2020 has been exhausting! We are all working hard to protect patients, clients, staff, and the practice but just when we think we’re starting to see a sliver of light, we’re hit with another challenge. Lately, colleagues have been concerned about the increase in client no-shows. In the context of this year’s world-shifting events, no-shows may seem like a mundane problem but left unaddressed, missed appointments can affect more than the practice’s bottom line.
Not just an annoyance!
No-shows---even if it’s only a few a week—impact a practice's processes and revenues. When clients bail and appointment slots remain unfilled, the practice must continue to meet its financial obligations for payroll, rent or mortgage, and professional services.
Missing scheduled appointments can have an impact on the health of the patient because the efficacy of medication can’t be monitored, preventive care is not provided per schedule, serious illnesses may go undiagnosed, and delayed treatment of chronic illnesses can put patients at risk for complications and additional problems.
Veterinary employees are compassionate, empathetic, and deeply committed to their work. In an increasingly stressful environment, when clients fail to keep appointments, they may unintentionally be sending a message that they do not prioritize their pets’ health. Whether true or not, client inaction places additional stress on staff who are powerless to impact compliance.
Many team members are putting their health and wellbeing at risk during the pandemic to care for patients. Ignoring a scheduled appointment communicates a lack of respect for the veterinary staff and the critical role they play. To maintain staff morale and ward off burnout, veterinary workers must feel appreciated and valued for their contributions. Clients who skip appointments sap employees’ spirit and the team’s energy.
A constellation of concerns
VHMA’s November Insider’s Insight Monthly Management Survey focused on the no-show clients to determine if their numbers have changed since the pandemic. The results seem to support what I’ve been hearing---approximately half of the respondents report that their practices are experiencing an increase in no-shows among both new clients and existing clients.
Personally, I am not surprised. The path of Covid-19 has been uneven. Although positivity rates declined, it wasn’t long before we learned that, across the country, rates were once again spiking. Appointments made in good faith may be ignored as the odds of contracting the disease rise.
With the economy faltering and government coronavirus bailouts stalled, the financial situation of many clients is changing. As disposable income previously allocated for pet healthcare becomes scarce, I am concerned that no-shows will become more widespread because clients simply cannot afford appointments.
A human medicine study reported in Annals of Family Medicine prior to the pandemic, identified three primary reasons for no-shows: symptoms subside, clients may not feel obligated to keep an appointment because they feel disrespected by the system, and, a lack of understanding of the scheduling system. None of these reasons are justification for neglecting to call, text, or email to cancel, they do provide insights into how to begin to address the problem.
Dealing with no-shows
The results of the November Insiders Insight survey are available from the VHMA. The in-depth discussion focuses on specific strategies managers have instituted to address the issue. The effectiveness of advanced payment, as well as deposits, are discussed. I encourage readers to review the results carefully and consider implementing them in your practice if no-shows are impacting the practice.
I would like to add a few words about managing during difficult times. Even under the best of conditions, managing can be tough. In trying times it can be impossible. The pandemic is taking a toll on everyone and no group is more susceptible to its impact than those in the veterinary field. Veterinary workers are front line employees who have been leaving their home, suiting up, and taking care of clients and patients, even in the throes of the pandemic. Our lives are different, more complicated, and to a great extent, unknown---a perfect storm that can make the team fragile and vulnerable.
I encourage managers to make every effort to be aware of employees who may be crumbling under the strain. More and more clients are manifesting pandemic-fueled behavior that is surly, impolite, and downright combative. To best handle these clients, staff should understand that they are not the cause of the behavior, but rather the object of the client’s discontent.
Each of us handles stress differently. We may not be able to control clients who externalize their (misplaced) anger and vent it on the team. As managers, we can protect staff by preparing them with de-escalation techniques to prevent and diffuse conflict. It is essential that we are also well-prepared to intervene and assist staff when necessary.
There’s a phrase we’ve been hearing recently---“we’re better than that.” As veterinary professionals, we need to develop tough skin for harsh times. If clients are no-shows, address the behavior with policies and penalties. Treat clients with respect but be firm that certain behavior will not be tolerated. Encourage staff to remain calm and businesslike when discussing client behavior. The goal is not to inflame the situation but to ensure the behavior does not continue.
Treating clients with respect, even when their behavior is distasteful, will not only set an example but may help to create an atmosphere of forgiveness and acceptance. The client may not be right, but we can hope that by not lowering standards to respond in kind, it may prompt them to be reflective and contrite.
This may be a lofty goal for difficult times, but when we are committed to being understanding and compassionate when emotions run high, we can only hope that our actions will serve as an example and they will show the practice and staff the same understanding and respect.
I wish you all peace, love, and understanding.#PracticePulse
Michelle Gonzales-Bryant, CVPM