The New Health Care Front Door

Patient No Shows: Root Causes, Inefficiencies & Systems Failure

This is Part 1 in a free 3-part training series. Part 2 (root causes of no-shows) is here, and Part 3 (reducing no-showshere

No, We want to stop” said Dr. Humphrey Ho, DDS from Austin 3D Dental from Texas. 

We keep calling. They either don’t show up or return our call”, he further added. 

Dr. Ho was one of our clients at American Implants Association, a nationwide network of dental implant practices I was building as a tech startup back in 2018, while pursuing my graduate degree at the University of Arizona in Tucson.  

Our goal at the American Implants Association network was to help people restore their missing, failing or broken teeth with dental implants in North America.

To achieve the same, we partnered with dental implant practices in each city, ran marketing campaigns to generate new implant inquiries from interested patients, and connected these patient leads with implant practices associated in our network.

As one of our clients, we were generating new implant inquiries for Dr. Ho in and around Austin by running implants awareness and marketing campaigns. 

We Keep Calling. They Either Don’t Show Or Return Our Call

Our campaigns targeted patients that were actively looking to replace missing teeth in Austin, educated them on implants and provided them self scheduling options to request a complimentary implants consultation with him. 

29 people had scheduled their appointments with Dr. Ho for a complimentary implants consultation in the first month. 

All these prospective patients go through a followup system that includes call, text and email based campaigns.  

This way, we can be sure that the patients are well educated about the consequences of not replacing missing teeth, the different options available, and also on why implants are the best long term solution to replace missing teeth. 

By the time the patients meet Dr. Ho for their scheduled appointment, we made sure they are already aware of how important it is for them to replace their missing teeth, and why implants are the best investment in the long term compared to other options. 

Out of the 29 new appointment requests, I thought, at least 3 to 5 of them must have accepted treatment plans and become paying patients for Dr. Ho. 

Even if each implant patient is worth $3000, I thought Dr. Ho must have made at least $10,000 or more in implants revenue from his investment of $1,500 with us. 

So, I was naturally excited that he must be happy with the results from the first month. 

But what I was about to hear from him when I reached out for the second month membership renewal was unexpected. 

He said, “No, We want to stop”. 

It was not what I expected. 

He wanted to stop the campaigns. 

He continued adding, “We keep calling the patients. They either don’t show up or don’t return our call.”

Is There A Way To Tweak Or Reduce No Shows?

But, this was not the first time I was hearing this. 

There were a few other clients who also complained that most of the new patient inquiries either don’t show up or they are of bad quality. 

Whenever I heard this complaint previously from other clients, I thought the practice must have an inefficient patient followup process, or their front office staff were not properly trained to assist patients, and that the dentist needs to improve their sales process. 

However, neither the dentist nor the staff are in the car sales business. 

They don’t need to use high pressure sales and marketing tactics to follow up and make patients buy the treatment. 

So, when Dr. Ho said that he wants to stop our services, it was disappointing as a graduate student who was trying to build a startup from the University of Arizona. 

At the same time, unlike any other previous clients at that time, Dr. Ho asked me, “Is there a way to tweak it and reduce no-shows?” 

That was something no one asked me before. 

In fact, it made me want to explore the “Patient No Shows” problem much deeper and find out if and how we can reduce patient no shows.

Therefore, I proposed a graduate research thesis on “Reducing Patient No Shows” to my graduate committee, as part of my final semester, back in Spring 2019, as you can see below.

It Was Like Opening A Can of Worms

Before I started working on the thesis, I thought creating an appointment scheduling system would reduce no shows. 

But, as I started learning more about why patients don’t show up for their appointments, I came across more and more problems, inefficiencies and barriers to healthcare.

It was like opening a can of worms. 

We came across various systems, human and societal inefficiencies and failure that prevent, restrict or stop patients from receiving the care they need. 

I will share with you about these inefficiencies that we identified in a few minutes.  

But, this research study would later result in a 9 months graduate research thesis on “Reducing Patient No Shows” funded by the University of Arizona, and later by the National Science Foundation. 

Before we get into the details of the research work, I want to introduce you to systems thinking principles which we extensively used in our study – so you’re able to easily understand what you’re going to learn from this 3-part free training series.

Applying Systems Thinking Principles

As an immigrant entrepreneur, I started my Graduate program with the University of Arizona under the Systems & Industrial Engineering department, in 2018. 

We extensively study Systems Thinking principles to understand how things influence one another within a whole.  

As per systems thinking, everything that we have ever known is a system

The human body is a large system made up of smaller systems. 

We have the digestive system, respiratory system, immune system etc. 

They are systems that work together in one larger system but each carry out their own purpose. 

This results in something where the sum is greater than the reports. 

In nature, systems thinking examples include ecosystems in which various elements such as air, water, movement, plants, and animals work together to survive or perish. 

In organizations, systems consist of people, structures, and processes that work together to make an organization healthy or unhealthy. 

As systems engineers, we are trained to approach problem solving, by viewing “problems” as parts of an overall system, rather than reacting to specific parts, outcomes or events and potentially contributing to further development of unintended consequences.

Developing An I.P. To Reduce Patient No Shows

So, when Dr. Ho asked me if there’s a way to reduce no shows, I wanted to understand the “No Shows” problem as part of an overall system, rather than only looking at “No Shows” individually. 

One of the main objectives of our thesis was to extensively study no shows, it’s root causes, time and financial impacts to practices.

More importantly, this 9 months research thesis was aimed at studying available literature, interviewing practice owners, associates and managers. 

Finally, we developed an I.P. to reduce no-shows, implemented them in dental practices, studied the results and then submitted the findings and reports to my graduate committee.

For my work on reducing no-shows, I was also awarded as the Student Innovator of the year for 2020 by the University of Arizona. 

In addition, our research project on “Reducing Patient No Shows” was also funded by the National Science Foundation (NSF), an independent agency of the United States government that supports fundamental research in science and engineering.  

NSF funded us via their I-Corps program to help us expand our research work out of the University to build products and services to reduce no-shows which is a pressing problem in the healthcare industry. 

No Shows Is Not The Problem

On average, clinics, systems, and practices are experiencing a no-show rate around 18.8 percent

That is 1 out of every 5 of your appointment slots end up becoming “not reimbursable”. 

And, every time a patient doesn’t show, practices lose about $150 in lost revenue. 

An average dental or a medical practice loses about $150,000 in total lost revenue per provider. 

This is not even considering the high cost of appointment cancellations. 

In fact, studies conducted on the impacts of missed appointments have reported that no shows cost the U.S. healthcare industry $150 Billion each year. 

More importantly, by not showing up for their appointments, patients not only fail to receive the care they need. 

But, they also prevent another patient from receiving the care they deserve by blocking the schedule of the provider in addition to wasting human and financial resources.

Given the scale and magnitude of the impacts, it’s imperative that no shows are reduced, if not eliminated, in private practices and healthcare in general. 

But, before we learn how to reduce no shows, we first need to take a look at what causes no shows. 

As I mentioned previously, problems are, in most cases, simply symptoms of different root causes, in an overall system. 

Therefore, rather than viewing “No-Shows” as a specific problem, let’s dig deeper and take a look at the different root causes, inefficiencies and system failures that result in No Shows in Part-II of this series. 

Click Here To Read Part-II Now.