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January 23, 2024

A Michelin Guide for Patient Experience - Part One: The Kitchen Sets the Tone

(This is a guest post by Jake Fishbein)


  • Better patient experiences lead to better financial and clinical outcomes. The building blocks of a great patient experience are processes and products designed to improve care teams;
  • Through the lens of a Michelin-star restaurant — the North Star of great customer experience — it’s clear that great outcomes are driven by thoughtful, human-centered design, flexible standardization, and reduction of cognitive burden;
  • Healthcare ops and tech should enable resilience, intuitiveness, and personalization


The Bear — FX’s award-winning breakout show about a tortured chef taking over his late brother’s restaurant — hardly seems like it would be an educational guide for healthcare companies. But as I watched the second season’s “Forks” episode, which takes place largely in real-life Michelin-star restaurant Ever, I found myself thinking, “Wait, we should be doing this in healthcare.” I’m not alone. The episode’s writers alluded to the parallels. “Taking care of people at the highest level is like working in a hospital,” quips Garrett, a waiter. “I think that’s why restaurants and hospitals use the same word, ‘hospitality.’” The episode focuses on the elements of a restaurant that contribute to an award-winning customer experience, both on the customer-facing side (front of house) and operations (kitchen). 

Below, I’ll explore how delightful customer service — whether in fine dining or healthcare — begins with great operations. Every square inch of a Michelin-star kitchen is designed, every movement choreographed, to create the most efficient, high-quality output possible, so that on the other side of the wall in the dining room, customers are wowed with the perfection, precision, and personalization of every dish. 

To deliver a great experience in healthcare, care operations — the processes and tech that support care — must be resilient, intuitive, personal, and optimized to improve CareEx. I’ll explain how this is achieved through standardization and thoughtful workflow and product design that leverages behavioral economics. 

Patient-centric care relies on delivering empathy and humanity along with treatment. And to deliver a Michelin-level, personalized patient experience, you first need to build the bedrock of exceptional care operations. 

The Expeditor - Orchestrating Care Operations 

In any busy restaurant, the flow of the kitchen is managed by an expeditor — the chef in charge who makes sure that everything comes out at the same time, perfectly, and meets the needs and expectations of the guests. In a healthcare setting, the expeditor role should be designed into product and operations — a meticulously choreographed, data-driven, and empathetic care flow built on complementary, thoughtfully designed tech. Ideally, the management of extraneous backend complexities should be baked in, enabling clinicians to focus on what they do best: providing exemplary patient care with Michelin-star service. 

The expeditor gathers historic and real-time data, contextualizes it, and uses those insights to respond to the unique needs of each diner. “Table 23 eats slower,” she explains, sending out an extra amuse bouche so as to not back up the kitchen staff. The yellow tables are out-of-towners — ask them how they’re enjoying their trip. “Birthday on 24. Hold dessert. Pick up a cake, candle, two balloons.” Like the conductor of an orchestra, she is intuitively aware of how every component contributes to the final plated product, and what everyone in the kitchen needs to do to empower the front of house to deliver exceptional experiences in the dining room. 

The expeditor collects information about the needs of customers and conducts the kitchen accordingly

Regardless of the dish being made, the system is flexible and intuitive such that the expeditor (or care team) can predict who needs to do what and when, as well as where all the ingredients (inputs, data, EHR clicks, etc) are, even when things don’t go according to plan. 

This builds resilience within the system, unkinking bottlenecks at the source. For example, in The Bear, the chef berates the staff (with admirable enthusiasm) because a smudged plate cost the team 45 – no, 47 – seconds and required them to reset the other plates at the table. But the expeditor knew exactly what five things needed to happen in order to get the plates out together, as quickly and smoothly as if nothing ever happened. Similarly, care flows should be resilient to no shows and late patients, unforeseen emergencies, etc. Including end users in the iterative design process helps with this, balancing rigid, top-down protocol with flexibility. This bottoms-up approach aligns the technical product inputs with real-world experiences and practical needs. 

The expeditor knows each table’s preferences and anticipates their needs, automatically responding as or before they arise. Clinicians, similarly, should be supported by care flows and products that anticipate needs, streamline processes, and ensure that they have the right tools at the right time to tailor their approach to each patient. 

Take Nicklaus Children’s Hospital, which built a new standard protocol to track patients with trypanophobia (fear of needles) and automatically use a VR headset known as SmileyScope to reduce the perceived pain of needles. SmileyScope reduces stress and anxiety in patients, leading to a better experience for patients, parents, and care teams while reducing time, costs, and sedation. Instead of relying on clinicians to remember these patients — or find out the hard way — Nicklaus used data and default protocols to create a superior experience. 

This concept is not just about speeding up processes; it's about creating space for quality human interactions. When care teams are freed from redundant tasks and inefficient workflows, they can devote more time and attention to their patients. They can engage in meaningful dialogue, offer empathy, and build trust — elements at the heart of an exceptional patient experience. 

