458 International Journal of Consumer Studies, 29, 5, September 2005, pp458–467 © 2005 Blackwell Publishing Ltd Blackwell Science, LtdOxford, UKIJCInternational Journal of Consumer Studies1470-6423Blackwell Publishing Ltd, 2005 2005295458467Original ArticleNo easy solutions H. Scott and P. Lyon Correspondence Hazel Scott, Corporate Services, Ninewells Hospital, NHS Tayside, Dundee DD1 9SY, Scotland, UK. E-mail: hazel.scott@tuht.scot.nhs.uk No easy solutions: lessons learned from an intervention to reduce clinic non-attendance rates in a Scottish hospital Hazel Scott 1 and Phil Lyon 2 1 Corporate Services, Ninewells Hospital, NHS Tayside, Dundee, UK 2 School of Nursing & Midwifery, University of Dundee, Dundee, UK Abstract Hospital waiting lists and times have become the public measure of government success or failure. This research examined existing hospital outpatient capacity and consid- ered the age-old problem of patients who fail to attend their appointment. A reduction in did-not-attend (DNA) rates would maximize utilization of capacity, ensure early diagno- sis and drive down waiting times. The research was designed to determine whether the introduction of outpa- tient letters, which included the need for positive con- firmation of attendance, decreased the incidence of patient non-attendance. Utilizing an experimental design, data gath- ered at two Plastic Surgery clinics were compared over two three-month periods, pre- and post-implementation. Total attendance and non-attendance were examined in terms of new and review patients, gender and age profile. The research concludes that the intervention tested in this form can now be discounted thus allowing the exploration of subtler solutions. Keywords Consumer behaviour, hospital waiting lists, communication. Introduction Increasingly, within the acute hospital setting, treat- ments and interventions are being carried out within the outpatient department. Patients are no longer admitted for minor procedures. If hospitals are to increase outpa- tient activity, fully utilize available appointments and achieve the objectives of Partnership for Care 1 we must consider the eternal problem of patients who did not attend (DNA) their appointment. When patients miss an appointment the opportunity of professional help and early diagnosis is lost and access is delayed for other patients. 2 This occurrence increases the waiting lists and represents an annual opportunity cost to the health ser- vice of over £8 million in Scotland alone. Information Services Division Scotland, 3 report 4.69 million outpatient attendances, with the DNA rate rep- resenting 11.9% in Scotland during the year 2002–2003, in contrast to 938 404 inpatient and 428 938 day case episodes. Outpatient attendances cost the National Health Service (NHS) Scotland an estimated £265 mil- lion annually. Current statistics from The Outpatient Appointment System (TOPAS) 4 database indicate an average DNA rate of 11% for return and 14% for new outpatients which, when considered cumulatively, indi- cate a slightly higher figure than the Scottish average. The health agenda enjoys priority in every current political manifesto. Because clinical quality outcomes are notoriously difficult to use comparatively, and for the public to comprehend, it is the ‘numbers game’ that is deemed to demonstrate governmental success or fail- ure. Waiting times, and numbers on waiting lists feature high, as targets are lowered, and additional funding promised, becoming the yardstick for each party to beat the other with. Unless the Scottish Executive delivers an NHS that treats patients with minimum delay, min- isters recognize they risk paying a heavy political price for failing to make the extra billions of investment count. 5 For all political parties there is a clear recognition of the importance that waiting times, whether in the pri- mary or secondary setting, now have as a proxy for the effective delivery of health care. For politicians and political commentators alike, waiting times have taken over the symbolic role that employment figures had 10 and 20 years ago as a demonstration of political success or failure. The interplay of policy, promises and opposi-