Quit waiting around for no-shows

At first, the three extra minutes seem like a blessing—it's really a good thing Mrs. Unrilyable isn't there yet because you checked on another patient, updated a chart, and even got to use the restroom—thank goodness for that! But now that it's been 15 minutes, and your team members are sharing bad-break-up stories instead of helping you examine Fuzzy's back foot because Fuzzy never arrived, you're really starting to get mad. And not just at the jerk who dumped your technician—though that wasn't very nice. You're irritated because your time and money are going down the drain.

Illustration by Steve Pica

Good scenario: You have 15 appointments booked for Tuesday and you have three walk-ins, so you see 18. Not-so-good scenario: You have 15 appointments booked for Tuesday and three no-shows, so you see 12. That's revenue lost in overhead and services rendered. Costly? You bet.

No shows can grind away at your productivity if you don't get them under control. So find out who's not showing up and why, and then refresh your system so that you don't get stood up quite so often.

Identifying the culprits

Who are these disrespectful wasters of your time? Some clients forget because they booked their appointment far in advance and didn't write it down. Some are just too busy and overcommitted.

"Most people really don't do it maliciously," says Dr. Mary Ann Vande Linde, a practice management consultant with VMC Inc. in Evergreen Colo. "They're trying to get their kids to soccer practice when they suddenly realize, 'Oh no, Princess was supposed to go to the doctor.'"

Better late than never?

Of course, some really do wrong by you. For example, a price-shopper who calls multiple clinics and books appointments and then keeps the least expensive one. "We've been seeing more of that," says Dr. Jeff Rothstein, MBA, Veterinary Economics Editorial Advisory Board member and president of The Progressive Pet Animal Hospitals and Management Group, which owns and operates hospitals in Michigan.

Of course, no matter why clients don't show up for their appointments, your goal is to minimize the disruption. And generally different causes will demand a different response.

Start with 6 preventive tips

"Often a no-show starts long before the appointment time," says Dr. Vande Linde. So you can sometimes improve your odds of seeing that client by playing your cards right between the recommendation and the visit. Some opportunities:

1. Schedule smart. Of course, booking next-visits at the end of appointments seems to result in a higher compliance rate with recommended health care. The client's more likely to book that dental right after the doctor suggested it. And you don't really want to bank on her remembering to call you back and make that appointment sometime next week. However, end-of-visit scheduling techniques can leave clients with inconvenient appointment times that they're unlikely to keep. The solution: If a client doesn't have her schedule or calendar with her and is guessing about when would be a good time, offer to call her back that night when she's had a chance to go home, review the calendar, and check with her spouse about their availability. Then you can set a time that she's more likely to make.

2. Get new clients engaged. When new clients call to schedule an appointment, offer to mail or e-mail them any paperwork that they'd otherwise have to arrive early to fill out. When they prepare for the visit, and don't have to arrive early, they're more likely to keep the appointment, says Dr. Vande Linde.

3. Keep it to Fluffy and Muffy. No-shows can do double, triple, or quadruple damage if the appointment was for multiple pets. "Don't encourage multiple pet appointments unless you know it's a reliable client," says Dr. Rothstein. To combat the one-client-with-multiple-pets-no-show, Dr. Rothstein suggests limiting appointments to two pets.

4. Make a call. A call the day before gives clients a critical reminder. "We input all appointments into a calendar by category of appointment. Our receptionists call the appointments for the next day and note the call in the entry," says Pam Weakley, practice manager at Dickman Road Veterinary Clinic in Battle Creek, Mich. (For more about using software, see "Use Your Software").

5. In fact, use any tactic that works. Mailed postcards, next-visit cards given at the end of an appointment, next-visit stickers that clients can adhere to their calendars, and e-mail could all work for your team. "E-mail has the potential to be a big time and money saver," says Dr. Rothstein. "The problem is you have no confirmation that it's getting to the client. With mailed postcards, you know if it doesn't get there, because it comes back."

Mix it up a bit to find out what works best for your clients. For instance, you might give out next-appointment cards at the end of visits, shoot clients an e-mail a week before—for those booked far in advance—and then call the night before.

