No Show is a leading driver of falling facility utilization, reduced availability and lower profitability
We service providers run tightly planned, fully booked calendars. We give customers an appointment far in advance so they can secure a slot that suits them, and then.. they do not turn up.. sometimes they call at the last minute to cancel, and in most cases they simply fail to arrive.
The phenomenon is familiar across every service world that is bound by time or by a facility. In sectors that run complex calendars – hospitality, hotels and restaurants, treatment services such as cosmetics and spa, and of course healthcare – No Show is a leading driver of falling facility utilization, reduced availability and lower profitability.
Every missed appointment carries consequences.
First, the provider’s time and the facility stand idle and unused: the physician’s time, the hotel room, the treatment room. The whole service envelope and its infrastructure were prepared in advance: administrative staff had already pulled the medical file, the restaurant bought its supplies against a forecast occupancy, and housekeeping had made up the room to the guest’s specification.
Time, money and materials are spent before the visit even begins. There is also a broader consequence for the availability of our services: the slot was held on the calendar, and for that entire period it could not be offered to another customer.
How do you deal with it, and what do you actually do? The approaches we know divide into several levels, each with its own set of actions.
This article deals with the level of No Show prevention. Further articles in the series will cover identifying a cancellation in time and rebooking the slot, and managing a No Show forecast and overbooking
So how do you prevent No Show
- Reducing the likelihood of non-attendance by building Engagement with the customer
Investigate why customers fail to appear and the reasons differ from sector to sector. In healthcare, for example, the known reasons are:
- On the substantive level, the problem has passed. The patient is no longer in pain and feels no need for treatment. At this same level, anxiety about learning a test result also drives avoidance, and with it a cancellation or a missed appointment.
- The customer had no way of getting there –the customer wanted and planned to come, but an unexpected traffic jam, public transport that never arrived and so on kept him away. Where we know this is a common problem, alternative ways of reaching the clinic can be arranged, such as shuttles from central pick-up points, a contribution toward a taxi fare and so on.
- The customer cannot afford to continue the treatment – a customer sometimes starts a course of treatment and decides part-way through that he cannot carry the cost. If we identify the problem, then helping patients understand their insurance plans, what they owe for particular services, and which treatment they need as against which treatment they can defer, will build deeper trust with them. When patients know they have a partner who sees things from their side and looks after their interests, and the more clearly they grasp what forgoing a given type of care actually means, the more committed they feel to attending and the more seriously they take the appointment.
- The customer forgot the appointment – the usual answer here is of course the reminder. Our work has shown that reminded customers do not all behave the same way. A customer who did not respond to a reminder is about as likely to miss the appointment as a customer who received no reminder at all. So if you run reminders, make the process interactive and require an active response from the customer.
Why not tell the clinic? There are two answers:
The customer tried to cancel but could not reach us by phone – if it genuinely matters to us to hear about a cancellation in time, we have to let the customer cancel conveniently and accessibly. That contact is also an opportunity: if the cancellation comes early enough, we can book a new appointment, or at least establish why the customer is not coming and address it.
Surveys show that the patient does not regard a missed appointment as anything unusual or significant – patients have a great deal of interaction with the health system and are required to deal with it constantly these days, but they do not know what they do not know. It is quite possible that most patients have no idea what a missed appointment costs the clinic.
Raising awareness, as in other areas, turns out to reduce the non-attendance rate as well.
Add the right script when the appointment is booked, or the right wording to the reminder message, along the lines of: you have been given an appointment in a much sought-after slot; it matters to us that you let us know if you cancel, so that another patient can be treated sooner. Wording of this kind raises awareness and improves the share of cancellations notified in advance.
- Reminders timed to customer behavior
Studies we have run across different sectors show that the likelihood of non-attendance can, to a degree, be estimated from various attributes of the appointment and of the customer. The reminder format, and the resources invested in it, can be set according to that likelihood – a live human reminder, for instance, for appointments with a high probability of a No Show.
We also found reminders more effective when they are sent at two separate points, with the timing depending on the gap between booking and the appointment itself. Reminders scheduled and tailored to the type of customer, the appointment time and the type of service raise the odds of preventing non-attendance, or at least of securing advance notice of a cancellation that allows the slot to be used.
- Payment up front, or a charge for cancelling
Buy a ticket to a show and fail to turn up, and you usually get no refund. Travel works the same way: cancellation fees or non-refundable rates are the norm, customers are used to them and accept the extra cost in order to lock in the service at the time they want.
In food service, medicine and personal treatment, a paid cancellation policy is less accepted and meets resistance. Even so, a financial incentive against non-attendance can still be created – for example, a standard price that permits cancellation and a reduced price (a discount) for committing to an appointment that cannot be cancelled.
Our work has also shown that services carrying some form of advance payment commitment – even simply handing over a credit card number when booking a restaurant table – create a level of commitment in the customer and lower the non-attendance rate.
No single approach fits every organization and every type of service. Run local research into the reasons for non-attendance and the reasons cancellations go unreported, and fit the solutions and the actions to your customer types, your services and the environment you operate in.
