The Exceptional Practice · Daily Brief10 November 2026

Costco Keeps One Small Promise. Your Clinic Can, Too.

Four ways to make one promise patients can check, keep it every time, and change the work behind it when it gets hard.

What you’ll take away
The problem
When a patient waiting for a biopsy result has nothing she can check, silence turns into worry, and whether anyone calls depends on who remembers.
What to remember
Keep one small promise patients can check, every single time. When it gets hard, change the back office, not the promise.
What to do differently
Promise every biopsy patient contact by a stated day, with a status call if the lab is late. Track it every week, and never let the promised day delay a ready result.

Waiting for a biopsy result is hard, and silence makes it harder. A patient has a spot on her back biopsied on a Monday. At checkout she hears, “We’ll call you when it’s back.” Nine days later she has heard nothing, so she calls. The scheduler can’t see the pathology status and promises a call back that doesn’t come that day. Nobody broke a rule. Nobody had made her a promise she could check. One small promise, kept every single time, gives a waiting patient something solid to hold. Costco’s $1.50 hot dog shows how to keep one for decades.

The shopper says: “Still a buck fifty?”

The food-court worker says: “Same as always.”

At the counter of a plain, unbranded warehouse-store food court, a smiling food-court worker in a sage-green polo, dark-brown apron, clear gloves and a plain dark cap hands a paper tray across the steel counter. The tray holds a hot dog with mustard and a lidded paper cup with a straw. A middle-aged shopper with short grey curls, tortoiseshell glasses and a rust cardigan takes it with one hand, her other hand resting on the counter, and smiles knowingly.

One small promise anyone can check. A hot dog and a soda at the same price for about forty years.

The operations lead says: “Our costs are up again on this one.”

The manager says: “The price stays. Let’s change how we make it.”

In a small, plain back office, an operations lead with auburn hair, reading glasses pushed up on her head and a grey cardigan holds out a page showing one rising line with no words or numbers, looking concerned. At the other end of the same desk, which holds a closed laptop and a green mug, a manager with greying temples in a navy quarter-zip looks at her calmly with a slight smile, his open hand raised as he answers.

Hold the price. Change the work. When keeping the promise got hard, the pressure went to the back office, not to the price.

The plant supervisor says: “Our own line is running.”

The manager says: “And the price out front stays put.”

In a clean food-production room with stainless tanks and white tile, a bearded plant supervisor in a white coat, hairnet, beard net and blue gloves rests one hand on the rail of a conveyor and opens the other toward rows of plain hot dog sausages moving along the line. The same manager from the office, now in a white coat over his navy quarter-zip, with a hairnet and blue gloves, stands with his hands clasped and smiles quietly.

Fix it behind the counter. Costco built its own plant to make its hot dogs, so the change happened in the work, not in the price.

Illustration of the practice described below, not of real people or events. Dialogue is illustrative.

At Costco food courts in the United States, a hot dog and a soda had cost $1.50 together since the mid-1980s, news reports said in 2024 and 2025. That is about forty years at one price.1, 2 It is a small thing, and Costco’s leaders treat it as a big one. In a 2018 talk, Craig Jelinek, then Costco’s chief executive, said a rise to $1.75 would barely dent sales. The reason to hold the price, he said, is what comes to mind when people think of Costco: the $1.50 hot dog. “It’s the mindset.”3

Keeping it got hard. In the same talk, Jelinek recalled going to Jim Sinegal and telling him, “we can’t sell this hot dog for a buck fifty,” because Costco was losing money on it. In Jelinek’s telling, Sinegal’s reply ended with three words: “Figure it out.”3

So Costco changed the back office instead of the price. Jelinek said Costco built its own plant to make its Kirkland Signature hot dogs, and later opened another one in the Chicago area.3, 1, 4 He credited the constraint itself: because the price could not rise, Costco had to find another way, and that discipline led it to make its own hot dogs.3

And a new leader said it plainly. In May 2024, on his first earnings call as chief financial officer, Gary Millerchip used his opening remarks to clear up media speculation: “I also want to confirm the $1.50 hotdog price is safe.”6

The parts work together. The promise is small enough for anyone to check at the counter. Holding one price for forty years means every rise in cost has to be met somewhere other than the price, again and again. Because the price cannot move, the pressure goes to the operation, which changes when the promise needs it. A new leader says it again in plain words. The promise stays still so the work can move.

