How to reduce appointment no-shows

No-shows and cancellations aren't the same thing

Count them separately from day one, even though both leave you with an empty room.

If somebody cancels a Wednesday appointment on Monday, you've got half a problem: the slot is free and there's time to offer it to somebody else. If they simply don't turn up, you lose the whole hour and you find out too late to do anything.

This matters most once you start measuring. When you switch reminders on, the first thing that happens usually isn't that fewer people miss appointments — it's that some of the people who were going to miss now tell you. Count both in the same box and you'll see a number that barely moves, and conclude it did nothing.

Why people miss appointments

The easy answer is that they don't care. It's almost never that. When you actually ask, no-shows tend to break down like this:

• They forgot. By far the most common. A slot booked three weeks ago is competing with everything that's happened since.
• They wanted to cancel and couldn't work out how. If the only route is a phone call during opening hours — which is when they're at work — then not calling is cheaper than calling.
• They were embarrassed. This one comes up a lot once somebody has already missed once. Saying nothing is easier than explaining yourself.
• They felt better and decided on their own that they didn't need it.
• They booked just in case, a long way out, and by the time the day came round it wasn't relevant any more.

The first three are friction, and friction is what the rest of this article is about removing. The last two won't be fixed by any message. Those are handled at booking, by explaining what the appointment is for and how many sessions people usually need.

What actually works

1. 1

   Give yourself room to rearrange

   A nudge an hour beforehand prevents almost nothing, because by then you can't do anything with the slot. The reminder that earns its keep is the one that lands while there's still time to ring somebody else.

2. 2

   Ask for a reply

   A reminder that only informs doesn't tell you anything; you're exactly where you started. One that can be answered with a tap — yes, can't make it — tells you today what you'd otherwise find out tomorrow at ten.

3. 3

   Make cancelling easy

   We know how it sounds, making the thing you don't want easier. But the person who was going to miss will miss anyway. All you're choosing is whether you hear about it two days out or when the room is empty.

4. 4

   Have somebody to call

   A slot that frees up on Monday is only worth something if you've got somebody to offer it to. Nothing clever required: four names on a sticky note, people who wanted an earlier time and couldn't get one.

When to send it

There's no magic hour, and be suspicious of anyone who gives you an exact figure. It depends on how far ahead people book with you and whether they can shuffle their day at short notice. As a starting point, this tends to work:

• One 24 to 48 hours out. That's the one that leaves you room to re-fill the slot.
• A second one first thing on the day, only for appointments nobody has answered. That one isn't chasing a cancellation, it's stopping people losing track.
• If you work in courses of sessions — rehab, therapy, treatment over several weeks — the pattern changes quite a bit, and it's worth planning separately.

What to write

Keep it short. Whoever reads it is in a supermarket queue, not sitting at a desk. In about three seconds they need to know who's writing, when the appointment is, and what you want from them.

Look at what it does. It gives just enough to decide on, it asks for one thing, and the answer is a tap rather than a sentence. For anything that won't fit in a button — moving the time, say — always leave a way out: a number to ring.

What to leave out: any hint of a telling-off. “Please remember that missed appointments affect other patients” is the fastest way to make sure the next message goes unopened.

How to tell whether it's working

You'll find published no-show rates for almost any specialism, and they vary so much between studies that they're no use for judging your own practice. The only number you can decide anything with is yours, and a pen and paper will get you it.

1. Count for four weeks before you change anything: total appointments, no-shows, and cancellations with more than a day's notice.
2. Change one thing. Move the timing and rewrite the message at the same time and you won't know which one did anything.
3. Count again four weeks later. Look first at how many no-shows have turned into early cancellations, not just at the total.
4. Do it again two or three times a year. This isn't a project that finishes.

Where a tool comes in

All of the above can be done by hand, and plenty of practices do exactly that: somebody on reception sends the messages each morning and notes down who replies. It works well. It stops working when the volume goes up, when that person is on holiday, or when there's a difficult morning and the messages quietly don't get sent.

That's the bit we do. agenda.hokzen reads the appointments from the calendar you already use, sends the WhatsApp reminder at whatever time you choose, and writes back onto the event itself whether the person confirmed or cancelled — so whoever looks at the diary in the morning can see it without asking. It works with Google Calendar today; Microsoft Outlook and ICS, coming soon. You can look at the plans, or try it against your real diary, which is the only way to find out whether it suits you.