The New Health Care Front Door

How To Reduce Patient No-Shows?

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

In the previous section, we learned:  

  • How patient no-shows is a recurring problem in dental practices
  • The different problems, threats and challenges that are facing private practices today
  • Practitioners’ perspective on why patients don’t come
  • Patients’ perspective on why they don’t come
  • Finally, we learned why patient no shows is not the actual problem 
  • And, we also learned why no shows is a result of multiple inefficiencies 

In this section, let’s dig further and take a look at the different reasons why patients don’t show up for their appointments and perform a root cause analysis of no-shows. 

In addition, let’s also take a look at how to eliminate these inefficiencies so you can start reducing no shows and grow your practice. 

Root Causes Of No-Shows

As we discussed in the previous section, there is no one specific reason for no-shows. 

Patients miss their appointments for multiple reasons, as shared by both practitioners and patients, as summarized in the table below.

Practitioners' Perspective Patients’ Perspective
Unable to take off work
Emotional barriers (afraid of pain or bad news)
Lower socioeconomic status
Perceived disrespect of the patient’s beliefs and time
Loss of Pay
Distrust and lack of understanding of the scheduling system
Weather
Too sick to come
Fear of treatment & pain
Forgetfulness
Lack of education
Transportation issues
Lack of health IQ
Family and employer obligations
Lack of insurance
Long wait time
Unable to afford treatment
Weather
Past trauma
Financial problems
Patient forgetfulness
Lack of coverage
Followup & front desk inefficiency
-
Expensive treatments
-
Lack of doctor trust
-

All these inefficiencies, individually or together, prevent patients from showing up for their appointments. 

In fact, these inefficiencies not only result in no-shows, but they also create the barriers to healthcare. 

But, before we learn about how these inefficiencies create barriers to healthcare, let’s organize the different root causes of no-shows visually using a “Fish Bone Diagram.”


The FishBone Root Cause Analysis

When tasked with solving a problem, brainstorming potential causes is a good place to start. 

However, without a way to organize the information visually, it can be hard to see how different aspects of the problem interact.

One visual method of root cause analysis that helps do just that is the fishbone diagram.

The FishBone diagram, also called an Ishikawa diagram, is a root cause analysis method that allows you to visualize and organize potential causes of a problem into a usable framework for solving it. 

As you can see in the image above, at the mouth goes the problem itself. 

Each of the bones feeding into the spine of the fish represents a specific category of potential contributors to the problem.

So, a fishbone diagram root cause analysis not only helps us to get to the root cause, but it also helps us to categorize the causes so we can better understand the root causes and create frameworks to solve the problem. 

Now, let’s use the fishbone diagram to categorize and visualize the different root causes of no shows. 

As you can see in the diagram, no shows by and itself is not the problem. 

Instead, no shows is a result of multiple root causes and inefficiencies that fall into different categories as below. 

1. Environment related reasons such as:

  • No transport 
  • Weather condition 
  • Parking space 
  • Distance

2. Equipment related reasons such:

  • Phone being switched off
  • Voicemail being full

3. Method related reasons such as: 

  • Inappropriate calling time 
  • Communication barrier 
  • Lack of knowledge on scheduling system
  • Waiting too long for appointment 
  • Lack of self scheduling options 
  • Contacting non-suitable caregiver

4. People related reasons such as: 

  • Lack of insurance
  • Affordability
  • Being seen in private
  • Language barrier 
  • Feeling lazy or unmotivated
  • Patient’s health improved
  • Patient missing phone calls
  • Unable to contact the patient 
  • Patient not interested in the appointment

The Barriers To Healthcare

Further, the above root causes can be grouped into 3 different types of inefficiencies as below. 

  1. System inefficiencies
  2. Human inefficiencies
  3. Societal inefficiencies
All these inefficiencies, individually or together, create a “Wall of Barriers” to healthcare. 
 
They act as the building blocks of the wall (or barrier) that prevents patients from receiving the care they need from their providers, as shown in the image below. 

This wall or the barrier is the reason why the healthcare system has so many problems and challenges. 

And, the wall is the reason why private practices face problems such as:

  • Patient no-shows
  • Lower case acceptance
  • Not generating enough new patients
  • Patient attrition rates
  • Increased workload
  • Declining income 
  • Burnout and stress 

So, How To Reduce No Shows?

As you might have guessed by now, if you want to reduce no shows, you first need to eliminate as many inefficiencies as possible. 

However, the problem is, we can’t eliminate all these inefficiencies because some of them are beyond our control. 

For one, dentistry has been separated from medicine. 

And, the dental insurance industry, federal and state programs and policies have been created on the separation of dentistry from medicine. 

This has resulted in so many societal inefficiencies that are beyond our control. 

It’s the responsibility of the government and the policy makers to solve some of the societal inefficiencies. 

However, using proper systems and software, you can definitely eliminate most, if not all, of the inefficiencies. 

Eliminating Inefficiencies To Reduce No Shows

Now, let’s compile all the different reasons that both patients and practitioners provided for no shows and discuss if and how to eliminate them. 

Root Cause Possible Solution
Unable to take off work
Unable to take off work
Lower socioeconomic status
Beyond your control
Loss of pay
Teledentistry, Mobile dentistry
Weather
Teledentistry, Mobile dentistry
Fear of treatment & pain
Teledentistry, Mobile dentistry
Lack of education
Patient education
Lack of health IQ
Patient education
Lack of insurance
Payment plans, Membership plans
Lack of insurance
Payment plans, Membership plans
Unable to afford treatment
Payment plans, Membership plans
Past trauma
Dental IQ & Awareness
Patient forgetfulness
2 way, automated booking & appointment reminder system
Followup & front desk inefficiency
2 way, automated booking & appointment reminder system
Expensive treatments
Expensive treatments
Lack of doctor trust
Create patient doctor trust & relationship
Emotional barriers (afraid of pain or bad news)
Dental IQ & Awareness
Perceived disrespect of the patient’s beliefs and time
Listening to patients’ opinion & attending them without making them wait for long
Distrust and lack of understanding of the scheduling system
2 way, automated booking & appointment reminder system
Lack of self scheduling options
Online self scheduling system
Too sick to come
Beyond your control
Transportation issues
Teledentistry, mobile dentistry
Family and employer obligations
Teledentistry, mobile dentistry
Long wait time
Schedule patients same day or at least same week
Weather
Teledentistry, mobile dentistry

As you can see in the above table, there are so many interventions you can take to eliminate the various systems, human and societal inefficiencies. 

The list of inefficiencies might look exhaustive. 

But, they basically create 3 different types of barriers to healthcare as below:

  1. Communication Barriers
  2. Commute Barriers
  3. And, Cost Barriers

Your goal as a private practice is to identify the different communication, commute and cost barriers and work towards eliminating them.

Here's What To Do Next

And, if you’re interested in eliminating the various communication, commute and cost barriers in your practice, here’s how we can help you. 

At the New Healthcare Front Door Incubator, we help private practices setup systems, tools and campaigns to help them eliminate the various communication, cost and commute barriers to they can: 

  • capture more patients without spending additional money on marketing
  • increase their case acceptance without becoming salesy
  • and double their production without needing to hire a marketing company
I’m not sure if this is for you, but, if you’re interested in eliminating the inefficiencies so you can start growing your practice, then, check out our “The New Healthcare Front Door Incubator” program where we help our private clients eliminate these inefficiencies and help them grow their dental practices. 
 

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