Principles of Excellence

4 Exceptional Practices for your Clinic

  1. Choose one small promise patients can check, and say it the same way every time. Costco’s promise is one item at one price that anyone can check at the counter, and Jelinek said its value is the mindset it creates. A promise that small can be kept every time, and a patient can tell that it was. When a patient has a biopsy, the clinician leads the consent discussion and gives the date in your clinic’s approved words: “You’ll hear from us by Thursday the 20th. If the lab isn’t finished by then, we’ll still call to tell you and give you a new date.” The medical assistant writes the date on the after-visit summary and reads it back. The practice manager and the medical director pick a day the clinic can keep in its busiest week. The consent form records how the patient prefers to hear; if results can reach the portal before the call, the script says so and gives a number to call. The promised day is the latest contact, never a reason to wait: results go out as the clinician instructs, earlier whenever the clinician judges it right.
  2. Keep it every time before adding anything extra. Costco held the same $1.50 for about forty years, news reports said in 2024 and 2025. In experiments with students and online volunteers, a broken promise was judged worse than a kept one, and an exceeded promise was judged no better. So the first effort goes to never missing. Every Friday, the lead medical assistant who owns the pending-biopsy log reports two numbers at huddle: patients contacted by their promised day, and the time from the clinician’s sign-off to the patient being told. The second number keeps the promise from ever becoming a hold point. If anyone was missed, the practice manager fixes that first, before anyone proposes extras such as an early-call list. Telling a patient a ready result is clinical care, not an extra. It never waits for the log to be clear.
  3. When the promise gets hard, change the back office, not the promise. When Jelinek reported losses on the hot dog, Sinegal, in Jelinek’s telling, told him to find a way, and Costco built its own plant. With the promise fixed, the pressure goes to the work, where it can be solved. When the Monday biopsy rush starts pushing calls past the promised day, the lead medical assistant flags it from the log, and the practice manager changes the work: a protected results hour each afternoon, a second medical assistant cross-trained on the log, and status-call scripts the clinicians have approved. The fix adds time or removes waste; it does not ask the same two people to stay late. A status call follows that approved script and gives status only: the lab isn’t finished, and here is when the clinic will call again. Urgent results go to the clinician at once. If the promise truly can’t be kept, the clinic changes it openly and tells patients.
  4. Say the promise again, plainly, whenever people change. In May 2024, on his first earnings call as chief financial officer, Gary Millerchip opened by confirming that the $1.50 price was safe. A promise lives in what people say out loud, and newcomers learn what never changes from what leaders say plainly. When a new medical assistant, scheduler or physician joins, the practice manager tells them the biopsy promise in their first week, word for word, and why it exists. Each newcomer says it aloud once before working a first biopsy clinic. When a patient calls about a result, the scheduler gives the same promise and passes any question about the result to the nurse or the clinical team.

Explore the Evidence Further

Explore the Evidence Further. All 15 sources, with methods, findings and clinic applications

Fifteen sources, grouped by kind of evidence: Costco executives’ own words, news reports and Costco’s annual report, experiments on keeping and exceeding promises, studies of how results reach patients in primary care and dermatology, and US federal guidance on releasing results. Each row gives the design and its main caution, the key finding, why it matters and a way to apply it. Study names link to the original sources, and the full references close this section. None of these sources studied a promise in a dermatology clinic, so every application is our proposal, not a tested intervention.

