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

Healthcare providers have long grappled with patients not showing up for their scheduled medical appointments; such no-shows lead to wasted resources and longer wait times for other patients. However, new operations research offers a promising solution to this problem. The study finds that using text message reminders that include an additional line of text indicating a potentially long wait for the next available appointment can significantly reduce no-shows by a factor of 28.6%. The intervention, called waits framing , was found to be more effective among patients who were more sensitive to wait times and when the information in the message was novel and credible. The study also uncovered the mechanism underlying the intervention. Specifically, the waits framing messages increased the perceived cost of missing an appointment, leading to a reduction in queue abandonment. This study provides insights into how behavioral science can improve service operations and help tackle challenges in healthcare delivery. 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, w