Drawing on lessons from hospitality, Dee Makadia discusses how intentionally designing every stage of the patient experience can support better clinical outcomes.
A 55-year-old woman had been visiting a clinic for two years. Every appointment told a similar story. Her eyes were burning in the evenings, and felt gritty on waking in the morning. She was frustrated that things were not improving. Her treatment plan was clinically correct and the drops she was using were appropriate, but something was not working.
On one visit to my practice, I asked her casually: How did she feel arriving at the practice that day? How well did she know the management plan? Did she feel genuinely cared for over the past two years?
She answered in a disheartened voice, as though she had been let down – she felt managed but not really cared for.
There is a difference, and they have different clinical outcomes.
Clinical excellence is the baseline. Patients expect it, and rightly so. But the practices that earn real loyalty, consistent adherence, and the kind of word of mouth that no marketing budget can replicate do something beyond clinical excellence. They design the experience of being cared for, deliberately, consistently, and at every point in the patient journey. This is not about service. It is about what designed care does for teams and clinical outcomes.
… the practices that earn real loyalty, consistent adherence, and the kind of word of mouth that no marketing budget can replicate do something beyond clinical excellence.
Every Touchpoint is Important
The moment a patient calls your practice is the moment their journey begins. Research confirms what most of us already know: first impressions formed on the phone, at the front desk, in the waiting environment, and in the way a staff member makes first contact, all shape how the patient feels before they have even sat in your chair.1
For a parent coming in to have their child’s eyes tested, this matters more than in almost any other situation we encounter in practice. Parents are not passive observers. They are actively scanning for trust signals from the moment they walk in. Is this a safe space for my child? Does this person know what they are doing? That assessment begins at the front door, and it never fully stops.
I have had many parents come to me for a second opinion after already visiting another optometrist. When I ask what prompted them to seek another view, the answers are consistent. They felt rushed. Things were not explained clearly. The clinician did not seem confident. Sometimes it was all of the above. The clinical care may have been entirely appropriate. But the experience of that care left the parent unsettled, and an unsettled parent will keep looking until they find a practice that makes them feel certain their child is being looked after properly.
A patient or parent who does not trust the optometrist will not follow the advice. They will seek further opinions. They will delay intervention. They will disengage.
I still think about a 15-year-old girl whose parents had avoided getting her glasses since she was 10 years old. They had seen an optometrist but left feeling uncertain and never went back. By the time I saw her, she was seeing 6/60 in both eyes and still had no glasses. That child navigated school, friendships, and adolescence for five years without the vision she needed, because the trust was never established at that first appointment.
Tipping the Scales
Trust at every touchpoint changes the clinical outcome.
Think of the patient journey as a set of balancing scales. On one side, trust. On the other, doubt. Every interaction in your practice places a weight on one side or the other. A receptionist who greets a returning patient by name. A clinician who explains an optical coherence tomography image in plain language rather than clinical shorthand. A follow-up call, two weeks after a new treatment begins, to check in on how a patient is feeling. Each one is a gold weight placed on the side of trust. Quietly, consistently, without the patient necessarily being able to name what is happening, the scales tip.
The reverse is equally true. A long wait with no acknowledgement. A rushed appointment. A handover between clinician and dispenser that feels abrupt and disjointed. Each one places a weight on the other side. The patient does not consciously keep score, but they feel the scales tip. And when those scales tip too far towards doubt, they stop following the advice, stop returning for follow-up, and eventually stop coming back at all.
In the best practices, every weight is placed intentionally. Nothing is left to chance or to whoever happens to be having a good day. The system ensures that each touchpoint, from booking to follow-up, is designed to add to the trust side of the scale. Not occasionally, every time.
What Hospitality Figured Out First
The world’s most admired service organisations did not get recognised simply for superior products. They were noticed through their relentless pursuit of developing outstanding customer experiences.
Danny Meyer, founder of Union Square Hospitality Group, built some of New York’s most enduring restaurants on a philosophy he called ‘enlightened hospitality’. His main insight was simple and transferable to any field that serves people, including optometry: hospitality is present when something happens for you, and absent when something happens to you.2 That distinction – for and to – describes the gap between a customer (or patient in our case) who feels genuinely supported and one who feels processed.