The Costco practice: executives’ own words

Study or sourceSetting, design and sampleKey findingWhy it mattersHow to Apply It to Your Derm Clinic
Matthews, “Costco CEO Craig Jelinek on Shareholders, Costco.com, and Hot Dogs”3Excerpts of a talk: 425 Business, 18 April 2018, printing excerpts of Jelinek’s remarks at an Issaquah Chamber of Commerce luncheon on 12 April 2018, when he was Costco’s chief executive. Excerpts, not a full transcript; the company’s own account. The conversation with Sinegal is Jelinek’s undated recollection; no other witness account was found, and this brief gives no date. The editor’s bracketed note placing the first plant in Los Angeles is not Jelinek’s wording. Read from a preserved copy of the page; a live reopening in November 2026 was refused by the site.Jelinek recalled telling Sinegal that Costco could not keep selling the hot dog at $1.50 because it was losing money, and said Sinegal’s reply, as printed, was profane and ended by telling him to find a way; the story above quotes only its last three words. He said Costco built its own plant to make Kirkland Signature hot dogs and later opened another in the Chicago area, and credited the discipline of not raising the price. He said a $1.75 price would barely dent sales, and that what matters is the mindset the $1.50 hot dog creates. He also said the price still earns a fair return; other reporting disputes that, so this brief does not say whether the combo makes money.It is the primary printed source for the promise, the strain and the fix, in the words of an executive who was there. The mindset remark is his opinion, not a measured demand response.Proposed: fix the promise first, then let the strain push changes into how the work is done, such as the biopsy results workflow.
Costco Q3 fiscal 2024 earnings call transcript6Earnings call transcript: Call of 30 May 2024, as transcribed by The Motley Fool, not Costco’s official transcript. Executives’ own statements to analysts. Read from a preserved copy.Chief financial officer Gary Millerchip, on his first call in the role, opened by clearing up media speculation: the hot dog would stay at $1.50. Chief executive Ron Vachris said Costco moves into making its own goods “as the need arises,” citing the hot dog story; the chicken plant came when supply would not meet demand and no partner would expand; and Costco does not integrate simply because it can.It shows the promise restated in plain words at a leadership change, and back-office change described as a response to need.Proposed: restate the clinic’s promise, word for word, whenever people change, and change the workflow only where the promise needs it.

The price, the plants and Costco today: news reports and the annual report

Study or sourceSetting, design and sampleKey findingWhy it mattersHow to Apply It to Your Derm Clinic
Ivanova, “Costco CFO promises the hot dog and drink combo will never cost more than $1.50”1News report: Fortune, first published 1 June 2024; the version read is a September 2025 republication that relies partly on earlier interviews and other outlets’ reports. Independent reporting, not a company document.Reports that the combo has held at $1.50 since the mid-1980s, and that Costco’s own hot dog plant went up outside Los Angeles. Accounts of the first plant differ: USA TODAY says “a plant in California”4, and Wikipedia names Tracy, California, and a second plant in Morris, Illinois5. Wikipedia is used here only to show the disagreement.Independent reporting confirms the long run of the price and the in-house plant, while the details of place and date stay unsettled.Proposed: choose a promise small enough to keep for years, not one that depends on a good week.
Treisman, “Costco hot dogs have cost $1.50 since the 1980s”2News report: NPR, 4 June 2024. Secondary reporting of company statements and earlier coverage.Reported in June 2024 that the combo had sold for $1.50 ever since it was introduced in the mid-1980s. Outlets differ by a year on when it began, so this brief says about forty years and gives no starting year.A second independent outlet agrees on the decades, not the exact year.Proposed: state the promise exactly, and keep claims about it no bigger than the record.
Costco Wholesale, Form 10-K for fiscal 202615Annual report (regulatory filing): Costco’s annual report for the year ended 30 August 2026, filed 7 October 2026. Company-reported, company-wide figures; renewal is a trailing measure defined by the company. Membership section and financial passages read, not the whole filing.When fiscal 2026 closed, 92.3% of members in the US and Canada renewed, and 89.8% across all countries; both rates matched fiscal 2025. The filing names Ron Vachris as Costco’s president and chief executive.Costco’s members were still renewing at high rates in late 2026, with the same chief executive on record. These are company-wide figures for paid members and do not measure any effect of the hot dog.Proposed: judge the clinic’s promise by its own process numbers, not by how well the clinic is doing overall.

