Six ways In-N-Out Burger is excelling in business – and five applications for healthcare today

In-N-Out Burger has developed a cult following with loyal customers across all age groups.

Much of their success is counter to the traditional burger restaurants and counter to traditional techniques. They do not advertise. They do not sell franchises. When others have IPOs and aggressive growth, In-N-Out Burger limits the number of restaurants and controls their growth strategy to ensure their focus is clear. Here are six things In-N-Out Burger focuses on to ensure their success.

1. They focus on quality.
• Early in the start of the business the founder, Harry Snyder, knew that fresh, quality ingredients would be paramount to their success. To control the ingredients, he built distribution sites within a days’ drive of each restaurant. If the distribution did not fit, the restaurant would not be built. To ensure the quality, In-N-Out employed secret shoppers who made monthly visits to the stores. The employees would not know about the secret shopper until the encounter was over.For those who did well, a cash bonus was given. For those who did not do as well, they were given an opportunity to improve.

2. They focus on customer service.
• A smiling, friendly staff member greets customers at the order counter. Employees continue this as they call out as the food is ready and as they make rounds in the dining room. It appears as if it’s their pleasure to serve their customers. According to, employees who currently work at In-N-Out state that their interview questions focused on customer service skills and attitude. The other components of the job could be taught.

3. They focus on simplicity
• In a recent USA Today article, competitors of In-N-Out were highlighted for “a pattern of introducing new products that surprise and delight customers”. In-N-Out’s menu has a total of three hamburgers, fries, drinks, and three flavors of milk shakes. There are no new products and their simplicity has a huge following. Though their menu is set, they are known for their “secret” menu.

4. They focus on presentation.
• They know that impressions matter. Employees are consistently cleaning the dining room sweeping the floors, and taking care of the restaurant before it becomes unsightly.
• Each hamburger is wrapped and presented in a paper pocket to ensure the burger is consistently presented to the customer.
• Every French fry is peeled and cut the same day at the restaurant. They have printed on the bottom of each fry serving tray a reminder of how fresh their fries are. This also allows them to take credit for what they do well.

5. They focus on training and teamwork.
• Entry Level managers are well trained at In-N-Out University and most become managers after working up through the ranks at the store. The areas of focus are on communication skills, a positive attitude, and how to motivate employees.
• Expectations are set and no one says, “That’s not my job.” Employees seamlessly move from preparing food to greeting customers and taking orders to calling out customer pickup numbers to cleaning the restaurant, all without being told to do so. No job is too big or small for any employee – and that includes the managers.

6. They focus on their employees.
According to, the starting hourly rate for In-N-Out Burger employees is approximately 50% higher than their competitors. Their employees ranked In-N-Out as one of the top-rated places to work for the last three years and 89% of employees would recommend working at In-N-Out to their friends. Comments from employees include, “Very competitive pay and (the) ability to move up; Better than average pay, culture, environment; Excellent training and clear-cut expectations.” Rich Snyder, the founder’s son and heir to the company, believed, “If you lose your employees, you lose your customers”. As a result, the turnover rate for their employees is one of the lowest in the industry and the employees have given the CEO a 95% approval rating.

Here are Five Take-Aways for Healthcare
1. Know what you do well, focus on that first, and use what you learned as a model for excellence. If you’re concerned your employees may not be providing the service that you expect to your family members and patients, recruit some secret shoppers to give you feedback. These could be patients called ahead of time by management and/or family members who are asked to provide honest feedback after their family members’ surgery.

2. Remember who your customers are. Some healthcare workers do not like to acknowledge that patients and physicians are customers. The truth is, patients, now more than ever, have a choice in their healthcare and physicians have a choice where they bring their elective cases. It’s up to us to create an environment, much like In-N-Out, where the staff are smiling and willing to accommodate their customers. Communicate to the patients and physicians that you realize they have a choice and you’re glad they chose your facility. Smiles, a kind word, and a thank you go a long way in building a relationship.

3. Provide a higher level of service than your competitors. In one hospital where I worked, we created a concierge service for the family members and patients. We renovated a small room, put soothing colors on the walls, calming pictures, and comfortable seating. We hired a concierge to greet the patient at their car and escort them to surgery. This person also checked with the family members throughout the day and smoothed any rough areas to make their stay easier. My personal cell phone number was available to the family members. I rarely received calls due to the placement of the concierge in the area, but it sent a message that I was involved and available. The program was a hit, and continues to this day.

4. Set the expectations early in the process and hire to the expectations. Take “That’s not my job” out of the vocabulary and lead by example. Let them know they are expected to work together seamlessly as a team, no matter their job title. If you want your staff to be courteous and caring about your patients, make sure to hire employees who understand the expectation that they focus on their customers through the care they provide. Smile. Say thank you. And take credit for what they do well. When you pull the curtain as you leave their pre-op cubicle, say, “I’m closing the curtain to provide you privacy.” That will help your patients realize that you’re concerned for their privacy and they’ll be more likely to remember when the patient satisfaction survey comes around.

5. Invest in your staff. Encourage the positive things you see them do and work to mentor them along the way. I’ve had several staff who, through a little encouragement, have realized their potential and began to grow. One of those staff members is now a surgery center administer, one is working on her MBA, and one is the director of surgery at a very well-known hospital system. Build a relationship with your staff, and as you see the areas where they need to grow, point it out to them in a way that would be meaningful to them. Building a relationship and showing interest in them and their growth will make a huge difference in the work environment. Provide small bonuses, cash rewards, gift cards, and words of encouragement along the way. People like to know their work is appreciated.

Just one more thing
As you travel and see areas of excellence, whether in healthcare or some other industry, make a mental note to see how that excellence could be translated to better care for your patients. Feel free to contact me at and share your ideas.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast