Why is Business Transformation so Hard? Lessons from the ‘Back Pain Industry’

By Pascal Dennis (bio)

Many fine discussions these days about the above question.

Thanks to Bob Emiliani & other colleagues for their cogent questions & reflections.

Let me add a few thoughts based on my observations of another field – the so-called “Back Pain Industry” – another area wherein smart, capable people can’t seem to do what their trying to do. The back pain industry is

a) Enormous (> $ 100 billion USD), and
b) Doesn't seem to work. (Some common back treatments are not only ineffective, they’re harmful. See: Watch your back! & 30 Surprising back pain statistics)

What’s going on here? Any lessons for Lean/Continuous Improvement leaders?

Here’s my personal experience.

The back pain industry doesn’t seem to work, but some individual practitioners are extremely effective. My sport physiotherapist, for example, the splendid Janique Farand, has helped to keep my spine strong & supple for the past decade. I’m more active, and in better shape now than I was twenty years ago. A few years ago I even returned to Aikido practice, which severely tests back strength and flexibility. No problem, knock on wood. (Am throwing the young fellows around, and getting thrown, like in the old days.) All this despite significant disk deterioration in the L1 to L5 vertebrae. “Degenerative disk degeneration (DDD)”, my physician & specialist told me. “Normal wear & tear. You’ll have to learn to live with it.”

I don’t want to be misunderstood. All the people I’ve met in the back pain industry are capable, committed and hard working. One of them is clearly a great sensei. But they all work for major healthcare organizations and are constrained by ‘protocols’ sent down from on high. Woe unto them if they deviate from protocol!

Janique, by contrast, runs a small private physiotherapy (PT) practice specializing in sports medicine. Her diagnosis and understanding of root causes seems to be much deeper. She is ‘in the gemba’, if you will, closely observing what’s there. Janique is a detective, guided by her professional training, experience & acute knowledge of the latest advances. Is it any surprise that her countermeasures are deeper and more effective than the back pain industry’s ‘one-size-fits-all’ approach? (“I couldn’t do what I do if I worked for a major clinic or hospital,” she tells me.)

Here are here core countermeasures include a) Daily inversion using an portable inversion table, b) vigorous core strengthening exercises, c) natural anti-inflammatories (GLA, turmeric, ginger), and d) massage.

(I shared her diagnosis and treatment plan with the top neurologist in town. “Excellent,” he said. “Please continue.”)

“You have to work at it and be a bit lucky with chronic illness,” my PT tells me. “But you can be strong & fit into your eighties and beyond, knock on wood!”

Any lessons here for Lean/CI and business transformation professionals?

1. Top-down improvement is slow & stupid. Bottom up improvement is smart, but can be chaotic. (Janique’s professionalism & experience are invaluable here.). This is called ‘Carlson’s Law’.


2. Senior leaders should define purpose overall direction (the ‘banks of the river’ or design space). They should reduce hassles for their people, then trust them to figure it out, based on what they see in front of them.


3. Respect the folks at the front line. Invest in them – give them the skills to improve the work. Then, let them do so.


4. To truly grasp the situation you have to go see for yourself. It’s hard to manage or improve anything from on high. In fact, you usually make things worse.


5. There are very few magic bullets. You have to work hard and stay with it. But if you do, very little is impossible.

I’m reminded of my physicist friend’s charming bumper sticker: GRAVITY – NOT JUST A GOOD IDEA. IT’S THE LAW.

There are immutable laws of transformation, no? We ignore them at our peril.

Best regards,

Pascal