By Susan Boston, BSN, RN, Nurse Manager, Orange Pediatrics
The Story
This story starts several years ago with a conversation I had with Karin Skeen regarding our no-show rate. As care providers, we spend a lot of time talking about no-shows and continuously struggle with the question, “What can we do?” Karin encouraged me to find out where people are and meet them there.
I started with research. I learned about all the ways we remind families about their upcoming appointments. We send letters, there are automated reminder calls from the University, personalized calls from team members, and text messages. Those methods haven’t worked for some of our families.
I saw a serious need with a particular family that we see here, a family with multiple children. Over the course of 12 months, they had 52 no-shows. We knew there were clearly barriers this family was facing and that we needed to be thoughtful in our approach.
Our volume was down because of COVID-19. I looked at my schedule and realized that I did have flexibility at the end of the day. I thought, “What if a family could call on the day they decided they could get here?” This wasn’t “saving” an appointment. It was carving out time each day that that would be available, if needed.
With a new plan in place, when this family would call to schedule, I had the team direct them to me. We said, “We know it’s been difficult for you. We want to accommodate you and we want your children to be seen.” When the mother called to schedule the first same-day appointment for two of her children, it was exhilarating! We didn’t know if she would show up, but we were so happy when she checked in.
We didn’t hear anything for the next few weeks. We knew she was feeling pressured to get her kids into school. She called and wanted to schedule ahead of time and the team reminded her that she could call the day she wanted to come in. She called back when she was ready and we saw the remainder of her children that day.
For one appointment, the family still hadn’t shown up after 10 minutes, so the mother was called. She said she could be there right away. I once again reminded her that the scheduled time was only for her. When they walked in, I said, “I’m so glad you could come today and I’m so grateful to see you.” She said, “Thank you so much for taking care of my children.” It was such a rewarding moment.
By holding the family accountable, with no judgement and no harassment, we were able to meet them where they were. We set out on a year-long journey and by the end of that year, all children received well-care visits and all received a follow-up. We were able to go from 52 no-shows to zero, a jaw-dropping success in our eyes.
Next Steps
This is reproducible! I would like to hand this pilot over to our RN Care Coordinator and Triage team. We will consult our doctors and ask what families really need to be seen. I think we could look at the top 3 families from the suggestions/number of no-shows. Each plan will be individualized because each family’s barrier will be different.
Lessons Learned
No-shows are the “unsolvable problem” that we don’t want to talk about. Answers are illusive and one size doesn’t fit all. My biggest piece of advice is to focus on kindness and compassion.
Our biggest learning curve was having a system in place for follow-up that was thoughtful, kind, and intentional. We needed to make sure the family doesn’t fall through the cracks if they didn’t call to schedule a same-day appointment. I had personal reminders set up to check in every few weeks. Since we were no longer calling the family to say, “You missed your appointment, let’s reschedule.”, a different strategy was necessary.
For anyone who wants to apply this to their own area, I suggest carving out one extra well-visit each day. If a family calls in and you can tell them, “We are full today, but I have a visit available for you because caring for your family is so important to us.”, that can make a huge difference.
Thank You
We care deeply for these children and want them to receive care. This effort took lots of support and trust. Thank you to the entire team for their flexibility and compassion to make this a success!
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