Standardization: Enabling Flexibility, Intuition, and Resilience for Improved Experience

To build resilience and flexibility in operations, standardization is imperative. While these may seem like competing qualities, standardization of workflows actually creates opportunities for data-driven deviations from a rigid protocol. Having standardized processes also allows end users and product teams to understand how each step or data point informs and influences downstream tasks in service of the end goal. 

In a kitchen, the layout, station prep, workflows, and governance are constructed with the goal of replicating a dish, as efficiently and precisely as possible, each time it’s ordered. How does a system like this breed flexibility? Say a gluten-free customer orders a salad. The expeditor knows exactly how the chef makes the salad, what prepared ingredients he has at his station, and how each ingredient adds to the character of the dish. She can direct the chef to use almonds instead of croutons to add that necessary crunch to the salad. Without standardized protocols, the chef would be forced to respond as new requests come in from each diner. Instead of the chef spending precious mental calories trying to identify the 'gotcha' cases, the expeditor alerts him of the need and already has a solution ready.

Standardization also helps healthcare organizations optimize products, train staff, and automate processes. Wondering if your organization can benefit from standardization? A key indicator may be the number of Post-its plastered on desktops or alerts that pop up to follow a certain workflow. When pitching an optimization project to a department head or chief informaticist at a hospital, I would come prepared with a tally of the number of Post-its or printed reminders that I saw when observing the back office flows. The greater the number, the more likely that they are a canary in the coalmine — a telltale sign of unstructured processes — and the higher the risk of inefficiency or patient safety issues down the line. 

By standardizing workflows across departments or teams, it makes it easier for product and ops managers to identify opportunities for improvement based on outliers in outcomes and process data. Training is simplified, and IT teams can manage issue tickets much more quickly. Reducing process and product variation also allows teams to more easily automate certain tasks based on protocols — instead of relying on providers to remember every protocol themselves or take action on a myriad of alerts, which is a harbinger of burnout and could cause patient safety issues due to the “cry-wolf” effect. 

Much like a meticulously designed kitchen, thoughtful and calculated care operations and products ensure that the patient journey is smooth and efficient, each user’s next step intuitive, and agile enough to adapt to the unique needs of each patient. 

In his book Prescription for the Future, Zeke Emanuel explains, “[Standardization] brings up the bottom by improving quality, reducing errors, and saving time and money because physicians and nurses do not have to work out all the details of care each time they see a patient. Instead, care of common problems, which usually consume a huge proportion of health providers’ time, becomes a kind of muscle memory.” 

While standardization is the baseline, care operations that are too rigid or narrow in scope can impede adoption. Flexibility allows room to respond to changing needs. 

According to Rik Renard, “work must be specific enough to be a useful guide, yet general enough to allow for some flexibility.” Balancing standardization with flexibility is the cornerstone of operational excellence in healthcare, enabling clinicians to deliver care that is not just clinically proficient, but also deeply personal and empathetic. 

Everything in its Place: Intuitive CareOps, Automation, and the Reduction of Cognitive Burden 

At the intersection of great operations and product is the concept of reduction of cognitive burden. While working as an EHR consultant, I developed the “reduction of cognitive burden” framework, which leverages behavioral economics principles, human-centered design thinking, and thoughtful UX & workflow standardization in product design to reduce the amount of thinking and decision-making an end-user must do to achieve their goal. In The Bear, this concept is represented by mise en place. The chefs spend much of the morning preparing and organizing mise en place — chopping vegetables, preparing stocks and sauces, portioning fish and meat, etc. — so when the rush of dinner service comes they just have to focus on execution instead of worrying about what they need, where it is, and how to prepare it. 

Chefs understand how each ingredient contributes to the end product, and preparing mise en place before service allows them to batch work, enables more efficiency and flexibility on the line, and reduces their cognitive and physical burden as they focus on execution. A chef doesn’t keep whole cloves of garlic around the kitchen, but rather sliced garlic by the pasta station, minced garlic at the saucier station, and crushed garlic at the meat station. In other words, a kitchen is architected using a primary principle of behavioral economics: let the desired action follow the path of least resistance. 

The elements prepared for the mise en place are not service-worthy by themselves, but in the context of a recipe, it becomes clear how important it is to have a thoughtfully designed and prepped space. 

Similarly, data and workflows without clinical context are not completely worthless, but require more time, effort, and decision-making to turn into something useful. Effective healthcare products (like EHRs) should make it immediately apparent what the patient need is, and translate that into a request — a task — which the user can respond to without having to remember a million details. An intelligently designed product integrates clinically relevant data seamlessly into the user's workflow, ensuring that they receive the necessary information precisely when and where they need it for optimal patient care. These tools are much more intuitive and adoptable, creating more time for things like, say, interacting with their patients. In essence, the care flow should guide the product design, and vice versa, aligning users with their end goal rather than focusing on the individual tasks and decisions needed to get there. 

