Reduction and Management of No-Shows by Family Medicine Residency Practice Exemplars

Abstract

PURPOSE We wanted to describe the methods used by family medicine residency practices with low no-show rates (rate exemplars) and those able to keep visit rates high despite no-shows (management exemplars).METHODS Program directors of US family medicine residency programs were asked to respond to a survey questionnaire. Telephone interviews were conducted with the administrators of rate exemplars (no-show rates of 10% or less) and management exemplars (average of 8 to 10 patient visits per half-day plus high administrator satisfaction with no-show management strategies).RESULTS Directors of 14 rate and 8 management exemplars, identifi ed from among the 141 practices (31.5%) that returned the initial survey instrument, were interviewed and subsequently resurveyed. All of the rate exemplars used multiple strategies, including patient education, patient reminders, patient sanctions, and some degree of open-access scheduling. Practices that managed no-shows well encouraged walk-ins and work-ins and overbooked resident schedules either equally or based upon individual no-show rates. Practice exemplars of both types were highly committed to addressing the no-shows problem and were diligent about following their policies and procedures regarding no-shows.CONCLUSION Some family medicine residency practices are able to achieve low no-show rates or keep them from affecting practice volume. Those that do use combinations of well-established methods. INTRODUCTIONP atients' failure to keep scheduled appointments (no-shows) is a major problem in family medicine residency practices. Prior research has focused either on predictors of no-shows [1][2][3][4][5][6][7][8][9][10] or the effectiveness of individual strategies, such as postcard reminders or variations in scheduling, for reducing no-show frequency [11][12][13][14][15][16][17] or impact. 18,19 Using best practices research, 20 a technique to gather and combine effective management strategies used by practice exemplars, we attempted to identify the methods used by family medicine residency practices that have been able to achieve low no-show rates (rate exemplars) or that manage no-shows well when they occur (management exemplars). METHODSTo identify a suffi cient number of practice exemplars, a 1-page questionnaire was mailed to all allopathic family medicine residency program directors in the United States (448). The questionnaire asked the "most appropriate person" to estimate for their residency practice the following information: (1) the distribution of patients by age and by type of health insurance; R EDUC T ION A ND M A NAGEMENT O F NO -SHOWS(2) the average numbers of new and established patients seen, and the average number of no-shows per half-day; (3) the level of satisfaction with the current methods for reducing no-shows and for managing no-shows (5-point Likert scale); and (4) an assessment of the impact of noshows on resident education, continuity of patient care, patient access to care, and clinic income (5-point Likert scales). Respondents were ...

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