How to calculate the cost of a cancellation: points, yearly hours and the effective target
One empty slot has a price in percentage points, and a year of them has a price in hours.
The cost of a cancellation, in productivity terms, is the slot length divided by your paid minutes. A 45-minute slot on a 450-minute paid day costs 10 percentage points. Three such slots a week add up to 103.5 hours over a year of 46 working weeks.
This guide works out those numbers and the effective target a no-show rate creates. For planning a single day or week around no-shows, see cancellations and no-shows: planning your productivity day.
The cost of a cancellation in points
Points lost = slot length ÷ paid minutes × 100
A 45-minute slot on a 450-minute paid day is 45 ÷ 450 × 100 = 10.0 points. The shorter your paid day, the more each slot costs.
| Slot length | 360 paid minutes | 450 paid minutes | 570 paid minutes |
|---|---|---|---|
| 30 minutes | 8.3 points | 6.7 points | 5.3 points |
| 45 minutes | 12.5 points | 10.0 points | 7.9 points |
| 60 minutes | 16.7 points | 13.3 points | 10.5 points |
Two 45-minute cancellations on a 450-minute day cost 20 points off whatever that day could have reached. The points come off the day's ceiling, so effort later in the day can't win them back unless the slot is filled.
Calculating your no-show rate
In this guide, the no-show rate counts late cancellations as well as no-shows.
No-show rate = lost slots ÷ booked slots × 100
Count over a month, not a week, so one bad week doesn't set the rate. In this example, 14 lost slots from 190 booked is 14 ÷ 190 × 100 = 7.4%.
The rate is a share of booked slots. Your productivity is measured against paid minutes, and you are rarely booked for every paid minute.
The effective target formula
The effective target is the share of the time when patients turn up that you must bill. The short version of the formula is:
Effective target = stated target ÷ (1 − no-show rate)
An 85% target with a 12% no-show rate gives 0.85 ÷ 0.88 = 96.6%. That leaves 3.4% of the remaining time for transitions, notes, equipment and everything else.
| No-show rate | 85% target becomes | 90% target becomes |
|---|---|---|
| 5% | 89.5% | 94.7% |
| 10% | 94.4% | 100.0% |
| 15% | 100.0% | 105.9% |
| 20% | 106.3% | 112.5% |
The short version assumes the loss applies to the whole paid day, as if every paid minute were booked. On that assumption, a 15% no-show rate makes an 85% target equal to billing every minute that arrives. Above 100%, the target can't be reached.
The full version, with your booked minutes
Booked time is usually less than paid time, so a no-show rate removes a smaller share of the paid day than the rate itself. The real effect is smaller than the table shows.
Share of paid time lost = no-show rate × booked minutes ÷ paid minutes
Effective target = stated target ÷ (1 − share of paid time lost)
Take nine 45-minute slots, or 405 booked minutes, on a 450-minute day with a 12% rate. You lose 405 × 0.12 = 48.6 minutes on an average day, which is 48.6 ÷ 450 = 10.8% of the paid day. The effective target is 0.85 ÷ 0.892 = 95.3%, against 96.6% from the short version.
Check the booking too. The minutes that arrive on an average day are 405 − 48.6 = 356.4, which is 79.2% of the paid day. With this schedule an 85% target is out of reach on an average day, whatever the effective target says.
The productivity cost over a year
Annual lost minutes = lost slots per week × slot length × working weeks
The examples use 46 working weeks. That is an assumption, so change it to match your own leave and holidays.
Three lost 45-minute slots a week gives 3 × 45 × 46 = 6,210 minutes, or 103.5 hours a year. In 450-minute paid days, that is 13.8 days of unfilled capacity for one clinician.
You can start from the rate instead.
Annual lost minutes = booked minutes per week × no-show rate × working weeks
Nine 45-minute slots a day for five days is 2,025 booked minutes a week. At 12%, that is 2,025 × 0.12 × 46 = 11,178 minutes, or 186.3 hours a year. Across those weeks, the average cost is 243 lost minutes out of 2,250 paid, or 10.8 points.
| Lost 45-minute slots a week | Minutes a year (46 weeks) | Hours a year | Department of eight, hours |
|---|---|---|---|
| 1 | 2,070 | 34.5 | 276 |
| 2 | 4,140 | 69.0 | 552 |
| 3 | 6,210 | 103.5 | 828 |
| 5 | 10,350 | 172.5 | 1,380 |
Tracking lost slots so the numbers hold up
Record four things for each lost slot: the date, the scheduled length, the type (advance cancellation, late cancellation or no-show) and whether it was filled. A month of that gives a rate and a split by type.
The split shows which fix applies. Advance cancellations can be filled from a short-notice list. Late cancellations and no-shows are the target for reminders. A 2013 review of randomized trials compared mobile text message reminders with no reminders. Text reminders improved attendance at healthcare appointments, with a risk ratio of 1.14.
Taking the numbers to the department
Give the cost in hours as well as points. Three lost 45-minute slots a week per clinician, across a department of eight, is 828 hours a year of unfilled capacity. Set that against what a fix would cost your clinic, such as a text reminder service or front desk time to run a short-notice list.
Give the target in the same terms. A manager can check a sentence like this one. "Our no-show rate is 12%, which turns an 85% target into 95.3% of the paid time that isn't lost to no-shows." Show the booked minutes you used, so anyone can rerun it with their own.
For capacity across a whole caseload, the caseload calculator takes an attendance loss percentage as one of its inputs.