Can the right message further reduce missed appointments?Topic: Healthcare
Patients missing appointments is a big problem for the NHS. Called ‘DNAs – Did Not Attend’ by the NHS, they’re costly and inefficient.
Missed GP appointments cost the taxpayer £162m and missed hospital appointments cost £750m. BBC News
Where adopted, sending SMS texts to remind patients of their appointment, has reduced the ‘DNA rate’ by as much as 30%. Let’s look at a few examples:
“The service has demonstrated a reduction in the number of patients not turning up for their outpatient appointments from 23% to 6%.” Doncaster and Bassetlaw NHS
“SMS texts sent to patients two days before a booked appointment reduced the DNA rate by an average of one in three.” Central Middlesex Hospital
However, the overall impact on the NHS is nothing like as marked:
This chart illustrates the DNA rate for first appointments (light blue) and subsequent appointments (dark blue) from 2008 to 2015.
While the rate’s dropping for subsequent appointments, it’s not for first appointments. The narrative provided by the NHS states:
Did not attend rate for first appointments for 2015/16 was 9.0% compared to 8.9% for 2014/15. NHS QAR Commentary
Why is this data so markedly different from the use cases quoted above? Well, not every NHS Trust is utilising SMS to remind patients of their appointments, and it’s reasonable to conclude that they won’t be enjoying the drop in DNAs that Trusts and other NHS organisations who’ve deployed this technology are.
But there’s also evidence that what you write in your SMS has a dramatic impact on whether the patient will turn up for their appointment or not.
The message is critical
A task team from the Department of Health, Imperial College London, and The Behavioural Insights Team experimented with four different messages, sent to over 20,000 patients, to see if there was any change in DNAs as a result.
To cut a long story short, yes, there was, as this table illustrates:
The ‘specific costs’ message informed the patient that their failure to attend their appointment would cost the NHS £160 – and it resulted in reducing the number of missed appointments by almost 25%.
As a result, the task team deduced that if this technique was used in every NHS Trust, there’d be 400,000 fewer missed appointments every year.
This evidence shows that the right message transmitted through the right medium can have a massive impact: reducing costs, empowering patients, and giving doctors and nurses more time to provide care.
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