The Carhop Problem: What Sonic and McDonald’s Are Teaching Healthcare About Dismantling Your Own Advantage

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07/28/2026|The Healer Revolution|

Years ago, as a proud recipient of the Michael Hutton Memorial Scholarship, I attended an annual recognition dinner hosted by Oklahoma City University. Seated at the table were Troy and Dollie Smith — the couple who, in 1953, turned a Shawnee, Oklahoma root beer stand called Top Hat into what became Sonic Drive-In — along with Cliff Hudson, who would lead the company for a quarter century.

I grew up in Oklahoma. My grandparents lived in the town next door to Shawnee. Sonic wasn’t a business school case for me; it was the sound of an intercom crackling on a summer evening, a tray hooked to a rolled-down window, a carhop who brought it out with a smile. And there were small plastic animals riding on your drink — a giraffe, a monkey, an elephant, and others — dropped in for no reason a ledger could defend. It cost Sonic something on every cup. It generated no line of revenue. And decades later, I can still see it. In fact, I still have one.

Hold onto that giraffe. It matters more than it looks.

Troy Smith didn’t invent fast food. He built an experience — angled stalls, covered parking, intercom ordering, service delivered to you — and that experience compounded into a national brand. Which is why Cliff Hudson and Craig Miller’s recent analysis of Sonic’s decline reads, to me, less like business commentary and more like a warning shot aimed directly at healthcare.

Because we are running a similar play. And we’re further along than we’re comfortable admitting.

The Sonic Lesson: Misclassifying Your Advantage

Hudson and Miller’s core argument is precise: when Inspire Brands acquired Sonic, leadership correctly credited the brand’s scale, franchise model, and menu — but misclassified the drive-in service model as operational complexity to be streamlined rather than the core value proposition powering the entire flywheel.

The efficiency logic was internally coherent. Reduce stalls. Cut carhop labor. Shift volume to highermargin drive-thru windows. Standardize across the portfolio. Every one of those moves showed up as savings on a spreadsheet.

But the modeling was incomplete. It captured supply-side costs with precision and ignored demand-side economics entirely — customer preference, visit intent, traffic elasticity, the emotional gravity of the experience itself. Loyalty. The analysis assumed customers would simply transfer from drive-in to drive-thru without any erosion of affinity.

They didn’t. By Hudson and Miller’s account — Sonic has been privately held since the 2018 acquisition, so the public sees only what insiders describe — the decline is now in its fifth consecutive year, and the brand that once defined an experience now, in the words of one major franchisee they cite, “looks like Arby’s with a better drink menu.”

Jim Collins, in How the Mighty Fall, argues that great companies rarely collapse from external shock. Decline is self-inflicted, unfolds in stages, and begins when leaders lose sight of — or never correctly understood — why the flywheel worked in the first place. Once you misidentify your competitive advantage, every subsequent decision is built on a false foundation.

Or, put the way I keep coming back to: the spreadsheet counted the carhops. It never counted what they meant.

The McDonald’s Contrast: When Standardization Is the Strategy

McDonald’s presents the opposite case — and in some ways the more unsettling one, because it’s working.

McDonald’s hasn’t accidentally eroded a differentiated experience. It has deliberately engineered one out. Kiosks, app-based ordering, AI drive-thrus, and the now-familiar gray-box restaurant design are the strategy: maximum throughput, maximum consistency, minimum labor variability. The financial results have validated the approach — same-store sales growth, margin expansion, and analyst narratives recasting the company as a tech-infused franchise platform.

But look underneath the quarterly numbers and the demand-side signals are flashing:

  • In a 2025 Harri survey of roughly 1,000 U.S. adults, 97% rejected fully automated guest interactions, and nearly a third reported having avoided a restaurant at least once because it felt “too automated.”
  • Software Advice’s 2024 global consumer survey found 67% rate human-centered service in restaurants as “very important.”
  • Roughly 60% of consumers still prefer interacting with human staf, per industry analyses — and a meaningful share actively avoid experiences that feel like vending machines.

Customers will tolerate automation of the transaction. They resist automation of the relationship — especially in emotional or problem-solving moments. Sociologist George Ritzer named this pattern decades ago: “McDonaldization,” the drive toward efficiency, calculability, predictability, and control that rationalizes an institution while hollowing out its human core.

Here’s the strategic distinction that matters: Sonic is being criticized for losing what made it special. McDonald’s has decided standardization is the point. Both are converging on the same destination — the experience as a machine — from opposite directions.

Now ask the uncomfortable question: which path is your health system on? And did you choose it, or drift into it?