Keeping versus exceeding a promise: experiments

Study or sourceSetting, design and sampleKey findingWhy it mattersHow to Apply It to Your Derm Clinic
Phillips, “Don’t bother doing more than you promised”7Experiments (university summary): Chicago Booth Review, 17 November 2014, summarizing Ayelet Gneezy and Nicholas Epley’s 2014 experiments with hypothetical, recalled and real promises, mostly with student and online samples. The puzzle study had 60 undergraduates in a laboratory. Read as the university’s summary of its own faculty’s research, not the full paper. Searches found no replication and no correction. The authors “postulate” that the pattern extends to business settings; extending it to patients is our inference. It says nothing about the order or timing of clinical results.Breaking a promise was judged worse than keeping it, but exceeding a promise was not judged better than keeping it. When concert seats were worse than promised, ratings fell; better seats did not raise satisfaction or willingness to recommend. In the puzzle study, students whose partner had pledged to solve 10 puzzles were no happier when the partner solved 15, and judged the partner to have worked no harder.It suggests where improvement effort pays first: in not missing, before extras.Proposed: fix overdue contacts before adding extras, and never hold a ready result for any reason.

Getting results to patients: primary care and dermatology studies

Study or sourceSetting, design and sampleKey findingWhy it mattersHow to Apply It to Your Derm Clinic
Choudhry and colleagues, “Patients’ Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods”8Survey: 301 English-speaking adult patients and 47 physicians at UCSF, Penn and Duke melanoma clinics, surveyed July 2012 to July 2013; published 2015. Abstract only. Preferences may have shifted as patient portals spread.67.1% preferred a telephone call from their physician for skin biopsy results. The most important consideration was speed: 51.7% wanted the most rapid method. 40.5% would want a different mode if the result were malignant. The authors suggest using the consent form, at the time of biopsy, to ask how each patient wants to hear, and note that state rules on online release varied.Patients waiting for a biopsy result put speed first, and preferences differ by person and by result.Proposed: record each patient’s preferred way to hear on the consent form, and keep the promised day as the latest contact, never the planned one.
Conlon, Kearney and Alani, “Patient and clinician perspectives on test result communication in dermatology”9Survey: 100 outpatients and 25 clinicians at one Irish dermatology centre, May to June 2025; published 2026. Small sample, not US. Abstract only.73% of patients rated how quickly they hear a result as “very important.” 59% said the way they would like to hear would change if the result were abnormal rather than normal. For an abnormal result, 64% of patients and 60% of clinicians wanted to meet in person.A recent dermatology sample also puts speed first, with preferences that change with the result.Proposed: never let the promise slow a ready result; let the clinician decide how an abnormal result is delivered.
Casalino and colleagues, “Frequency of failure to inform patients of clinically significant outpatient test results”10Observational study: Record review of 5,434 patients chosen at random, all 50 to 69 years old, in 23 US primary care practices; published 2009. Abstract only. An association, not proof that the process causes the difference. Not dermatology. A published erratum corrects author contributions, not results.7.1% of abnormal results (135 of 1,889) were apparently not communicated to the patient or not documented, ranging from 0% to 26.2% between practices. Better result-management processes were associated with fewer failures (odds ratio 0.68; the abstract does not state the unit). Practices with partial electronic records had higher failure rates.Whether a result reaches the patient goes with how the back office manages results, and that can be measured.Proposed: give every pending biopsy an owner and a due-by contact date in one log.
Rajan and colleagues, “Technology-Based Closed-Loop Tracking for Improving Communication and Follow-up of Pathology Results”11Observational study: 48,515 skin biopsy orders placed by 20 dermatology providers and sent to 8 labs in one US health system, 2016 to 2017, comparing orders tracked with radio-frequency (RFID) tags against untracked orders. Abstract only. The authors write that tracking “considerably improved” timeliness; the design is observational, so we treat it as an association. It tested RFID tracking specifically, not an ordinary clinic log.Tracked orders reached all five milestones, from provider receipt to patient notification and case closure, at higher rates and 3 to 5 days sooner (hazard ratios 1.3 to 4.9).It is the closest dermatology evidence that tracking pathology results goes with faster patient notification.Proposed: track every biopsy through to patient contact, without expecting a simple log to match these figures.

