Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Insights from the book “Unreasonable Hospitality”  

Parting gift for every customer—homemade pistachio granola.


Healthcare delivery is complex, and hospitality may not be prioritized. As individuals and teams, small changes in behavior may improve patient experience. 

As I was reading the book “Unreasonable Hospitality” by Will Guidara, I was thinking about medicine and healthcare. A pair of young men in their mid-twentiesone in the kitchen and one in the dining roomcommitted to making their restaurant, 12 Madison Park, among the best restaurants in the world. Unreasonable hospitality and incredible food were the two areas where they hoped to differentiate themselves from other restaurants.   


Working in healthcare for the last 30 years and being a healthcare consumer for more than 55 years, it’s blatantly evident that the hospitality shown to patients isn’t highly prioritized in almost all our clinical settings. (Notably, hospital food isn’t great either and maybe that can become the focus of another CLOSLER piece.) 


Broadly speaking, patients aren’t especially warmly welcomed when they arrive, nor are they sent off with a warm goodbye or an exclamation that we look forward to seeing them again soon. Chairs in waiting and exam rooms are often uncomfortable and the rooms are mostly dull and not aesthetically pleasing (sometimes they’re not even that clean.) There’s often nothing to read, drink, or eat in waiting rooms despite the sometimes-prolonged periods of delay and anticipation.  


At the restaurant described in the book, the entire team went out of their way to deliver over-the-top hospitality. They routinely did the following:  


1. Googled the guests coming each evening, so they were recognized upon arrival and are greeted by name.


2. Ran out to put change in the parking meters associated with guests’ cars to ensure they’re not ticketed.


3. Gave patrons a small, unexpected parting gift (like top-notch granola [with pistachio nuts]) when they leave to show additional appreciation and so their experience is remembered the next day.


4. Listened attentively to guests in case an opportunity is presented to “wow” them. One story was that when a waiter overheard their table lamenting that they hadn’t tried a NYC street hotdog during their visit to the city, he went out on the street to get one. He asked the kitchen to cut it into four pieces and then served it to the guests (with several types of exotic mustard of course.)


So, what have I or will I try to do to move the “hospitality meter” a little bit higher in our divisional ambulatory practice?

1. I now greet all patients a little more warmly. I thank them for coming. I more empathically apologize if I’m behind. For new patients to our practice that I’m seeing, I (i) genuinely welcome them, (ii) ask them to let me know how I can serve them best, and (iii) urge them to let me know if I or my team does anything that dissatisfies them or makes them feel as if we have let them down in any way.


2. I asked our lead physician and practice manager if  “hospitality” can be the focus of our upcoming monthly practice meeting. I suggested that it would be great to pose the question about increasing the practice’s hospitality for a brainstorming session to get everyone’s input (front desk, medical assistants, nurses, other providers.) While the “granola parting gift” isn’t likely to come up, I suspect our list will include some low-cost ideas that will make us better.


3. I decided to write this piece for CLOSLER so that you can reflect on how you and your team are doing in terms of hospitality.


My parting gift for this piecetwo quotations from the book (not quite pistachio granola): 


“Hospitality is a dialogue, not a monologue.” 


“The way you do one thing is the way you do everything, and we found, over and over, that precision in the smallest of details translated to precision in bigger ones.” 










This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.