• Thousands of people miss their outpatient appointments at hospitals every year

  • St Vincent’s Hospital sends reminder text messages to patients to remind them of their outpatient appointments

  • Even with these reminders, nearly 15 per cent of people still miss their appointments.

St Vincent’s Hospital wanted to reduce the number of missed hospitals appointments even further and reached out to us to see if behavioural insights could be used to achieve this. 

Redesigning reminder text messages

We explored research that found it wasn’t enough to send a reminder text message - the content of the message also matters.

Based on this finding, we work with St Vincent’s Hospital to test a variety of text message reminders to see which one was the most effective at getting people to attend their appointment. We ran two randomised controlled trials. Each trial ran for six-months over a 13-month period and included nearly two-thirds of all outpatient appointments at the hospital. During the two trials around 20,000 text messages were sent to nearly 7,500 people.

First trial

In the first trial, seven new messages were developed. The new messages built on the original text message reminder sent by St Vincent’s Hospitals.

Text messages used in trial 1

Version

Text Message

Original

You have an appointment with Dr [XXXX] in [clinic XXXX] on [date] at [time]. For enquiries, call 8382–3150. Do not reply.

Version 1

Original Message + Last year the hospital lost $500,000 due to lost appointments.

Version 2

Original Message + If you do not attend the hospital loses $125.

Version 3

Original Message + If you do not attend the hospital loses $125 that can be used to treat other patients.

Version 4

Original Message + If you attend the hospital will not lose the $125 we lose when a patient does not show up.

Version 5

Original Message + By attending the hospital will not lose the $125 that we lose when a patient does not turn up. This money will be used to treat other patients.

Version 6

Original Message + You are free not to attend but please call us on 8382–3150 if you need to cancel or rearrange.

Version 7

Original Message + Please attend or call 8382–3150 to cancel/rearrange, or we will record as a missed appt.

These seven new text messages, plus the original reminder, were randomly sent to patients over a six-month period. The trial measured by which reminder text message had the largest appointment attendance rates. The two most effective messages were: 

  1. You have an appointment with Dr [XXXX] in [clinic XXXX] on [date] at [time]. If you attend the hospital will not lose the $125 we lose when a patient does not show up.
  2. You have an appointment with Dr [XXXX] in [clinic XXXX] on [date] at [time]. By attending the hospital will not lose the $125 that we lose when a patient does not turn up. This money will be used to treat other patients.

Second trial

The second trial tested the two most effective messages from the first trial and two additional messages which focused on non-financial impacts that missed appointments have on clinics and staff.

New messages introduced in the second trial

VersionText Message
Version 8 We are expecting you at [clinic XXXXXX] on [day] [date] at [time]. If you do not attend, St Vincent’s loses the ability to treat others in need of our services. Please call 8382–3150 if you need to cancel or rearrange.
Version 9 We are expecting you at [clinic XXXXXX] on [day] [date] at [time]. Your clinic is depending on you to attend. Please call 8382–3150 if you need to cancel or rearrange.

While all of the messages in the second trial led to a reduction in people missing their appointments, the most effective message was: You have an appointment with Dr [XXXX] in [clinic XXXX] on [date] at [time]. By attending the hospital will not lose the $125 that we lose when a patient does not turn up. This money will be used to treat other patients.

During the first trial there was a 19 per cent reduction in the number of the people missing their appointments, saving St Vincent’s Hospital more than $68,000.  

While all messages in the second trial reduced missed hospital appointments, we are not able to conclude the extent to which the text messages contributed to this decrease. However, the information from this trial was useful for St Vincent’s Hospital as it allowed them to target their messaging strategies for patients in the future.