How to avoid no-shows: friendly policies for your patients
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Summary: No-shows are a common nuisance to dentistry practices – surveys show they can add up to 10% of all appointments!¹ No-shows happen when patients don’t come to their scheduled appointments, without notifying staff or canceling. This phenomenon hurts both clinical practices and patients, through many negative impacts. So let’s see how you can identify high-risk patients and greatly minimize missed appointments.
Why no-shows happen and who is most at risk
It may seem that these days, thanks to the many communications channels available like e-mail, texting, cell phones, automatic reminders, etc., it shouldn’t be difficult to cancel or honor an appointment. And yet no-shows keep happening, so which factors are at play?
Can you predict which patients are at high risk?
Many studies 2 3 4 have tried to predict no-shows and reveal that patients miss appointments for a variety of reasons. While some factors are linked to patients’ negative perceptions of the healthcare system, others are related to their socio-economic status.
Many factors are tied to external circumstances and patient history. It goes without saying that those who have previously missed appointments indicate a much higher risk of a no-show. You can reasonably expect the following situations to hinder compliance with appointment keeping:5 6 competing work or meetings, lack of available transportation and geographical distance from clinic, related patient health issues (pre-existing conditions), appointments made by others than the treated patient, low appointment urgency, first appointments, long intervals between appointments.
Personal perceptions play a big role
Negative emotions: fear of pain, anxiety, overwhelmed, etc.
Distrust, or perceived disrespect from the healthcare system: waiting times, staff treatment, feelings of being ignored, etc.
Confusion or misunderstanding about the scheduling system
5 tips to deal with specific no-show situations
We recommend you to do some in-house research, to identify which groups of patients are not honoring their appointments – as it can differ from one practice to another. As for some high-risk situations, you can implement specific protocols to fit each patient group or demographic. A few examples:
Some patients may have financial constraints or no insurance coverage. Offer these patients financing plans in order to combat no-shows.
Hire multilingual and multicultural staff when possible; this will improve the patient experience for international people or non-native-speakers.
To reach younger patients, reinforce your social media presence. You can also use social media for patient support and outreach.
Prioritize phone calls for older patients and use their preferred communication channels.
Reinforce reminders and communications for people who may lack a support system.
Did you know?
Certain personality types are more prone to no-shows: controlling and performing types.7 Have your staff learn to identify types to communicate more effectively. And don’t forget that new patients have no personal relationship with you yet. Extending a personal welcome after their 1st visit could ensure they return.
Negative impacts of no-shows: everybody is concerned8
Disruption and heavy financial impact: unpredictable schedules and non-optimized booking means idle time, “chair time” loss with potentially less patients, so less business (losing up to thousands $ a year9). As a result, practitioners are forced to charge more for their services, so other patients lose as well.
Reputation impact: ignoring no-shows can hurt your reputation, as word gets around that patients are not honoring appointments, it can cause widespread unreliability.
Patients’ health is jeopardized in the long run: delaying their treatment can cause future complications, and patients who wait are more likely to need expensive emergency care later on. Dentists agree that prevention is key, so it’s important for everyone involved to minimize no-shows.
Try these 4 approaches to prevent and avoid no-shows
Some practices have gone to extreme lengths to discourage no-shows. No-shows are a hindrance of course, but the goal for dentists is to set firm boundaries, all while maintaining a friendly practice and without alienating their patients. You can never fully eliminate them, but you can implement new practices and focus on preventive measures to strongly minimize no-shows. Of course, all of these tips depend on your practice’s policies and your personal relationships with patients.
Digitize your administration and implement clear policies
Multiple and automated reminders: implement an automatic confirmation protocol in the days leading up to the appointment (and leverage different channels)10. Invest in an SMS/text system to avoid using up too much manpower. You can also ask patients to confirm their appointment.
Set up electronic forms for patient intake: patients who fill out forms in advance are much more likely to come. 11
Hybrid system: Set up your practice to accommodate same-day/short-notice appointments, on top of pre-appointments. (Organize tools and keep stock ready in advance, account for extra time, etc.)12
Quick rescheduling is not permitted. Ex: missed appointment can only be rescheduled after 2 weeks. This creates a “demand” for appointments.
Write and share a clear cancellation or “broken appointment” policy and explain the impact on your business.
