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

Dr. Leo Poll, President of Akendi UK and a member of the IET Healthcare Panel, explains how understanding users’ ‘pain points’ is crucial to creating solutions that could help cut down on common problems such as missed appointments.

GPs, dental surgeries, outpatient clinics are all encouraged to publicise long lists of DNAs (“did not attends”) regularly because around one in ten hospital appointments are missed every year in England alone. 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.

Last year the financial costs were in excess of £10 billion - that’s the equivalent of around 440 nursing jobs; 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 and 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 on receiving a text message? How likely are you to call a phone number of which you know will put you in a waiting 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/rebook. 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 this example 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.

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)
  3. Collaborate with the stakeholders, including engineers, to come up with the best possible solution from an organisational/technical point of view. This doesn’t have to be high tech.

Dr. Leo Poll was also the author of

  Design and Evidence - Does involving users slow down or speed up innovation

A piece of thought leadership published in support of IET Healthcare’s first ‘Think BIG Future Health & Life Science’ event in Glasgow.