Reduce DNA’s by a Further 20% with a Tweak to Wording

Wirral University Teaching Hospitals NHS foundation Trust remind patients of upcoming appointments using Agent calls and Interactive Voice Message (IVM).

In September 2015, the Trust introduced SMS reminders to ensure every demographic received a prompt in the most cost efficient way. The addition of this digital channel reduced Did Not Attends (DNA’s) from 9.4% to 8.5% in 3 months!

Based on the success of a recent trial, Wirral then subtly changed the SMS reminder wording to a ‘Specific cost’ template in December 2015. The message now included the cost of a patient missed appointment to the NHS, ranging between £120 -£160!

DNA’s quickly dropped by a further 20%, providing further evidence of the power of words in reducing missed attendance.

How was this achieved?

The most common reason for a patient DNA is simply forgetting and SMS reminders are a key factor in successfully reducing missed appointments by up to 50%!

The knock on effect is better demand management with advanced warning of cancellations increasing slot reutilisation. This in turn improves patient access to care and significantly contributes to Cost Improvement Programs (CIP).

The Trial

Many patients are unaware that missing an appointment can cost the NHS and UK tax payer up to £160. By mentioning the specific costs of not attending in the SMS reminder, could this influence DNA’s and attendance?

From March – May 2014, The Department of Health worked with Barts Health NHS Trust to study the impact of rephrasing SMS reminders on patient DNA rates. Behavioural psychology initiatives such as persuasion theory and heuristics were applied to subtly change the reminder wording.

Table 1

chart assertive messaging

Did Attend Rates

The specific message was most effective in reducing missed appointment rates to 8.2%. Interestingly, the ‘General Costs’ did not have the same impact and DNA’s were 9.8%. The ‘Empathy Message’ had the least effect with a rate of 10.6%.

Attendance rates

In the study, missed appointments reduced by 5,800 using the specific cost template. It is important to note that this could have been as high as 28,900 annually if the Trust had a record of all patient’s mobiles. Both templates that mention cost increased attendance, however the ‘Empathy message’ once again had the lowest impact on attendances rates, with a 2.8% difference from the ‘Specific Cost’ message.

A Simple Change, Big Impact

This is an easy to apply innovation to improve both Trust productivity and patient experience. It’s low cost, low effort and quick to return results. Healthcare Communications can have this up and running for your Trust within a day, simply email our support team: or call 0845 9000 890 to get started.