Your clinic's no-show policy

49 minutes ago

5 min read

Dear colleague,

Your clinic almost certainly has a no-show policy. You may not have written it down, you may never have decided what it should look like, and it probably gets used several times a week by people who do not know they are using it.

How it came to be

Follow an ordinary appointment through your clinic's daily routines.

The patient is in the chair and needs to come back in four months. Whoever books finds a time, writes it on a card and hands the card across the desk. It is neat and tidy, it gives the receptionist a feeling of good service, and it is how it has always been done.

The day before the appointment the system sends a reminder. That it goes out the day before and not three days before was settled on the day the system was installed. Maybe by a vendor, maybe by an employee who no longer works at the clinic. Nobody has looked at that field since.

The patient does not come. The chair sits empty for forty-five minutes. If it can be done, another patient is moved up, and otherwise the time goes to whatever is always waiting in the sterilization room and the office.

When the patient calls again, she gets a new appointment. Nothing is said about the time she did not use, because whoever answers the phone does not know whether she is allowed to.

The third time, somebody says something. What gets said depends on who is holding the phone and on how the day is going otherwise. One employee says it kindly, and then nothing more happens. The other lets the patient hear that this is the third time.

That is your clinic's no-show policy.

It was built over a couple of years, everyone follows it loyally, and nobody has actively decided a single part of it.

Nobody has done anything wrong

Your team is doing exactly what they were set up to do. The rule about the reminder was set once, and nobody has asked for it to be adjusted. Nobody has been told what should happen at a first no-show, so they do what feels reasonable that day. Nothing about that is wrong. What is missing is a decision. Nobody has pointed out to you that making it is your job.

The solution I tried first

At the end of September a Norwegian trade journal wrote about a political proposal to let public dental services charge a fee to young adults who do not show up. I mention it because the fee is the solution most of us reach for first. Time at the chair never comes back, and it is expensive, so it feels right to put a consequence on the patient who left us waiting with an empty and costly chair.

I tried it myself. One of my first mistakes as a new clinic owner was introducing a no-show policy that we sent out with the recall cards.

The problem with that method is that the wrong patients feel targeted. The patients who ought to think twice usually never read the clinic's cancellation policy at all. The ones who read it carefully are the ones who always turn up, and they experience it as a warning they do not feel they have earned.

That cost me patients before I learned to do it differently.

A second consequence is harder to spot.

When the clinic tells its patients indirectly that so many people stay away that a policy is now needed, we signal at the same time that this is ordinary behavior among people like the ones we are writing to. As human beings we mirror the crowd, and the crowd here is the clinic's other patients. So my well-meant attempt to get fewer no-shows simply gave me more.

The same goes for the bill. Even when we waive the fee after a good conversation, the damage is done, and we have spent some of the trust our whole profession rests on. I learned that the hard way. I see no reason for you to do the same.

What works instead

Let the patient write her own appointment on the card. That is all.

She has already said yes to the time, and the moment she writes it down herself it becomes her own decision instead of the clinic's service. That alone reduces cancellations and no-shows by up to 18 percent.

Then ask for the promise.

Tell the patient why the appointment matters for her mouth in particular, and then ask whether she will call at least two days ahead if something urgent gets in the way. Wait for the answer. She has to say "yes, I promise" herself. That sentence is the reason she calls instead of staying away.

Then put the right number on the wall.

Instead of advertising the rule for the two percent who do not keep their appointments, you can put a sign by the exit thanking the 98 percent of your patients who turn up at the agreed time.

Check your own number and write that one. This sets off the same behavior, herd mentality, that gave me more no-shows, just used in a way that produces the result you want.

The decision takes twenty minutes

You do not need to buy a new booking system, and you do not need to spend a staff meeting on behavioral psychology. You need to write three sentences and pass them on.

The first is, how an appointment is booked and confirmed.

The patient writes it herself, and she is asked for the promise.

The second is, what happens at a first no-show.

Who calls, when, and what she says. My recommendation is a call where somebody asks whether the patient is okay and offers her a new appointment. That signals care, and underneath it signals that you only cancel if something is really wrong. It is a completely different conversation from the one where she gets told something.

The third is, what happens with the small group who never arrive on time.

My own answer is to call them and say that it is hard to make our two appointment books fit together, so we will do it the other way around. You get a reminder when it is time, and on a day when you can come, you call in the morning and ask if we have an opening. Then they fill gaps instead of making them.

Finally, set aside five minutes to find out when your reminder goes out and who decided it. The answer surprises most owners I ask.

If you have not decided what happens when a patient does not come, you have now made an active decision anyway. You have decided that it gets settled by whoever picks up the phone, on the day she happens to be holding it.

Think about what your clinic told the patient the last time somebody did not come.

And who decided that?

The policy nobody wrote

The reminder is one of the places where a habit has taken a decision's seat. Training a new employee is another, and I will write more about that over the fall.

Would you like a friendly reminder when a new post goes up? Sign up below and I will send you a link one to four times a month, and if you get tired of reading about clinic optimization, patient communication and marketing, you can unsubscribe with one click without me taking offense.