Better communication to get patients invested13
Educate patients: Explain procedures as you go and answer any questions. Offer brochures, etc. And go over all the details before a patient leaves the clinic.14
Create “value”: You can implement different methods of internal marketing to establish your practice as valuable for your patients.15
Talk patients out of canceling if they don’t give immediate valid reasons and offer alternative solutions (financing, etc.)16
Be empathetic when real emergencies and accidents do happen to keep patients from showing up.
Leverage new solutions for pain management and single-session treatments
Invest in innovative dental products to improve patient experience and lessen pain, which will reduce chances of no-shows from fearful patients. You can use ergonomic syringes, high-quality needles, or biocompatible solutions for minimally invasive procedures. Painless procedures also improve your overall reputation.
Use versatile products that let you adapt treatments according to patients’ profiles and attendance history. For instance, using Biodentine practitioners can do a Bio”bulk-fill” procedure, where they use only one material to fill the cavity. This helps to easily and quickly treat at-risk patients, sometimes in one setting when the case allows it.
Create a specific system for unreliable patients
Have scheduling coordinators or assistants call personally to confirm. Or train scheduling coordinators to learn what works best for each patient.
Put repeat offenders on a separate scheduling system. EX: Put them on a “quick call” list – to check their availability the day of cancellation. Try to schedule them during challenging slots – Don’t fill up “prime time” slots with unreliable patients.17
Ask for a financial “deposit” to schedule appointments. Patients forfeit the deposit if they don’t show up!18
How effective are strict policies and penalties?
Studies and testimonials show that strict measures and financial penalties usually aren’t worth your time. You could charge a fee for broken appointments or threaten to charge patients after too many missed appointments – even if you don’t intend to. This works best for repeat offenders but be warned that this method rarely works. You risk making patients angry and being stuck with unpaid fines. No one likes to lose patients, but many dentists will prefer to deregister a patient from their practice after too many no-shows.19
 McGuire, Jen. No More No-shows. Dentaleconomics.com – Jan 17, 2014. Accessed June 2, 2021.
 Bedford, Lydia & Weintraub, Collin & Dow, Alan. (2020). Into the Storm: a Mixed Methods Evaluation of Reasons for Non-attendance of Appointments in the Free Clinic Setting. SN Comprehensive Clinical Medicine. 2. 1-7. 10.1007/s42399-020-00585-6.
 Lacy, Naomi L et al. Why we don’t come: patient perceptions on no-shows. Annals of family medicine vol. 2,6 (2004): 541-5. doi:10.1370/afm.123
 Parsons, Joanne, Bryce, Carol and Atherton, Helen. Which patients miss appointments with general practice and the reasons why: a systematic review. British Journal of General Practice 2021; 71 (707): e406-e412. DOI: https://doi.org/10.3399/BJGP.2020.1017
 Pfeifer, Erika. Oh no! A No-Show! Why Patients Don’t Show Up For Appointments, and How to Reduce Patient No-Shows. equiscript.com. Accessed June 2, 2021.
 Toland, Bill. No-shows cost health care system billions. Post-gazette.com. Published Feb 24, 2013. Accessed June 2, 2021.
McGuire, Jen. Ibid
 Long, Ryan. Reducing the cost of cancellations in your dental practice. Dentistryiq.com. Published July 24, 2015. Accessed June 2, 2021.
 Levin, Roger P. 3 ways to reduce no-shows in your dental practice. Dentistryiq.com. November 26, 2018. Accessed June 2, 2021.
 RevenueWell. 6 Ways to Eliminate No-Shows at Your Dental Practice. revenuewell.com. Accessed June 2, 2021.
 McGuire, Jen. Ibid
 McKenzie, Sally. How to reduce cancellations and no-shows and grow the bottom line of your dental practice. Dentistryiq.com. Published July 20, 2015. Accessed June 2, 2021.
 Levin, Roger P. Ibid
 Colicchio, Heather. Handling dental patient cancellations and no-shows. Dentistryiq.com. Published May 17, 2018. Accessed June 2, 2021.
 Colicchio, Heather. Ibid.
 Du Molin, Jim. Dental Management Survey: How Do You Handle Missed Appointments? Thewealthydentist.com. Accessed June 2, 2021.
 Du Molin, Jim. Ibid