"It's tough to know what triggers clients to remember and keep appointments," says Dr. Rothstein. "Many clinics switched from phone calls to postcards. But now, they've found more value in phone calls again—people appreciate you jogging their memory, even if it's in a message on their answering machine."

6. Whatever else you try, do this. Include a statement on your next-visit cards or postcards that says, "If you need to cancel, please call 24 hours in advance to let us know." This approach makes it clear to clients that you expect a courtesy call.

No-shows happen. Four tips for "now what?"

"Have a plan of action," says Dr. Rothstein. A protocol for how to handle late and no-show clients will minimize the stress on your team members.

For example, a team member can call the owner who missed the appointment and say something along the lines of, "Hi Mrs. Standusup, Bob missed his appointment today, and we just wanted to check in and make sure everything is OK." Chances are at this point a light bulb will flash in most clients' heads that, oops, they forgot. Or, if he or she price shopped and went somewhere else without extending the courtesy of canceling the appointment with your practice, at least you know.

1. Decide how many missed appointments warrant a call. As part of your protocol for handling no-shows, you should decide when it's time for the practice manager or owner to call. Drs. Vande Linde and Rothstein agree that three is the magic number. Keep in mind, says Dr. Rothstein, while three in six months is a problem, three in three years is not such a heavy offense—so track the time period. (See "Use Your Software")

Use your software

2. Find out whether they're salvageable. To decide, when you approach them you might say, "It seems as though we're having difficulty getting our schedules to work together. And the miscommunication affects our practice because we've scheduled staff members and other appointments around the services that we planned for your pet—so we really need to find a solution."

Your clients may not realize they're upsetting the apple cart, so at least make them accountable for their behavior, says Dr. Vande Linde. Then look for a solution that works for both of you—and ask them whether there's an alternative that would make it easier to get their pets the care they need. Options:

3. See repeat no-shows on a walk-in basis. Ask these clients to please call ahead, and then if you can get them in, you will. Of course, they will need to wait until the doctor has time in the schedule. And emergencies and previously scheduled appointments will take priority.

"It may seem counterintuitive, but many clients are more comfortable with the fly-by-the-seat-of-their pants scheduling," says Dr. Rothstein. "They may have to wait, but there's no commitment. So they can adapt to their changing schedules without standing you up."

4. Board the pet for the day. "Suggest that the client drop the pet off in the morning on the way to work or before taking the kids to school. Then he or she can pick the pet up on the way home," says Dr. Vande Linde. In some circumstances clients would be willing to pay to board their pets for a day to eliminate the hassle of taking off in the middle of their workday.

Dangling financial fruit: One last strategy

Your dentist or podiatrist charges you if you don't show up. So the big question is whether that approach would work for your practice. "Chances are a client will pay the fee once and then not come back. So if you want to divorce these clients, charge them," says Dr. Vande Linde.

Dr. Rothstein agrees that a charge isn't likely a cure-all. "If new reminder systems and scheduling techniques don't solve the problem, the threat of a bill for a no-show probably won't be the antidote either," says Dr. Rothstein. "The client is most likely a bad fit for your practice."

How many constitutes a problem?

However, if you have a certain type of appointment that is a high-risk for no-shows, you may be able to work a financial incentive into the equation that's not a charge for missed appointments. For example, Dickman Road Veterinary Clinic had a problem with clients no-showing for ear cropping appointments. So they have them come in for a consultation before they schedule the appointment to discuss the procedure with the doctor, says Weakley.

They credit a $25 consultation deposit at the first meeting that goes toward the fee when they perform the surgery. This gives clients an incentive to show up for the service they scheduled. But the practice doesn't bill them if they don't, they just forfeit the deposit—and this approach works for this situation.

And that's really what you need to develop. A mix of prevention, education, and communication strategies that work well in your specific situation.

The bottom line

Prevent no-shows from happening with a few key steps:

• When you book the next appointment at the end of a visit, give clients an opportunity to check their schedules if they need to.

• Limit the number of pets scheduled in multi-pet appointments.

• Develop a reminder system using postcards, e-mail, or phone calls.