Surprises Revealed by Recent Research for the NHS

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Appointment By Bobette Gorden

Recently, the result of a fascinating set of studies sponsored by INFLUENCE AT WORK, BDO and the National Health Services UK (NHS)was released.  Steve Martin, CMCT and director of the INFLUENCE AT WORK UK office led this research with Dr. Suraj Bassi and Dr. Rupert Dunbar Rees of BDO.

This research examined DNAs (Did Not Attend/No-Shows) in doctor’s offices.  DNAs are a significant and costly problem all over.  But according to The King’s Fund, a health think tank based in the UK, there is an estimated direct loss of ÂŁ700m annually due to patients failing to come to their appointments or failing to cancel in time. 

The goal of this study was to find simple and cheap approaches to reduce DNAs.  This pilot study is now being peer reviewed by the Journal of the Royal Society of Medicine.


In one condition patients making their appointment were asked to verbally repeat the date and time for their next appointment before hanging up the phone.  This simple and virtually costless change used the Principle of Consistency an led to an immediate reduction in DNAs by 6.7%

In a second condition, which again employed the Principle of Consistency, nurses and receptionists, when making the patient’s next appointment in person, instead of filling out the small white appointment card asked the patient to fill out this card themselves. This small change produced an 18% reduction in DNAs. 

A common practice in UK medical offices is to have a very visible sign in waiting areas that highlights the number of DNAs that previous month.  This is not only wrongheaded, but encourages exactly the opposite behavior that these medical offices are trying to extinguish. Because the Principle of Social Proof is so powerful, instead of discouraging DNAs, this poster was actually encouraging DNAs by insinuating that it was a very common practice to not show up for medical appointments.  Such use of the Principle of Social Proof can work to help or hurt desired activities.

In an attempt to reduce DNAs, the researchers replaced these signs with alternate signs that simply stated the truth…in another way.  The changed sign read that 95% of patients at (the name of the office) turn up for their appointments or call (insert phone number) if they have to cancel. 

This strategy (using Social Proof correctly) combined with the appointment card intervention examined above (using the Consistency Principle)  produced a 31.4% reduction in DNAs. 

A health economist working within the NHS calculated that if the simple changes tested in this study were employed across the NHS the savings would be the equivalent to the cost of hiring an extra 472 physicians each year.

Now, what can YOU do with these same easy and nearly costless approaches?

For more information about these studies, see this article from The Guardian.

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