Those Darn No-Shows

by Pamela Weisse
Coleman Associates

It’s another busy day at the clinic. You look at the schedule for the doctor you’re working with today and your hair just about stands on end. Who’s responsible for this mess? She has three patients scheduled for 8:15, two for 8:30 and another two for 8:45. The morning is in a shambles. How will everyone get through it in one piece? It seems impossible!

But then, as the morning evolves, it’s not as bad as it looks. There’s a whole hour, in fact, when none of the appointed patients show up. As a matter of fact, about half the scheduled patients never make it in to the clinic, and most didn’t even call to cancel. You’re able to fill in some of the open slots with walk-ins, but the morning feels so chaotic, and there aren’t enough walk-ins to make up for all the no-shows.

What’s happening here? Patients who don’t show up for their appointments wreak havoc with a clinic day. And the problem of no-shows just compounds itself. No-shows eat up appointment slots that could have been used for patients calling in and asking to be seen that day. Often the no-shows are rebooked for another appointment, so, in effect, two slots are consumed per patient, making the wait for new appointments that much longer. And to compound matters even more, you’re forced to double and triple book the same appointment slot to try to make up for the high no-show rate.
In clinics all around the United States we see no-show rates that vary from 10% to 60%.

In clinics all around the United States, whether they’re community health centers or hospital ambulatory clinics, we see no-show rates that vary from 10% to 60%.

What to Do?

One clinic in New York City had a great idea for how to tackle this issue. The physician, Dr. Reddy, a pediatrician, is very popular with patients and has trouble keeping up with the demand. She’s booked four months in advance. She always has walk-ins who want to see only her—they won’t accept anyone else.

Her medical assistant, Rosie, and the front desk person, Karen, had a brilliant idea. They collared Dr. Reddy during her administrative time and all three sat down and reviewed her patient schedule, one clinic session at a time, for the next two weeks. For each patient with an appointment, they pulled the medical record to see the reason why the child was coming in.

About 25% of the time, they found the patient didn’t need to be seen at all.

It was very illuminating—about 25% of the time, they found the patient didn’t need to be seen at all. In some cases, the child had been seen recently, for a cold or sprain, for example. While the child was there, the well child check was done and immunizations were given, so now the child didn’t need the appointment that had been booked two months ago. In other cases, when an appointment was made to follow up an acute illness, the parents of the child could simply be called to see if the condition had resolved. Other times, the parents had taken the child elsewhere because the wait to get in was so long, but had kept the appointment with Dr. Reddy “just in case.”

What Rosie, Karen, and Dr. Reddy found out was that they could eliminate a significant number of appointments—sometimes three or four a session—by this systematic review of the schedule. This freed up slots for patients wanting same-day appointments.

When Rosie and Karen called the parents of the patients who didn’t really need to be seen, the parents were thrilled to be told they didn’t need to bring their children in.

How easy was that!

A No-Show Playbook

Well, there are lots of strategies to lower your no-show rate. We’ve developed a No-Show Playbook to provide clinics with a set of “plays” to use in reducing no-show rates. (You can find it in Tools You Can Use in the Techniques section of this website.)

What is a Play?

What is a play, you might wonder? A play is a specific set of moves a Patient Care Team (or bunch of people in a clinic) can try to achieve results that are different from what usually happens. They’re a new set of “tricks” which you can use to solve old, vexing problems. That’s actually what Rosie and Karen came up with—a “play” to reduce no-shows. But theirs is not the only tactic you can use—there are many more in the Playbook.

How Do We Use This Playbook?

Keep the playbook handy and look at it often. Try various plays. If a play works and it makes sense to keep using it, then keep using it. If it doesn’t work in your setting, then try another play until you find some tactics that can make inroads into your no-show rate.

Try these plays. And come up with some of your own!

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