Releasing results: US federal guidance

Study or sourceSetting, design and sampleKey findingWhy it mattersHow to Apply It to Your Derm Clinic
ONC, “When would a delay in fulfilling a request for access, exchange, or use of EHI be considered an interference?”12Federal guidance (FAQ): US Office of the National Coordinator for Health IT, FAQ IB.FAQ22.1.2021MAR, last updated 12 September 2025. Guidance, not regulation text; determinations are fact-specific; US only; state law not researched; not legal advice.A clinic-wide rule that holds back lab results, even briefly, so the ordering clinician can look first or tell the patient in person before the patient can see them online would probably count as interference. A hold that state law requires is unlikely to count, as long as it lasts only as long as the law needs.A service promise has to fit how results already reach patients; it can never justify holding them back.Proposed: write the promise around your actual portal release, and never delay portal access to protect a call.
ONC, “Would the Preventing Harm Exception cover a ‘blanket’ several day delay on the release of laboratory or other test results?”13Federal guidance (FAQ): FAQ IB.FAQ33.1.2021JAN, last updated 14 September 2025. Guidance; fact-specific; US only; not legal advice.A blanket hold on routine results falls outside the Preventing Harm Exception. What can fall inside it is a judgment the ordering clinician makes in good faith about one particular patient’s risk.Any decision to delay one patient’s result belongs to the clinician, case by case, never to a clinic-wide rule.Proposed: leave any individual timing decision to the ordering clinician and the clinic’s compliance process.
ONC, “Can an actor grant a patient’s request to delay the release of a patient’s test result(s)?”14Federal guidance (FAQ): FAQ IB.FAQ45.1.2022FEB, last updated 12 September 2025. Guidance; fact-specific; US only; not legal advice. Whether a given clinic’s electronic record can honor such requests was not researched.Honoring a patient’s own request to hold back their results is likely not interference. The guidance looks at, among other things, whether patient and provider agreed on when, or on what condition, the results would be released (for example, once the clinician has reviewed them), whether that was met, and whether the hold lasted longer than it needed to.A patient may choose to wait for a call; the clinic may not choose that for her.Proposed: route a patient’s own request to wait for the call through the clinic’s compliance process, never a clinic-wide hold.

Across all fifteen sources:

  • None studied a promise in a dermatology clinic. The clinic practices and today’s action are our proposals, not tested interventions.
  • The Costco story rests on executives’ own words and news reports. The exchange with Sinegal is one executive’s undated recollection; the start year and the first plant’s location differ by source; whether the combo makes money is disputed.
  • The promise experiments used mostly student and online samples and were read as a university summary; no replication was found.
  • The primary care and dermatology studies were read as abstracts. The surveys are small, and the tracking and process studies are observational associations.
  • The federal guidance is US only, fact-specific and not legal advice; state laws and any clinic’s own record system were not researched.

Principles of Excellence: related evidence from other settings

The main text explains Costco’s practice in plain English. These sources describe it or study related ideas elsewhere; none measured what the promise does for Costco.

Point in the briefRelated evidence
One small promise anyone can check.The price’s long run (news reports; the start year differs by source).1, 2 Jelinek on the mindset (excerpts of a talk; his opinion).3
The price holds; the work changes.Jelinek’s recollection and the in-house plant (excerpts of a talk; one executive’s undated memory).3 The plant reported independently, with differing locations (news reports).1, 4
Say it plainly when leaders change.Millerchip’s first call as chief financial officer (earnings call transcript).6
Keeping counts more than exceeding.Broken promises were penalized and exceeded promises earned no extra credit (experiments, mostly student and online samples; university summary).7

Our clinic suggestions: proposed, not tested

The four practices and today’s action are our suggestions for a dermatology practice, not a tested program.