S. Truett Cathy, founder of Chick-fil-A, now the restaurant chain with the third-highest revenue in the United States, after McDonald’s and Starbucks, built one of the most recognisable service cultures in the world on a related principle: leaders model the behaviour they want the team to deliver, every day, visibly, and without exception. He said, “If we have to keep telling people what to do, it means we are not modelling the behaviour ourselves.”3
US marketing strategist David Meerman Scott and his medically trained daughter, Dr Reiko Scott, in their book Fanocracy, explored what happens when organisations move beyond satisfying customers and begin genuinely connecting with them. They found the organisations that create true loyalty are those that build meaningful human connection into every interaction.4
In the medical context, Dr Reiko Scott described this dynamic as a healing force in the exchange between patients and doctors.4 What she is pointing to is not a treatment or a procedure. It is something that exists in the space between the clinical moments. When a patient feels genuinely connected to their practitioner, something shifts. They open up more. They ask the questions they were too uncertain to ask before. They follow the advice because they trust the person giving it. They return for follow-up because the relationship feels worth returning to. The healing force she describes is human connection. And when it is consistent and intentional, it changes clinical outcomes. At the centre of all of it is communication. Not just what is said, but how it is said, when it is said, and whether the patient feels that someone is genuinely listening.
The lesson from hospitality is not to make optometry feel like a restaurant. It is to understand that excellence, if left to chance, will produce occasional sparks of success. Caring for your patients by design, however, produces something far more valuable: consistent results.
The quality of the human experience around the clinical encounter can be taught, refined, and consistently delivered. It can, in other words, be designed.
What I Noticed Over Time
During my years in practice, I gradually became aware of a pattern. The patients who became raving fans were not always the ones with the most sophisticated treatment plans. They were consistently the ones who felt the practice was genuinely invested in their outcome and made them feel part of our tribe, at every appointment and interaction.
Patients rarely commented on the specifics of my clinical decisions. They commented on my communication style. That observation changed how I thought about my role. I learnt that quality communication can improve patient-centred health outcomes.5 Over the following 15 years I made communication a deliberate part of how I trained the graduate optometrists who came through my practice. Watching them develop, and watching their patients respond differently as a result, confirmed what I had begun to suspect: patient care is more than clinical acumen.
The quality of the human experience around the clinical encounter can be taught, refined, and consistently delivered. It can, in other words, be designed.
Designing the Culture, Not Just the Care
None of this happens by itself. And it cannot be carried by goodwill alone.
Designing care requires clarity about what you actually want. That means defining the standards you expect, the behaviours that reflect those standards, and who is responsible for what at every point in the patient journey. Ownership matters here. When a team member knows exactly what they are responsible for and understands why it matters clinically and not just operationally, they stop waiting to be told what to do and start taking initiative. That shift from responsibility to ownership is where culture begins to move.
It also means identifying the behaviours you want to see more of and rewarding them consistently and visibly. Not just the clinical wins. The receptionist who remembered a patient’s name. The dispenser who noticed a patient looked anxious and slowed down. The optometrist who called after a difficult appointment. These moments, when noticed and acknowledged by leadership, become the standard rather than the exception.
And it means extending the same care to your team that you ask them to extend to patients. A team that feels genuinely valued, clearly directed, and supported in their growth will deliver a patient experience that no script or policy document can manufacture. Care flows in both directions, or it does not flow consistently at all.
The design takes time. Clarity takes effort. But once it is established, something changes in the practice. The culture realigns to the vision. Conversations become easier because everyone knows the standard. New team members find their footing faster. Patients feel the difference, even when they cannot name it.
We enter this profession wanting to serve, wanting to make a difference, wanting to build something that genuinely looks after people. But very few of us are ever shown how to design the environment in which that becomes possible, consistently.
Once it is designed, it gives you focus. It gives you a path. And it gives you the language to have the conversations that keep the whole team moving in the same direction.
That is what designed care looks like at its best. Not a better checklist – a better culture.
Key Takeaways
- Clinical excellence is expected, but designed care is why patients return.
- Every interaction places a weight – negative or positive – on the scales of trust.
- Patients cannot assess your refraction, but they can assess whether they feel heard.
- Communication is not a soft, optional skill; it is a necessary clinical tool.
- Define the standard and model it daily; watch the culture shift.
References
- Szewczyk T, Hoque F. Improving patient experience in healthcare. J Brown Hosp Med. 2026;5(1). doi: 10.56305/001c.147405.
- Meyer D. Setting the table: The transforming power of hospitality in business. New York: Ecco; 200p.
- Yaeger D. Chick-fil-A on exceeding customer expectations. Chief Executive. 19 Jan 2023 available at: chiefexecutive.net/chick-fil-as-dan-cathy-on-exceeding-customer-expectations [accessed Sept 2026].
- Scott DM, Scott R. Fanocracy: Turning fans into customers and customers into fans. New York: Portfolio/Penguin; 2020.
- Sharkiya SH. Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Serv Res. 2023;23(1):886. doi: 10.1186/s12913-023-09869-8.
