Reducing No-Shows at a Community Clinic
A 12-physician clinic loses an estimated $480k/year to patient no-shows. Leadership wants a low-risk, low-cost intervention before investing in a new EHR.
Problem statement
Patient no-show rate has risen from 9% to 17% over 18 months. Front-desk staff manually call to remind patients but only reach ~40% of them. The clinic needs to lower no-shows without hiring additional staff or replacing the existing scheduling system.
Context & constraints
The clinic uses an older scheduling system that exposes a REST API for appointment data. Patients skew older (avg. 58) but 86% have a mobile phone capable of SMS. HIPAA constraints apply: appointment details cannot be sent to a phone number that has not been verified as belonging to the patient.
Who's involved
Stakeholders
Reduce revenue leakage from empty slots
Reduce manual reminder calls
Predictable schedule, fewer gaps
Convenient reminders, easy reschedule
HIPAA-compliant patient communications
Minimal load on legacy scheduling system
What they need
User needs
- 01
Patients want a reminder a day before, with one tap to confirm or reschedule.
- 02
Front-desk staff want to focus calls on high-risk patients only.
- 03
The Operations Director wants weekly visibility into no-show rate by physician and slot type.
- 04
Compliance needs an auditable opt-in record for SMS communications.
Written for the ECBA
Sample requirements
Reduce overall no-show rate from 17% to ≤10% within 6 months of launch.
Rationale: Aligns with the sponsor's revenue-recovery target of ~$280k/year.
As a patient, I want to confirm or reschedule my appointment with one tap from a text message.
Rationale: Captures the convenience need that drives confirmation rate.
The system shall send an SMS reminder 24 hours before each scheduled appointment to patients who have a verified mobile number and active SMS opt-in.
Rationale: Operationalises the reminder need within HIPAA constraints.
The system shall allow the patient to confirm, cancel, or request a reschedule via reply codes (C, X, R).
Rationale: Supports the one-tap interaction without a smartphone app.
All patient SMS communications shall be logged with timestamp, opt-in status, and message body, retained for 6 years.
Rationale: Compliance and audit requirement.
During a 4-week pilot, the system shall run alongside manual reminder calls; manual calls shall be retired only after no-show rate is verified ≤12%.
Rationale: Reduces operational risk during cutover.
How it runs
Process flow
- 1Scheduling systemPublishes appointments for the next 48 hours via API.
- 2Reminder serviceFilters to patients with verified phone + SMS opt-in.
- 3Reminder serviceSends SMS 24h before appointment.
- 4PatientReplies C (confirm), X (cancel), or R (reschedule).
- 5Reminder serviceUpdates appointment status; routes R replies to a callback queue.
- 6Front deskCalls only the callback queue and unreached high-risk patients.
Your turn
Practise the next step
You have one week for the first round of elicitation. Which technique gives the highest-value insight for this problem?
Hint: Think about what you genuinely don't know yet, and what data already exists.
Hint: Specify the trigger, the action, and a measurable outcome.
The Compliance Officer asks how you will prove HIPAA-compliant consent. Which artefact best answers this?