Implementing innovation in the UK National Health Service A case study in patient compliance

Missed appointments are a common form of patient non-compliance. One reason often given is they had been forgotten. We evaluate two recent innovations to address this problem introduced at one of the Scottish health boards to increase compliance at consultant-lead outpatient clinics. Patients with long waits were more likely to miss their appointment, but not, apparently, because they were more likely to forget it. Nevertheless, both innovations made a big difference and, combined, reduced recorded non-attendance rate by 90%. The administrative innovation changed the way appointments were made. At its most basic, bookings were made no more than five to seven weeks in advance, at no additional cost. Some of these patients also had to confirm their appointment. This reduced non-attendance still further, but at a cost of at least £150 per missed appointment avoided. The technological innovation used SMS and E-mail messages to send last minute reminders. It more than halved non-attendance, but the inability to collect contact details limited it applicability, and few of the patients reached provided contact details. Some fifty to one hundred messages have had to be sent to avoid one missed appointment. However, the use of the NHS network avoided significant recurrent costs.