SuggestionWhat it draws on
One small promise patients can check: contact by a stated day, given by the clinician at the biopsy visit and written on the after-visit summary by the medical assistant, with a status call if the lab is late and approved wording that fits the portal.Jelinek on the mindset (excerpts of a talk).3 Patients put speed first (surveys, abstracts only).8, 9 Delaying results so a clinician can tell the patient first would likely be an interference (federal guidance).12, 13 The clinic scene is an illustration, not a documented case.
Keep it before adding extras: two numbers from the pending-biopsy log every Friday, and missed contacts fixed before any extras.Keeping versus exceeding (experiments, student and online samples; university summary).7 Better result-management processes went with fewer missed notifications (observational study, primary care; abstract only).10
Change the back office, not the promise: a protected results hour, a cross-trained second medical assistant and clinician-approved status scripts.Jelinek’s recollection and the in-house plant (excerpts of a talk).3 Tracked biopsy orders reached patient notification sooner (observational study, RFID tracking; abstract only).11
Say it again when people change: the promise, word for word, in every new team member’s first week.Millerchip’s first call as chief financial officer (earnings call transcript).6
One action today: ask what biopsy patients are told about when they will hear, and draft one promise they could check.No study tested this one-day step; it applies the same pattern. A patient’s own request to wait for a call is handled through compliance, never a clinic-wide hold (federal guidance).14

Sources

  1. Ivanova I. Costco CFO promises the hot dog and drink combo will never cost more than $1.50. Fortune. 26 September 2025 (version of a story first published 1 June 2024). fortune.com
  2. Treisman R. Costco hot dogs have cost $1.50 since the 1980s. Here’s why prices aren’t changing. NPR. 4 June 2024. npr.org
  3. Matthews T. Costco CEO Craig Jelinek on Shareholders, Costco.com, and Hot Dogs. 425 Business. 18 April 2018. 425business.com
  4. Guynn J. How Costco’s inflation-proof $1.50 hot dog deal became an icon. USA TODAY, via The Spokesman-Review. 19 November 2025. spokesman.com
  5. Wikipedia contributors. Costco hot dog. Wikipedia. Accessed 10 November 2026. wikipedia.org
  6. Costco Wholesale Q3 fiscal 2024 earnings call transcript, 30 May 2024. The Motley Fool. fool.com
  7. Phillips DJ. Don’t bother doing more than you promised. Chicago Booth Review. 17 November 2014. Summary of Gneezy and Epley’s 2014 experiments on keeping and exceeding promises. chicagobooth.edu
  8. Choudhry A, Hong J, Chong K, Jiang B, et al. Patients’ Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods. JAMA Dermatol. 2015;151(5):513-521. doi:10.1001/jamadermatol.2014.5634. PubMed
  9. Conlon OJ, Kearney N, Alani A. Patient and clinician perspectives on test result communication in dermatology. Ir J Med Sci. 2026;195(1):145-148. doi:10.1007/s11845-025-04154-5. PubMed
  10. Casalino LP, et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med. 2009. PMID 19546413. PubMed
  11. Rajan SS, Baldwin JL, Giardina TD, Singh H, et al. Technology-Based Closed-Loop Tracking for Improving Communication and Follow-up of Pathology Results. J Patient Saf. 2022;18(1):e262-e266. doi:10.1097/PTS.0000000000000759. PubMed
  12. Office of the National Coordinator for Health IT (ASTP/ONC). When would a delay in fulfilling a request for access, exchange, or use of EHI be considered an interference under the information blocking regulation? FAQ IB.FAQ22.1.2021MAR. Last updated 12 September 2025. healthit.gov
  13. Office of the National Coordinator for Health IT (ASTP/ONC). Would the Preventing Harm Exception cover a “blanket” several day delay on the release of laboratory or other test results? FAQ IB.FAQ33.1.2021JAN. Last updated 14 September 2025. healthit.gov
  14. Office of the National Coordinator for Health IT (ASTP/ONC). Can an actor grant a patient’s request to delay the release of a patient’s test result(s) without implicating the information blocking regulations? FAQ IB.FAQ45.1.2022FEB. Last updated 12 September 2025. healthit.gov
  15. Costco Wholesale Corporation. Form 10-K for the fiscal year ended 30 August 2026 (filed 7 October 2026). US Securities and Exchange Commission, EDGAR. sec.gov