Decreasing Patient No-Shows is All About Tight Fists and Open Hands

1 June, 2017

Patient no-shows are a vortex of problems. Costing the U.S. healthcare system more than $150 billion dollars a year on a macro-level, the issue is just as problematic on an individual basis. Each patient who doesn’t show up creates a domino effect of revenue loss for providers. One no-show means another patient was needlessly bumped back to another day, week, or even month, kickstarting a vicious cycle.

Providers have attempted myriad solutions to varying results. Startups have chipped in with innovative apps and tools. Overbooking is a common band-aid and it has proven to help, but is unsustainable. What if the patient just plumb forgot? Appointment reminders seems like an obvious remedy and this has also shown to lessen the problem. But, like all these measures, it’s easier said than done. Should it be over email or a notification on a patient’s smartphone or do clinical workers need to literally pick up the phone and holler at every patient? Revenue regained in a decrease in no-shows would lose a significant chunk to capacity loss in the name of nagging patients to please, show up.

Like most things in healthcare, there is no magic bullet to solve the problem, no one turnkey tool or single behavioral engagement strategy. Providers also can’t just double book patients forever (though it may help), even though filling appointments is very much a part of the equation. And of course, there will always be no-shows for whatever reason no matter how well you attack the problem, but providers need to know that improving patient experience and building trust is the foundation for making headway. To properly begin to address the no-show problem, health systems need pull up to a high-level view and ask themselves two questions:

1) Are we fully embracing transparency with our customers?

2) Are we owning the patient experience as much as we can?

Owning the patient experience and embracing transparency are inextricably (and somewhat ironically) linked. Having “tight fists and open hands” seems like an oxymoron, or like a mind-over-matter meditation mantra, but taking control and being humbly open to critique is actually simpler than health systems think, and the endeavor will bring big returns in profitability. Looking to fill more appointments and decrease no-shows; i.e., achieve new patient engagement nirvana? Here are 3 ways (with some case studies) to get started.

1. Embrace transparency like it’s your childhood teddy bear (that talks to you about how you can treat teddy bears better)

We begin with what is most often the hardest. Health systems and other providers have typically attempted to skip over this crucial step. They have tried to run straight to quick fixes, to reminders and apps, rather than taking a hard look at how their customers view the problem.

One health system in Virginia has broken the mold. After embracing transparency in the form of collecting regular feedback and making reviews public, Sentara has seen massive returns in patient acquisition and increased patient satisfaction scores. Sentara Healthcare and Medical Group is a mid-sized system, consisting of 12 hospitals, over 180 sites and over 30,000 employees. The decision to make feedback public was not only risky from a PR-perspective, but it was a sizable logistical undertaking.

Sentara’s strategy was simple, yet quite brilliant, from a few vantage points. For one, Sentara, like other providers, was already collecting feedback for patient satisfaction scores, so the ball had already started rolling. They already had piles of feedback. It was really just a matter of making them public, but this is the rub: if a provider makes feedback public, they’ll actually have to do something about it. As opposed to merely taking feedback and making strategic internal changes to increase patient satisfaction scores to get regulations off one’s back, honestly embracing transparency means Sentara was committing to constantly improve in the ways their customers want. And fast! Sentara’s newly implemented feedback loop had patients filling out surveys immediately post-visit and they had visibility into service issues within four days.

Exposing what goes on behind the curtain to the world sounds a bit scary, and in some ways it is, but take a deep breath because the ROI is impressive.

It doesn’t take a rocket surgeon or a brain scientist to guess what was mentioned in over half of the comments: wait times. And guess what Sentara did? They improved their wait times. That was just the start. In the first six months of implementation, their medical group saw a 5.5% increase in patient visits, achieving their internal new patient goals by mid-year, and meeting their internal patient experience goals in Q2 for the first time in history. Sentara Urgent Care increased patient volume by 25% with a 6.5% increase in patient satisfaction scores.

What does Sentara’s transparency strategy have to do with reducing patient no-shows? Sentara’s patients requested improvement in categories that so easily overlap with behavioral engagement measures providers attempt as quick fixes to the no-show problem. So why not just fix those things that are obvious? Showing patients a strong listening ear and a desire to improve builds big-time trust.

Embracing transparency for Sentara had the included bonus of publishing their new and improved review scores. Sentara’s customers started giving rave reviews and Sentara marketed them heavily. They began to own their Google search ranking. Patients searching for healthcare online were met with a top search result with a high star rating. Who wouldn’t click? Sentara’s utilization of their newfound customer appreciation invigorated their digital experience. They moved from embracing transparency to owning their digital experience, the next step in our process. For patients who were experiencing Sentara tabula rasa, this public transparency starts new patient engagement on a sure-footed, trustworthy note.

Open hands and tight fists sounding a little bit more doable yet? Stay tuned for part two! We’ll tackle what it means to take control of patient experience, starting with the touch points in the digital channel, and then curating the experience after booking.