Healthcare Is Already Running This Play

Ritzer’s framework was applied to medicine years ago — by Ritzer himself, who co-authored “The McDonaldization of Medicine” with neurologist E. Ray Dorsey in JAMA Neurology, warning that efficiency, calculability, predictability, and control threaten the patient-physician relationship. This isn’t a hypothetical risk; the man who named the pattern saw it coming for us a decade ago. Walk through the parallels:

We’re cutting our carhops. Nursing ratios stretched to the mathematical limit. Environmental services, food services, patient transport — the roles that generate thousands of daily human touchpoints — treated as line items to compress. When Sonic cut carhops, the spreadsheet called it labor savings. When we do it, we call it workforce optimization. The math is identical, and so is the blind spot: the model prices the cost of human presence and assigns zero value to what that presence produces.

We’re routing patients to the drive-thru window. Portals, kiosks, chatbots, self-scheduling, asynchronous everything. Much of it genuinely valuable — I am not arguing for less technology. But notice the pattern: we are systematically shifting patients from high-connection channels to high-throughput channels, and our models assume affinity transfers with them. Sonic’s owners made exactly that assumption.

We’re measuring calculability and calling it quality. Door-to-doc times, RVUs, length of stay, patients per session. All necessary. But when the measurable crowds out the meaningful, clinicians learn that the system values what it counts — and the sitting-down conversation, the remembered name, the unhurried explanation quietly exit the operating model. Research on the rationalization of healthcare finds physicians reporting precisely this: efficiency systems stripping out the best parts of practicing medicine.

We’re building gray boxes. Not just architecturally — operationally. Standardized encounters, scripted interactions, interchangeable experiences across sites. Predictability has real clinical value. But there’s a line where consistency becomes sterility, and patients feel it long before it shows up in a metric.

The deepest parallel is the one Hudson and Miller name for Sonic: leadership hasn’t failed to see the deterioration — declining loyalty, workforce exodus, eroding trust in institutions — it has misdiagnosed it. We treat burnout with resilience modules, patient dissatisfaction with service scripts, and turnover with sign-on bonuses. Symptom management, while the flywheel keeps losing momentum. That is Collins’s Stage 3, denial of risk and peril, described almost verbatim.

The Diagnostic: Five Questions for Healthcare Leaders

Before your next efficiency initiative, run it through the Sonic test:

  1. What is our carhop? Which human elements of our care experience do patients actually choose us for — and would our current financial model even detect their removal before the damage was done?
  2. Is our economic modeling complete? Does the business case capture demand-side effects — loyalty, trust, return intent, word of mouth, workforce retention — or only supply-side savings?
  3. Are we standardizing a system or dismantling a ritual? McDonald’s standardized a system it built for that purpose. Sonic dismantled a ritual it didn’t understand. Know which one you’re touching.
  4. What can’t our competitors copy? Technology and facilities are replicable. A culture where people are treated as persons — patients and staff — is not. Are we compounding that advantage — or cashing it out?
  5. Who is telling us the truth? Hudson learned about Sonic’s misdiagnosis over lunch with a franchisee. Your equivalent is a charge nurse, a hospitalist, a unit secretary. When did leadership last ask them what’s actually being lost?

Revolution as Return

Here is where I depart from the case studies, because healthcare has something the restaurant business doesn’t: our “product” was never the transaction. It was always the relationship. Healing has been a human-to-human act for the entire history of our species. The efficiency era didn’t create that value proposition, and it cannot replace it — it can only support it or strangle it.

This is the central conviction behind The Healer Revolution: the revolution healthcare needs is not an advance toward something new but a return — a deliberate restoration of the completed cycle of giving and connection that made this work a calling before it became an industry. Sonic’s flywheel, Hudson and Miller insist, is not broken beyond repair; it can be restarted by rebuilding the core elements that made the brand great. The same is true for us, with stakes immeasurably higher. Nobody’s grandmother is on the line at a drive-in. In our buildings, she is.

Efficiency is necessary. Margin is oxygen. But the moment we start treating the human beings in our buildings — patients and healers alike — as units of throughput rather than persons, we have misclassified our competitive advantage. And every decision after that is built on a false foundation.

Troy Smith understood something in Shawnee in 1953 that our industry is at risk of forgetting. People don’t return to a transaction. They return to a place where someone brought the tray to them — and every so often, for no reason a spreadsheet could ever defend, sent along a little plastic giraffe they’d remember for the rest of their lives.

What’s the plastic giraffe in your organization? Find it. Then guard it with everything you have.

I’d genuinely like to hear yours. Share it in the comments, or reach me through HealerRevolution.org.

Sources & Further Reading