Design as Hospitality: A Healthcare Manifesto

Did you know that "guest" and "host" come from the same word?

The Latin word hospes and before that ghostis held both meanings in a single root. It meant the person who arrives and the person who receives.

From this one word, a family of words was born: host, hostel, hotel, hospital, and hospitality. They share an origin because they once shared a purpose: the care of someone who has crossed a threshold into unfamiliar territory.

But somewhere along the way, these words diverged.

Hotels became places of comfort while hospitals became places of efficiency. Hospitality became about luxury and healthcare became about throughput.

But the original meaning held something different. It suggested mutual obligation, sacred duty, and moral virtue. In ancient Europe and some parts of Asia, taking in a stranger wasn't a simple act of generosity, but rather, it was expected because if you needed shelter, you'd want someone to treat you the same.

These are notions we don't really hear in healthcare anymore. This essay is about getting back to them through design.

The Gap

There's a distance between what healthcare intends to do and what it actually feels like to receive it.

You've felt this before: the clipboard under fluorescent light, writing your name and date of birth for the third time, getting called through a sliding window, being told to wait but never told how long, and being discharged without being told what comes next.

You've sat in an urgent care lobby with no idea how long you'll wait. You've walked into a specialist's office for the first time and not known if they can actually help you with what you need. You've put on a paper gown in a cold exam room and waited, half-dressed, staring around the room, wondering when someone will come and, if enough time has passed, whether they still remember you're in there.

This is the natural shape of a system designed around compliance, liability, and operational efficiency. It's devolved into a system that has been refined for everything except the person at its center.

Even the language tells you. Patient comes from the Latin pati meaning to suffer, to endure. To be patient is, by definition, to wait. The word itself assigns a passive role: you are the one who endures and the system acts upon you.

But there's another industry that welcomes people who are anxious, disoriented, and vulnerable, and solves it entirely differently: hospitality. Their incentives may be different, but healthcare has much to learn from it. After all, as mentioned, they come from the same essence.

What Hospitality Understands

When we think of hospitality we tend to associate it with tasting menus and all-inclusive hotels, but what it is at its core is a discipline of care. Hospitality is the practice of making someone feel welcome and oriented when they're in a moment they didn't choose.

A great restaurant host reads the room before you sit down. Are you celebrating? On a first date? Running late? They don't ask, they just notice and adjust. The corner table instead of the center one, water without being asked. A small decision that says, quietly, "we see you, and we've thought about this."

Will Guidara ran Eleven Madison Park when it was named the best restaurant in the world in 2017, and he drew a distinction I keep coming back to in his seminal book Unreasonable Hospitality. Service is a mere transaction: you asked, I delivered. But hospitality is how you make someone feel, and that difference is everything. Service gets the job done, but hospitality makes you want to come back.

At Union Square Hospitality Group, where Guidara had various roles early in his career, there's a story of a guest who got up mid-meal to feed her parking meter. So someone on the team started doing it for her, and then they made it standard practice for every guest. Guidara called these grace notes: small, anticipatory gestures that told the guest, "We thought about what you might need before you needed it."

Healthcare has mostly forgotten this idea, which is unfortunate because the experience around the core service is not merely peripheral. Instead, it shapes whether the person trusts you, returns to you, and follows through on what you've asked of them. The rituals of hospitality, the greeting, the orientation, the check-in, the graceful exit, are not simple gestures but a collection of moments that make people feel held. And feeling held is what makes people trust you enough to actually listen.

Healthcare needs those same rituals.

The Framework

Design as Hospitality is a way of seeing, not a surface-level treatment, and it begins with a single premise: that every person entering the healthcare system is crossing a threshold into a place they did not choose to be.

Once you accept that, the rest becomes clear.

1. Assume anxiety.

Every patient carries some degree of fear, uncertainty, or discomfort into every encounter. This is the baseline to expect, not the exception. Hospitality designs for the anxious guest and healthcare should, too.

Think about what it's like to visit a new PCP for the first time. You enter the building and don't know which floor. You walk in and there's no clear indication of where to go. You hand over your insurance card and fill out forms that ask for information you already submitted online. Then you sit in a chair and wait, and no one tells you how long it'll be.

Every unanswered question is a small failure of anticipation. A moment where anxiety fills the gap that information should have occupied.

Now imagine the opposite. What if you get a text the day before with the address, the suite number, and what to bring. You walk in and someone greets you by name. The forms are already pre-filled from your intake. Someone says, "The doctor is running about ten minutes behind. Can I get you anything while you wait?" The anxiety doesn't disappear, but it loosens. Because someone anticipated it.

At Photon, we discovered the same dynamic in digital prescriptions. Patients were replying to our SMS messages with questions they shouldn't have needed to ask. What happens next? When will it be ready? How much will it cost? So we redesigned the anatomy of a status update. Every message in 160 characters or fewer had to answer three things: what just happened, what happens next, and what you need to do. We compressed an entire orientation into a text message, not because it was easy, but because the patient should never be left wondering if there's something we can do about it.

The principle is the same whether the experience is physical or digital. A lesson from Unreasonable Hospitality: anticipate the anxiety, eliminate it before it becomes a problem, and standardize the grace note.

2. Design the threshold.

The first moment sets the emotional tone for everything that follows, whether that's walking into a clinic, opening an app, or sitting down in an exam room for the first time.

Hospitality obsesses over this: the lobby, the greeting, the first impression of the room. Healthcare treats this as purely administrative. You check in, you sit down, you wait.

But a threshold is not a formality; it's a transition from one state to another, from well to unwell, from outside to inside, from autonomy to dependence. How someone is received in that moment shapes everything that comes after.

Walk into any decent boutique hotel and notice what happens. Within seconds, someone makes eye contact, moves toward you, and says your name. Before you've oriented yourself, you've already been received.

Now walk into an urgent care. The sliding glass window, the clipboard or the kiosk, a television mounted to the wall playing something no one chose. You sign in and take a seat, rarely having an idea what happens next or how long you'll wait.

These are both thresholds. One was designed. The other was defaulted into.

The exam room is a threshold too, and most of them feel like storage closets with medical equipment. The lighting, the temperature, the gown, the stool the doctor sits on relative to the patient. All of these are design decisions even if no one made them deliberately. Especially if no one made them deliberately. A clinic that takes thresholds seriously might warm the exam room before the patient enters. Might replace the paper gown with something that offers more dignity. Might have the doctor introduce themselves and explain what the visit will involve before touching anything. These aren't luxuries. They're the difference between a patient who tenses up and one who settles in.

3. Orientation is care.

Telling someone what to expect, what's next, and how long it will take is not a logistical courtesy but an emotional one. Just remember the last time you felt lost and out of place.

When a person doesn't know what's happening to them or why, they don't engage with their care. What they do instead is endure it.

Think of the small things they do in hospitality to orient you: a good server tells you the courses with enough detail. A good hotel tells you where the elevator is after you check in. These aren't interruptions but acts of care.

Now think about what happens when you get referred to a specialist. Your PCP says you need to see a cardiologist. Then what? You get a name, maybe a phone number. You call, wait on hold, eventually get an appointment three weeks out. You show up not knowing what the visit involves, what tests might happen, how long it'll take, or what you're supposed to do with the results afterward. You've been sent across a threshold with no orientation at all.

Or think about what happens after a procedure. You're wheeled out, handed a discharge packet you're too groggy to read, and told to follow up in two weeks. Your family member drives you home and neither of you fully understands the aftercare instructions. That's not a communication failure. That's an orientation failure.

In healthcare, orientation might look like a text that says your prescription has been sent and will be ready by 3PM. It might look like a specialist's office that sends you a short video the day before explaining exactly what will happen during your visit. It might look like a PCP who ends every appointment by saying "here's what I want you to focus on, here's what I'll handle, and here's when we'll talk again." It might look like a nurse who walks you through the next two weeks and actually follows up instead of handing you a printout.

Small things, but not small at all.

4. The guest never feels the kitchen.

Eleven Madison Park had a concept called “The One-Inch Rule.”

The idea is that the person placing the dish in front of you was the last in a long chain of events: someone designed the menu, sourced the ingredients, prepared the mise-en-place, cooked the food, and told the story of the meal. If the placement was off by an inch, the entire chain was compromised.

Even if there's so much that happened to get the meal in front of them, the guest never sees the chaos behind the kitchen doors. The guest only cares whether the food arrived beautifully, on time, and delicious.

Healthcare is full of kitchens: insurance verification, prior authorizations, pharmacy transfers, stock checks, referral coordination, and so on. The complexity is real and immense but none of it is the patient's responsibility to manage.

And yet how often does the patient actually manage the complexity, often alone, and left to them to navigate? A patient gets a bill they don't understand, calls their insurance, gets transferred twice, and ends up mediating between their provider's billing department and their insurer. A referral gets lost and the patient is the one who has to chase it down. A prior authorization is denied and the patient finds out only when they show up to the pharmacy.

