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Regardless of cast, color and creed, and irrespective of the flags and tribes, we do owe a due share of contributions towards the society. Undoubtedly, the foremost, is “serving the world indiscriminately to the utmost; with a keen focus over putting finest efforts towards the humanity”. The very same should be of the prime concern – and also obvious – while stating a ‘no show’ policy.

That is accomplished with a patient centric approach; that is drafting a policy that benefits the patients to the fullest, while also discouraging no-shows. “No Show” refers to the cancelled medical care appointments, that despite incorporating best possible practices may be up to 9-10 percent, while the average no show rate is generally as high as 20 percent.

No-Show: Implications & Mitigation

In addition to potential health hazards faced by the patients, missed appointments may cause certain administrative plus managerial concerns for the health care service officials and/or staff. Therefore, these cause serious implications towards the overall quality, hence compromising it significantly.

Being human, on the other hand, holds certain limitations as well, such as family commitments, personal emergencies or any of the unforeseen circumstances – perhaps the patient, at times, may altogether forget the appointment at all. So, keeping in view all this, the policy needs to be fair enough so as to balance the either side i.e., patient and the health-care facility. Putting it simpler, it must be compassionate, yet firm enough to cater for the interests of either end.

Rational Cancellation and/or “No-Show” Policy

Drafting a fair policy is however challenging, yet inevitable; that is, it must be a thoroughly balanced approach -neither altogether causing patient loss by the health care facility, nor compromising the overall facility stakes. Making it simple, it must not penalize the patient in terms of fine/fees so harshly that it may cause the patient to sway. At the same time, it must also ensure to contain the no-shows or cancelled appointments.

Policy Patterns

Therefore, a vast variety of the policies exist round the globe, incorporating friendly policies to the best of practical. Policies are predominantly dependent over the patient base; hence there is no hard-core map for policy development. A “rule of thumb” (a general rule) consisting of several postulates, however, proves to serve in most of the situations. The set encompasses a variety of ‘stick and carrot approaches’ that optimally incentivize as well as deter the patients, so as to meet the aforesaid objectives:

• Penalizing (stick approach)
• Incentivizing (carrot approach)
• Hybrid Policy
• Confinement
• Revertible Penalization

Furthering Elucidation

• Penalizing (stick approach) – incorporated most widely round the globe. The patient pays a fine as per the pre-set ‘Standard Operating Procedures (SOPs)’. As the name depicts, ‘stick approach’ refers to discourage the patients from cancelling the appointments by imposing a cancellation fee, if the cancellation is at the eleventh hour i.e., once the facility is not informed about the cancellation well-in-time. The SOPs refer to the pre-defined rules, stated within the policy and shared with the patients and/or guardians.
• Incentivizing (carrot approach) – one of the most recommended approaches. As the name depicts, ‘carrot approach’ refers to mitigating the cancelled appointments by incentivizing the patients rather than imposing fines. The patient gets rewarded once the scheduled appointments are successfully met. Rewarding may involve:
  • certain discounts
  • cash-backs
  • draws for presents/gifts etc.
• Hybrid Policy – a blend of stick and carrot approaches i.e. penalizing as well as incentivizing.
• Confinement – the patient is neither charged nor incentivized, rather detained to partake certain healthcare sessions that not only deter against future misses, but also indulge useful content / information into the patients’ minds and hearts. The recommended content encompasses health-care awareness and/or setbacks for missing the appointments.
• Revertible Penalization – a fee/fine is charged that is refundable subject to future compliance by the patient. In other words, once the patient recompenses the no-show by rescheduling and subsequent timely arrival, the charged fee is subtracted from the total charges.

A Step Ahead: An optimal “Win-Win” Policy

An inclusive approach is always the best one. So as to curb a problem, the root-cause identification is a must. Making it simple, identifying the prime factor governing a problem is inevitable while solving a problem until its logical end. Hence, a realistic way-out must be there while addressing the policy.

For instance, fear, finances, conveyance and other unforeseen issues are the genuine ones faced by the patients. Similarly, the facility itself faces certain issues at times, like official rescheduling and procedural delays etc. that are ultimately bore by the patients.

Hence, the patient as well as the facility must provide room to each other by means of mutual cooperation. Therefore, ensuring a fair policy draft, not compromising either of the parties (patient and the health facility itself) is indispensable.

No Show Policy: Final Verdict

The ideal way to sort it out is to mitigate misses to the utmost, preferably below 7 percent. A firm, yet compassionate set of SOPs must however stand-by to cater for the misses, if occur at all. Even though, ‘carrot approach’ is always recommended, yet at times, it does not serve the purpose all alone – consequently compelling a sway – hence moving towards the ‘stick approach’.

However, it is ideal to have a blend of two, in case the former does not work; rather than absolutely moving towards the latter. A simple way to accomplish the aforesaid is to devise such a plan that ensures the patient to feel the heat, yet not burning him out thoroughly. That is, penalizing such that it ultimately comes out to be beneficial for the patient himself – with a repeated emphasis over trying hard to avoid the no-shows at all. Having it ensured, the policy may qualify as a ‘rational or fair one’.

• Devise a clear no-show fine policy
• Ensuring repeated automatic reminders
• Way-outs for the patients to get-off the ‘no-show’ list
• Free-pass – providing a fairish room to the patients to address their genuine constraints
• Marking or setting a probationary threshold (which hinders further appointments for a set time-frame to discourage no-shows)

Indispensables

The policy must encompass the ‘musts’; that is the crucial information such as:

• Mandatory vaccination certificates – like the one for novel ‘corona virus’
• Implications of no-shows in the longer as well as shorter terms
• Clear demarcation of the maximum allowable misses – say three or five

Encapsulation

The no-show policy is a must while governing the health-care facility, in each and every sphere of it. It predominantly depends upon the patient base and its importance varies from specialization to specialization. It is primarily meant to mitigate the ‘no-shows’ or ‘appointment cancellations. It is crucial for some spheres, while recommended for others.

Safeguarding mutual gains

A fair draft safeguards the mutual interests of the either party – that is patient and the facility itself. The no-shows, on one side, may cause procedural turbulences for the facility; while may prove even fatal for the patients, on the other hand. A policy must be therefore, devised such that it puts a check over the patient, ensuring his responsiveness but at the same time not antagonizing the patient – consequently deteriorating the facility-patient relationship. It is hence recommended to incentivize the patients rather than penalizing, though practical solutions employ a blend of both.

Nutshell

It is recommended in the strongest terms to avoid the misses at all, to the best of practical. Furthermore, the policy must be crystal-clear, with a laser focus over the ultimate and indiscriminate service, so as to fabricate finest of the socio-cultural fabric. Last but not the least; it must have fairish leverages for either party so as to engineer most sophisticated of the patient – facility bond.