A No-Show Analysis: A Process Improvement Plan to Lower No-Show Rates

1. A No-Show Analysis: A Process Improvement Plan to Lower No-Show Rates Lindsey Preston University of Kentucky Martin School of Public Policy and Administration Masters in Health Administration Capstone Project Spring 2008

2. Statement of Problem • $612 million is wasted on non-attendance annually (Oladipo et al., 2007) • No-Shows • Hinder productivity and efficiency • Increase provider and clinical staff frustration • Provide less continuity of care • Interrupt critical treatment follow-up

3. Statement of Problem • Pediatric patients have the highest rate of broken appointments • Shriners Hospitals for Children of Lexington, KY is a 50 bed pediatric orthopedic hospital and outpatient clinic • Provides free care and transportation for all patients • Shriners Hospitals for Children no-show rate continuously fluctuates

4. Purpose of Study • Identify problem areas that lead to Shriners Hospitals for Children’s current no-show rate • Identify effective process improvement solutions for lowering Shriners Hospitals for Children’s no-show rate

5. Data Collection • Existing data from May 2007 through January 2008 • Provider type • Month • Time of day • Day of week • Interview data • 150 patients who showed for their appointment • 150 patients who did not show for their appointment

6. Results • Average no-show rate 13.4% • 1905 no-show patients in 9 month period • 5 problem areas • Attending physicians • Absence of appointment reminders • Short distance traveled • Long time between scheduling and appointment date • Short relationship with Shriners Hospitals for Children

7. Attending Physicians • No-show rate 15.4% • 1242 no-shows • Highest volume provider type • Case load vs. no-show rate

8. Absence of Appointment Reminders • 42% of no-shows did not receive a reminder • 16.6% of shows did not receive a reminder • 29% of all patients did not receive a reminder

9. Short Distance Traveled • 90% of show patients live over an hour away • 25% of no-shows live within 1 hour • 11% of no-shows live in Lexington

10. Long Time Between Scheduling and Appointment Date • 16.6% of no-shows were scheduled within 2 weeks • 36.0% of shows were scheduled within 2 weeks • 45% of no-shows were scheduled 3 to 4 weeks out

11. Short Relationship with Shriners Hospitals for Children • 130 patients in Shrine system for 1 to 3 years • 34.6% patients showed for their appointment • 65.3% of patients did not show for their appointment

12. Recommendations • Advanced access appointment systems • Patient education • Scheduling flowchart development

13. Advanced Access Appointment SystemAttending Physician and Time Between Scheduling and Appointment Date • Matches day-to-day appointment demand with appointment supply • 70% of appointments scheduled within 2 weeks • 30% of appointments scheduled after 2 weeks • Reduce no-show rate by 50% • Shriners Hospitals for Children unique culture

14. Advanced Access Appointment SystemAttending Physician and Time Between Scheduling and Appointment Date • Gustafson Change Model • Tension for Change • Staff attitude • Communication • Pilot Testing • Attending physicians • Discover kinks in system • Monitoring and Feedback • Continuous change • Risk free employee feedback

15. Patient EducationDistance Traveled and Relationship Duration with Shriners Hospital for Children • Patient Empowerment • Each visit is imperative • Disrupt Patient Care • How does my absence affect others? • Signed Agreement • Importance of appointments

16. Scheduling Flowchart DevelopmentAppointment Reminders • Correct Breakdowns • Cancelled appointments • 29.3% did not receive a reminder • Develop Process and Procedure • Employee and Patient Needs • Fast and efficient • Do patients know what to do if they need to cancel?

17. Limitations • Human Error • Real World Events • Single Investigator • Random Sample • Generalize to Other Pediatric Hospitals and Out-patient Clinics

18. Dr. Sarah Wackerbarth, Chair Dr. Martha Riddell, Major Advisor Dr. Dwight Denison, Reader Tony Lewgood, Outside Advisor Administrator Shriners Hospitals for Children of Lexington, KY THANK YOU!

19. QUESTIONS