Nudging Patient Choice: Reducing No-Shows Using Waits Framing Messaging

Patient no-shows for scheduled medical appointments are of great concern for many healthcare providers. In this paper, we tackle the no-show problem by applying insights from behavioral science. Specifically, we “nudge” patients into arriving for their scheduled appointment using text reminders of their upcoming visit. We conduct a field experiment at an outpatient specialty clinic, where we add to the standard message an additional line of text that indicates a potentially long wait for the next available appointment (we call this intervention “waits framing”). Based on a difference-in-differences estimation strategy, we find that waits framing messaging significantly reduces no-shows by a factor of 28.6%. We also find heterogeneous patient responses to the nudge. First, the increased salience of waiting time is more effective in reducing no-shows among patients who are more sensitive to wait. In addition, the effectiveness of our nudge also depends on the novelty and credibility of the information in the message. For example, the waits framing effect is stronger when the patient is less familiar with the provider (i.e., the information is new), and if the scheduled provider is in higher demand (i.e., the information is credible). In a laboratory experiment, we uncover the mechanism that underlies the nudge—waits framing serves to increase the perceived cost of missing an appointment. Through the combination of field and designed laboratory studies, we provide both external and internal validity to the effects of waits framing. Our results have implications at the system level; the message framing leads to a significant improvement in capacity utilization and patient throughput. These findings contribute to the literature on behavioral queuing by showing that through appropriately framed messages, queue operators can influence the waiting cost perceptions of individuals and thereby engender a desired queuing response such as a reduction in queue abandonment.