The longer the lead time, the higher the risk of no-show
The longer the lead time for patients, the higher the risk of no-shows. What we see in practice is that patients often out of necessity shop for the earliest possible appointment, but do not cancel the other appointments they made in the meanwhile.
Patients frequently do not show up for their appointment with a healthcare provider. To patients this problem is hardly visible. Even for healthcare providers the problem is of a latent nature. At least, that’s what we see in practice: healthcare providers just lack the – both quantitative and qualitative – data in regard to no-shows.
Both the lead time and no-show rate depend on the type of healthcare provider. Healthcare providers with whom a patient schedules an appointment the day itself or the day before, which is typical for general practitioners, will most likely suffer low no-show rates, whereas dentists for instance are exposed to higher no-show rates as the lead time is a lot longer.
Lead time is the time between the time of scheduling the appointment and the actual occurrence of the appointment.
In Belgium a lot of healthcare providers cope with extensive waiting lists. It concerns particularly dentists, ophthalmologists, dermatologists, gynaecologists and other physicians-specialists. The longest lead time we’ve encountered in Belgium amounts to 12 months!
Given that healthcare providers are faced with high no-show rates, this leads to absurd situations where both healthcare providers and patients lose time.
Lead time and no-shows have a reinforcing effect
The easiest way to explain this is with an example.
Let’s say a patient wants to schedule an appointment with a dentist. The secretary of dental practice A says the earliest available moment is within 4 months.
A bird in the hand is worth two in the bush. So the patient schedules the appointment. But of course, the patient isn’t really keen on waiting 4 months. So the patient calls dental practice B, where he could book an appointment within 3 months.
And so on, and so on. Until the patient finds a dental practice Z who could see him the day after. He finally books this appointment, shows up for it (hopefully), but will not cancel all the other appointments – this takes way too much effort.
So the longer the lead time, the more likely patients will make several appointments whereas the patient will only show up for one. In turn, the more no-shows, the longer the lead time.
No-shows are a complex problem caused by a multitude of factors. The good news is: due to scientific insights and technological advances we are able to create solutions that can copy with such complex problems like no-show behaviour and (the lack of) therapy adherence.
Lead time is just one facet of the no-show problem
It’s important to see that long lead times are just one explanation why no-shows occur. There are a number of reasons why patients do not show up for the appointment. Downsizing the problem to the hectic lives we lead and the fact that we just forgot the appointment, would just be too blunt. It would reduce no-shows to a simple problem with a simple solution. Often patients are well aware of their appointment, they’re just not motivated to show up or cancel their appointment in a timely manner.
No-shows are a complex problem caused by a multitude of factors. And as is the case with all complex problems, they require a complex solution. An online scheduling tool sending one-size-fits-all reminders via email or text message will not solve the problem.
People are complex creatures, who need a highly personalized approach – instead of a mass-produced, one-size-fits all approach.
So in regard to no-show behaviour, you’d first have to have a clear view on which patients present no-show behaviour and why.
Secondly, you’d have to understand who the patient is and how you should approach him/her. You’d have to address the patient with an adequate message in an adequate tone through an adequate channel. Only then will you be able to relate to the patient, and be able to motivate him/her.
But there's good news too! The insights from behavioural sciences and the technological advances enable us to create solutions that can cope with complex problems such as no-show behaviour and therapy adherence (or better, the lack thereof).
How long is the lead time you incur? Would you agree that it reinforces the number of no-shows you encounter?
 J.B. Norris, C. Kumar, S. Chand, H. Moskowitz, S.A. Shade, D.R. Willis (2014). "An empirical investigation into factors affecting patient cancellations and no-shows at outpatient clinics", Decision Support Systems, 57, 428-443.