Did not attend: what to do about missed appointments

Every appointment-based service loses capacity to people who do not arrive. The slot cannot be resold, somebody else was turned away for it, and the cost falls entirely on the provider. A did-not-attend policy is how an organisation decides, in advance and in writing, what follows — which is better than deciding it case by case at a reception desk with a queue forming.

What a did-not-attend policy must settle

• The definition: how late counts as missed rather than late, stated in minutes.
• Whether late cancellation counts as a non-attendance, and from what notice period.
• What happens after one, two and three occurrences, since escalation has to be stated to be fair.
• Who may waive it, and on what grounds — illness, bereavement, transport failure.
• Whether anything is charged, and if so how that is communicated before booking rather than after missing.
• How the record is kept and for how long, because a pattern used in a decision has to be evidenced.

Whether to charge

Charging reduces non-attendance and also reduces attendance by the people least able to pay, which is frequently the group that most needs the appointment. In healthcare and public services that trade-off usually settles against charging; in private services with scarce capacity it often settles for it. If you do charge, the amount has to be stated at booking and acknowledged, the first occurrence is usually better waived with a warning, and a mechanism for genuine hardship is the difference between a policy and a penalty. Taking a deposit against the booking achieves most of the same effect with less bad feeling than an invoice sent afterwards.

Before enforcing anything, check how easy you have made cancelling. A service that requires a phone call during working hours to cancel an appointment has partly caused its own non-attendance rate, and no policy fixes a structural obstacle.

Finding the real causes

1. Group by appointment type, time of day and how far ahead it was booked — long lead times are the strongest single predictor.
2. Check whether reminders are actually reaching people, which is a different question from whether they are being sent.
3. Look at first appointments separately, since people who have never attended behave differently from established patients or clients.
4. Ask a sample of non-attenders rather than assuming; the answer is often something procedural you can change.
5. Track the rate rather than the count, or growth in volume will hide a worsening rate.

Ettex Records keeps the attendance history with the reason where one was given, which is what turns a sequence of individual frustrations into something you can act on. The intervention that moves the number most is usually the reminder rather than the policy.