JMIR Publications

ABSTRACT

Background:

Approximately one third of patient appointments in Health Care fails. Failed appointments put patients at risk, and they create a sizeable “waste” of resources. Most interventions in health care target the patient. They do not always work and may lead to social biases and more health inequality. A more holistic understanding of no-shows at hospital appointments would optimize processes and reduce waste, and it will support for particularly vulnerable patients.

Objective:

The study seeks to provide a deeper and more comprehensive understanding of why (and how) patients do not show up for hospital appointments by involving the patient perspective and analysing the relational and organizational processes around no-shows in health care. It also aims to identify interactional strategies and organizational processes that work well, to support an appropriate implementation effort.

Methods:

The project uses mixed quantitative-qualitative methods. It addresses structural, relational, and pragmatic dimensions of failed hospital appointments in the Region of Southern Denmark through 4 analytical projects: 1) analysis of non-attendance patterns based on a regional patient population, 2) analysis of patient knowledge, attitudes, and behaviour, 3) analysis of the management of hospital agreements, and 4) in-situ (mis)communication. Chi2 and Kruskal-Wallis tests are used to compare the baseline characteristics of the patients across different levels. The three qualitative studies will share a common data pool consisting of ethnographic observational data, individual interviews with patients and practitioners, questionnaires regarding patients’ satisfaction with consultations, and video recordings of patient consultations. Both the traditional ethnographic method and cognitive video ethnography will be used.

Results:

This paper describes the protocol of the study. As of January 2023, the study was registered with The Danish Data Protection Agency (Registry ID: 22/54791), and with The Open Patient Data Explorative Network (Registry ID: OP_1800). The recruitment commenced in February 2023. It is anticipated that the quantitative data analysis will be complete by the end of august 2023, with the qualitative investigation beginning September 2023, and the first study findings available by the end of 2024.

Conclusions:

The many failures indicate that there is a lack of an offer within the healthcare system that can accommodate the vulnerable patients. To design effective interventions, the description and categorization of failures at hospital appointments must be supplemented by a more qualitative approach and solid ethnographic data that provides insights into the organizational and communicative processes leading to hospital errors and appointment failures. Achieving more comprehensive knowledge about the causes of failed patient appointments will have major practical benefits, contributing to a better, safer and more coherent treatment in health care.