These are kitchen problems leaking into the dining room. And they happen constantly, in every care setting, every single day.

At Photon, to manage the complexity, we mapped every step of the prescription process and sorted every scenario into three buckets: everything is fine, there's an issue and the patient needs to do something, or there's an issue and the patient just needs to wait. We built tools for human agents and AI agents to work together to process every order the exact same way whether there were ten or ten thousand. Then we communicated just enough, at just the right time, so the patient only ever saw the plated dish.

A clinic that takes this seriously might build its operations the same way. The front desk handles the insurance confusion before the patient arrives. The care coordinator chases the referral. The billing team resolves the coding error without the patient ever knowing it happened. The patient walks in, gets care, and leaves. That's the plated dish.

That's what orchestration looks like in practice. You follow through on every step, you absorb the complexity, and you protect the patient from ever having to feel the kitchen.

5. Finish strong.

The one-inch rule applies at the end too. The handoff between provider and home, between one care team and another, between diagnosis and treatment, between filling the prescription and actually taking it. These are the seams where people fall through.

Hospitality designs for transitions: the checkout, the follow-up note, the question was everything to your liking? Healthcare often just ends. You're discharged, you leave, and you're left to figure it out on your own.

A patient leaves their PCP with a new diagnosis. Maybe it's diabetes. Maybe it's hypertension. The doctor explained it clearly, prescribed a medication, and said to come back in three months. But between that visit and the follow-up, the patient is alone with a condition they're still processing. No one checks in. No one asks how the medication is going. No one makes sure they actually filled the prescription.

Three months later, they come back and nothing has changed because no one designed for the space between visits.

Or consider what happens when a patient is discharged from a hospital after a surgery. They go home, and for the first 48 hours everything feels uncertain. Is this amount of pain normal? Should the incision feel like this? When am I supposed to take which medication? The discharge packet has answers, somewhere, buried in twelve pages of 10-point type.

A hospital that finishes strong might call the patient the next morning. Not an automated survey. A person, asking how they're doing and whether anything feels off. That single phone call could be the difference between a smooth recovery and a readmission.

The last moment of a care experience is not the least important but may be the most. It's the difference between a patient who follows through and one who drops off.

6. Small gestures signal care.

At Eleven Madison Park, they kept what they called a Plus One Card. Guests often asked the same kinds of questions, about the cheese, the art on the walls, and especially the plates which they'd flip over to see who made them. (I still do this to this day, and have literally bought a teapot from Sant Ambroeus in New York as a gift because I looked under it to see which brand it was). So EMP printed elegant index cards with the answers to these common questions on heavy paper with beautiful typography and handed them to the guests as a gift when they see them look around during service.

This was so powerful that what people remembered most wasn't the meal. It was the card.

In healthcare, small gestures carry even more weight because people are at their most vulnerable: A warm blanket offered without being asked. A pediatrician who gets on the floor to talk to a child at eye level. A receptionist who remembers your name on your second visit. An OB who draws a diagram to explain what's happening instead of just using clinical language. A clinic that gives you a written summary of your visit, in plain language, before you walk out the door.

At Photon, the equivalent was a prescription experience that shows you the price before you commit, generates a coupon card automatically, and asks when you actually need the medication. Not because any single feature is revolutionary, but because the combination of them, delivered at the right moment, tells the patient: someone thought about this for you.

The ideal healthcare experience is not needing care at all. But people get sick, people need prescriptions, people undergo procedures. And when they do, the distance between terrible and decent is often not clinical, it's experiential. It's the accumulation of small, well-timed gestures that lower stress and move people toward the outcome they actually care about.

There is no upper bound to user experience. The work is never finished. You just keep closing the gap.

7. The incentives are the design.

The honest tension in everything I've just written is that the hospitality industry doesn't pursue great experience purely as a moral commitment (though of course, the people who do this well clearly find deep fulfillment and inspiration in delivering great hospitality) but because their business's survival depends on it.

If a restaurant makes you feel bad, you don't come back. The guest is the paying customer. The feedback loop is immediate and unforgiving; the business model and the experience are fused, and that fusion is what produces the discipline.

Healthcare's dominant incentive structures are designed differently. Fee-for-service pays for volume, not outcomes. Insurance, not the patient, is often the economic unit. A hospital can make you feel terrible and still get paid, and the experience does not impact customer acquisition or retention. A clinic can leave you disoriented, lose your referral, and discharge you into confusion, and the revenue cycle still continues.

