable, it’s that much harder to get well.

Unlike listening to machines, getting into the details of people’s lives can be intimidating. It requires getting into people’s health conditions, what they eat and drink, how they live at home, their genetic inheritance, and what all of this means for health. Much of it is none of our business. And yet it seems employers need to understand that there are these common failure modes for non-engagement with wellness programs. If they want bang for the buck, at least part of the incentive should be not of the “keep if flowing” type but of the “let’s see if there are some stressors we can remove” to stop the forced deterioration.

Respect for Humanity

What I took from the article is that employers serious about wellness programs need to meet people where they are and offer them solutions they can use, even if doesn’t look like a typical program. A person may be able to improve their health and wellness not through a free gym membership, but because an employer gives a person options to use time in a way that removes a burden known to them. Likewise, a particular solution, tool, or practice pattern in a “lean program” may not be at all what an organization needs to be more productive. In fact, requiring people to sit in a training class and take on yet another goal often has the opposite of the intended effect. Limit inputs and keep it moving.

But there is a more common, even universal principle, that ties successful wellness programs and lean programs. In lean thinking terms we call it respect for humanity, or respect for people. Humans aren’t machines, but if we learn to pay attention to the signs of forced deterioration in ourselves and others, we can find earlier, smaller interventions closer to the root cause. If we asked people, some of them would surely tell us why are lean programs don’t work, and what we can do to change it.

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