Stripping down a workflow to its most basic elements and delivering the right data to the right person at the right time is the essence of the reduction of cognitive burden framework. 

Another way to do this is to reduce the movement needed to get from point A to point B. That’s where automation comes in. Default data entry, recommended actions, and automated execution reduce decision burden on end users by anticipating needs and baking the decision-making into the design of the product. For example, to provide the highest quality care at the lowest cost, organizations build protocols based on evidence-based guidelines, incorporate preventative cost-saving measures like cancer screenings, and try to incentivize provider behavior with financial bonuses or other acknowledgement. Still, the onus is typically on the provider to remember which protocol fits each scenario, and what that means at the point of care. 

In a transformed practice, the desired protocol becomes the path of least resistance. As an example, at one health system, basically all drug orders (with a handful of evidence-based exceptions) were defaulted to be placed as generics. While the providers retained the autonomy to change those to brand names as needed, the path of least resistance is to just place the generic prescription. This saved patients, and the hospital, potentially hundreds of thousands of dollars with hardly any investment beyond a few configuration changes to the EHR. And, because we also built intelligent clinical decision support into the ordering process for inpatient venues, the cognitive burden on the clinicians was reduced, which also marginally improved ordering efficiency. The goal was to provide the same or better quality of care at lower cost. The recipe, if you will, was a standardized protocol to prescribe generics, and the product was built to provide the right data, at the right time, to the right user. 

This same concept can be applied to improve patient engagement. App usage data, such as when users are logging in and how they’re navigating, can be used to optimize outreach efforts. Similarly, RPM device data can be used to trigger behavioral nudges or communication, and create opportunities for lifestyle interventions and personalized engagement. 

At one point in “Forks” the episode’s main character, Richie, mentions to the expeditor that he sees a “pattern.” This pattern is a strict protocol, a set of rules and workflows without which the restaurant simply would cease to function. But the protocol leaves space for the chef to add their flourish to meet and exceed the expectations of their diners, and the well-rehearsed kitchen choreography allows enough flexibility to build customization and resilience into the end product. It also relies on intuitive and thoughtful design, preparation, and creativity to deliver exceptionally delightful and personalized experiences to customers. Much of medicine is based on patterns. However, it’s important to the sustainability of the healthcare system that the interactions with patients maintain some humanity as opposed to being inflexibly algorithmic. 

In part 2, coming soon, we will focus more on this concept of using personalization to achieve a more delightful, empathetic, human experience, just like the best restaurants in the world strive to do. 

Next Steps

If you’re looking to transform operations to deliver Michelin-star service at your care organization (or level up in the kitchen), here are some helpful tips and resources. 

  • Work directly with end users in the iterative product development lifecycle. Learn where opportunities exist to add flexibility through self-service (great takes on this here). 2. Build products that anticipate needs — like an expeditor 
  • Start by focusing on workflow or product areas where there is duplication or the 80/20 rule is in effect. This is typically a low-hanging fruit where choice architecture and automation can add efficiency 
  • Think about workflows in terms of goal-orientation rather than task-orientation. When training users and solving issues, teach users how to fish (i.e., what’s the ideal end-state and what components are needed to get there) 
  • Look for variable workflows – shadow end users and observe where, in practice, the workflow deviates from the defined standard protocols. There are a number of screen recording tools (allowing you to watch without influencing behavior change) and process mining tools (analyze user behavior at scale) on the market that can help. However, I find live shadowing can add a lot of context because you can ask ‘why’ a user deviated from the standard process; this helps shed light on what design elements may be inherently confusing or subconsciously causing a behavioral response. 
  • When you read a recipe, chop, dice, slice, and portion all of the called-for ingredients beforehand and separate into bowls. Arrange the bowls in the part of the kitchen where they’ll be needed. By standardizing, over time you’ll start to be able to intuitively know what spices or ingredients go with each other, and will eventually become the mayor of Flavortown. 

Further reading

There are dozens of valuable resources to learn about Behavioral Economics as a discipline. But as a starting point, try to find some examples of BE principles in action and apply them to your organization’s unique problems. For example, have product managers work with clinicians and data analysts to identify a flow/existing behavior pattern that could be modified. Then, for some users rearrange a dropdown or add a default response, and run an experiment to see how that impacted the workflow outcomes 

Leverage process mining to identify opportunities for optimizing products and workflows.

Read Connected Strategy by Christian Terwiesch and Nicolaj Siggelkow. This book holds a veritable treasure trove of information on strategic methodology for creating great delivery models and customer experiences, as well as practical application of these strategies. You can check out the accompanying online course at edX.org. 

This post was written by Jake Fishbein.

Thank you to Rik Renard, Caren Rabbino, Mary Tindall, Ben Lee, and of course ChatGPT for their valuable feedback which helped make this piece more digestible. Thanks to Rik, Thomas, and the fine folks at CareOps.org for agreeing to subject their readers to this – my first real attempt at non-academic writing.

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