This is not a character failure of healthcare operators. It's a structural feature and it's the most important thing to understand about why the gap exists in the first place. You cannot simply decorate your way out of a broken incentive structure. The experience layer can only hold if the incentive layer supports it.

But the structure is shifting. Value-based care contracts tie reimbursement to outcomes, and experience drives outcomes. Readmission penalties make finishing strong a financial imperative, not just an ethical one. Employer-sponsored health plans are choosing networks based on member satisfaction. Direct primary care, concierge medicine, and elective services (fertility, LASIK, aesthetics, and others like them) already live in a world where the patient is the paying customer and every interaction is a retention decision. These are the growing edges of healthcare where design as hospitality has immediate commercial logic, not just moral appeal.

And even in the fee-for-service world, the business case is building: patient retention, treatment adherence, referral networks built on trust, the five-star reviews that determine whether someone makes an appointment. These are not soft metrics but primary drivers of revenue. The feedback loop is longer than in a restaurant or a hotel, but it exists.

The work of design, then, is not only the lobby and the threshold and the discharge call. It's the underlying architecture too. How is the care team incentivized? What gets measured? What gets rewarded? These are design decisions. The incentive structure is the most upstream experience decision you will ever make, because everything downstream from it will reflect it.

Hospitality has always known this. The best restaurants don't just train servers to be warm. Rather, they build compensation models and cultural norms that make warmth the natural output of the system. Healthcare has to do the same.

Design as Hospitality is incomplete if it only addresses surface. The principles above are the visible layer, the plate presented to the guest. The kitchen has to be designed too: the incentive structure and the feedback loops that promote the level of hospitality that we desire.

Why this matters

When patients feel disoriented they disengage and when they don't understand what's happening, they don't follow treatment plans. When the experience is confusing or cold they don't come back, or they delay until the problem is worse. When they feel processed instead of cared for, they lose trust. And trust is what every clinical outcome depends on.

The business case is there too: when we design with hospitality in mind, we build retention, adherence, and word of mouth. But the business case while important is secondary. The primary case is moral. These are people at their most vulnerable and they deserve the same rigor applied to their experience as to their diagnosis.

Sure, we can wax poetic about this endlessly. After all if morality was all that mattered and not business, healthcare may have already been fixed by now. But part of Design as Hospitality is also designing the business model and the incentive structure and the cultural impact as much as we do the experience. We don't separate interface design from behavior design. Rather, they are reinforcing pieces of one another and inextricably linked to deliver the experience we want.

This matters not only because it's our sacred obligation, but because we can't call ourselves true designers simply by designing the one piece we like and leaving the rest to fate. It's like being an architect who only cared about blueprints, or a musician who only cared about one underlying chord. There may be a lot of individual components that are necessary in creating something special, but the totality of something, whether that's a building, a painting, or a song, is what makes it great, and that's what ultimately endures.

The work ahead

One chef does not make a restaurant just as one designer does not make a product or one entrepreneur an entire massive business. Hospitality is a culture, not a role. It's the collective decisions, made by everyone who touches the patient's journey, that this experience will be worthy of the trust someone has placed in it.

Design as Hospitality is a concept the best caregivers have always practiced: anticipating need, orchestrating complexity, and elevating moments of vulnerability into moments of trust. What's new is the argument that it can be systematized. That it can be designed. That it can be borrowed from the industries that have already solved these problems, from hospitality, retail, and architecture, and applied with rigor to the industry where the stakes are highest and the experience is often the worst.

This is the work of Feel Eternity: to study the patterns, to bring perspectives from outside healthcare's walls because the best ideas for how to welcome a sick person might come from a hotel lobby or a restaurant kitchen, and to build playbooks for anyone who wants to close the gap between clinical intention and human experience.

And to keep returning to the root of it all: the idea, as old as the word itself, that when a stranger crosses your threshold, you owe them something. Not just your competence or your efficiency, but your full attention, your anticipation, and your care.

Find one thing in your process, one threshold or transition or message or handoff, that you can design better. Subtract it to its essence, and deliver hospitality.

Anticipate. Orchestrate. Elevate.

That's what care feels like.

Jomi Cubol is the founder of Feel Eternity and the Head of Member Experience and Design at Harbor Health. He has spent a decade designing healthcare experiences at Thirty Madison, Balanced, Photon Health, Harbor Health, and building new consumer businesses for world-renowned brands like GQ, Wired, and Architectural Digest.

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