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Leo Poll

Leo Poll

PhD – President Akendi UK

Using the principles of experience thinking to reduce ‘no-shows’ in healthcare

It is a shocking statistic and a pure waste of precious (and stretched) resources: more than 15 million general practice appointments are missed each year. The knock-on effects are poorer patient care, inefficient use of staff, increased waiting times and healthcare services implementing stop-gap coping measures, such as overbooking, to try and counteract the problem.

The total cost to the NHS in the UK are in excess of £200 million – that’s the equivalent of around 8,424 community nurses; the emotional costs and resulting health implications for other patients are arguably even greater.

Patients don’t intentionally skip appointments

It’s important to remember though that, for the most part, patients don’t deliberately miss appointments because they can’t be bothered to turn up; they simply forget. But in a digital world, where there are more smartphones than people, there’s no need for anyone to miss an appointment because “they have forgotten” – all they need is a gentle reminder with an easy way to cancel or reschedule.

Understanding the whole experience journey

So, why is sending a reminder not enough? Isn’t it simply common sense that when people forget something they need a reminder? Yes it is, but it is only a solution to one of the pain points in the patient’s experience journey of making, managing and attending an appointment. All the SMS reminder systems I am aware of send a text that includes a phone number to call if a patient wants to cancel an appointment. Just think about that – how often do you call somebody immediately when you have received a text message? How likely are you to call a phone number that will put you in a queue for who knows how long? The effectiveness of the action on the reminder is just as important as the reminder itself.

Surely technology can come to the rescue here?

Location and activity awareness combined with an AI-powered app could work out the best time and place to send appointment reminders, as this would increase the chance that the time is right for a patient to call to cancel/re-book. There is certainly potential here, and developing a solution like this would be impressive (to engineers).

However, before indulging in ‘solution thinking’ it is important to assess whether the feedback mechanism itself – making a phone call – is fit for purpose in the first place. Technical solution thinking should be preceded by technology independent experience thinking, focusing on the 5WH: ‘Who’ is doing ‘What’, ‘Where’, ‘When’, ‘Why’ and ‘How’. Understanding, through research, what really goes on during the experience journey will identify several pain points for which a joined-up solution can then be found. In the case of patient appointment reminders I have heard of one solution that is beautiful in its simplicity: simply reply to the reminder to cancel; literally quick and easy. It is a solution of which you will say: “yes of course, that is trivial” to which I will respond: “if it is trivial then why don’t all appointment reminders include it?”

Of course, you may find that, for other types of users, different solutions are more appropriate. Our social media generation might prefer a reminder from a chatbot that can be cancelled by simply typing: ‘Cancel’. For users without mobile phones, speech recognition might provide the right answer.

Whatever the solution, understanding the pain point fully is the starting point for identifying solutions of which a user will say: “Yes of course it works like this; this is trivial.” However, it was so trivial that before it existed nobody thought about it. These kinds of solutions are real innovations but they do not need to be high tech. That doesn’t mean that the technology is trivial – the software required to cancel an appointment on the basis of an empty reply to a reminder is certainly not trivial.

As easy as one, two, three

Putting experience thinking first before technical solution thinking enables the development of solutions that are known to work most of the time before a solution is released. To achieve this, just take three steps:

  1. Do experience research to uncover the 5WHs.
  2. Identify the pain points the target audience might not even be consciously aware of (most people accept life as it is including the pain points)
  3. Collaborate with the stakeholders, including engineers, to come up with the best possible solution from a service & technical point of view. This doesn’t have to be high tech.
Leo Poll

Leo Poll

PhD – President Akendi UK

Since 1996, Leo has been helping organizations provide an intentional customer experience while matching technical innovations to market needs. He uses the Akendi blog to share his thoughts about the challenges of addressing business problems from an end-user perspective and finding solutions that work for real people.


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About Akendi

Akendi is a human experience design firm, leveraging equal parts experience research and creative design excellence. We provide strategic insights and analysis about customer and user behaviour and combine this knowledge with inspired design. The results enable organizations to improve effectiveness, engage users and provide remarkable customer experiences to their audiences.