What does “no show” mean in orthodontics?
A no-show is an appointment for which a patient does not show up without canceling in time. This includes short-term cancellations (e.g. on the same day) and delays. These also exceed time windows, but should be resolved in a different way from an organizational point of view.
Important: No-shows are not a “character problem” for patients, but in many cases a process problem: reminder, confirmation, simple rebooking, clear rules.
Why no-shows in orthodontic practices can be particularly expensive
No-shows can cause particularly high costs in orthodontic practices because scheduling is usually tight and many treatments take place in short, clearly defined time windows.
If a patient does not show up, the treatment chair often remains unused, even though staff and rooms have already been planned.
In addition, vacant slots are difficult to fill in the short term because orthodontic appointments are often linked to specific treatment steps and cannot be filled with other patients at will.
This not only results in direct sales losses, but also additional organizational costs and delays in the entire treatment plan.
The most common causes of no-shows
The reasons for no-shows are often banal, but are repeated in many orthodontic practices:
- Patients forget the appointment: Especially during routine checks, the appointment is not perceived as urgent and slips through in everyday life.
- The deadline is too far in the future: The longer the period between booking and appointment, the higher the risk that it will be forgotten or omitted.
- Adolescent patients + parent communication: It is often unclear who is really keeping an eye on the appointment. If parents and children are not both informed, the failure rate can rise.
- Uncertainty or fear of treatment: Some patients deliberately avoid appointments when they feel unwell or have had bad experiences.
- Unclear communication (time, duration, location): Misunderstandings about the time, duration of treatment, or location of the practice may result in patients not showing up.
- Rejection processes that are too complicated: If rebooking or cancellations are only possible by telephone and at certain times, it is sometimes postponed and ends in a no-show.
Reduce no-shows: 5 effective measures
1. Automated appointment reminders (SMS, email, WhatsApp)
Automated reminders are one of the most effective ways to reduce missed appointments.
Ideally, reminders are sent not just once but in several stages, for example:
- 7 days before the appointment
- 48 hours before
- And on the appointment day.
It is important that the message is short and clearly states the date, time and practice location.
With Nelly Search appointment reminders can be sent automatically via SMS or e-mail, without additional effort on the part of the practice team.
Note: Channels such as WhatsApp should also ensure that data protection and consent are properly regulated.
2. Appointment confirmation instead of just a reminder
A reminder alone doesn't always lead to a reaction. A system works much better in which patients must actively confirm that they are coming.
As a result, commitment increases and practice recognizes early on which deadlines are uncertain.
Exemple: Patients receive a message 48 hours in advance with a confirmation link (“confirm appointment”) or the option to answer directly with “YES.” Unconfirmed appointments can then be reworked in a targeted man instead of the team blindly hoping to be present.
3. Simplified rebooking and cancellation
The easier it is for patients to cancel or rebook, the fewer no-shows occur. If cancellations are only possible by telephone, they are often postponed or forgotten. A digital path that works around the clock significantly lowers this hurdle.
Exemple: The appointment reminder contains a link (“move/cancel appointment”), which patients can use to directly select a new slot.
The aim is not to encourage cancellations, but to receive cancellations early enough to be able to reschedule the appointment.
4. Create commitment (without scaring patients away)
In addition to technology, there is a need for clear rules so that appointments are taken seriously. This includes transparent communication as to when an appointment is considered to be short-term and what consequences may arise as a result.
The tonality is decisive: Factual, fair and without threatening background.
When patients understand the process, acceptance increases and at the same time decreases the likelihood that appointments simply expire.
5. Use waiting lists and follow-up systems
An additional lever is a waiting list for appointments available at short notice. If an appointment is canceled, patients who are flexible can be notified about the waiting list and take over the vacant slot early on.
This helps to fill up free time in the short term instead of leaving it unused.
Exemple: “Tomorrow 4:30 p.m., there is an appointment available at short notice. Would you like to take over? Please confirm by 18:00.” Such a follow-up logic improves planning and uses freed up capacities more efficiently.
Practical example: This is how a modern orthodontic practice could work
A patient at the orthodontic practice has a check-up appointment on Wednesday at 3:20 p.m. 48 hours in advance, he receives a message asking him to confirm the appointment. It does not respond; the appointment remains marked as “unconfirmed” in the system.
A short reminder is automatically triggered the next morning. No confirmation again.
This makes it clear: The appointment is a risk and the practice doesn't wait until the afternoon to notice it. The receptionist sees the unconfirmed appointments in a list and calls the patient specifically. It turns out that the patient has the appointment wrong in the calendar and is unable to keep it.
The appointment will be rebooked directly. At the same time, the vacated slot is played to a waiting list.
Another patient makes the appointment at short notice.
Outcome: No idle time, the original patient gets a suitable alternative appointment, and the no-show was not only visible “in an empty chair,” but well in advance.
What digital processes do better than telephone and paper
Digital appointment processes are not only “more modern,” but also measurably more efficient because they:
- Automatically play reminders: Without additional effort for the team
- Make confirmations visible: The Practice Recognizes Risky Appointments at an Early Stage
- Capture cancellations faster: Slots become free earlier and can be reassigned
- Enable standardized communication: Every patient receives clear, consistent information
- Simplify follow-up processes: Waiting lists can be specifically activated instead of being processed by telephone
Key Figures: How to Measure No-Shows Correctly
1. Calculate no-show rate
The most important indicator is the no-show rate. It shows how many patients do not show up without a cancellation.
Formula: No-show rate (%) = (no-shows/all booked appointments) × 100
Sample calculation:
In One Month, a Practice Has 800 appointments. Of these are 40 Patients Did Not Show Up, without canceling.
→ (40/800) × 100 = 5% no-show rate
Important: Only real no-shows count, not last-minute cancellations.
2. Rejection rate vs. no-show
Cancellations and no-shows should be considered separately. A high rejection rate is not automatically bad as long as it arrives early enough to reschedule.
No-shows without any information are particularly critical because they lead directly to idleness.
A practice can therefore be economically stable despite many cancellations if rebooking and restaffing work well.
3. Identify no-show patterns (days of the week, patient groups, appointment types)
No-shows are rarely evenly distributed. They often accumulate during certain types of appointments, times of day or patient groups. That is why it is worthwhile to evaluate failures by category, for example:
- Checks vs. longer treatments
- Appointments on Monday morning or Friday afternoon
- Adolescent patients vs. adults
- First Appointments vs. Routine Appointments
Search patterns show where processes need to be adjusted, for example through additional confirmations or other reminder times.
4. Target values for well-organized practices
A realistic goal is not “0 no-shows,” but a stable quota that can be planned. It is particularly crucial that potential no-shows are cancelled early so that free slots can be resigned.
Good processes can be recognized by the fact that unconfirmed appointments are noticed early, cancellations are received in good time and practice can actively fill up free capacities.
Common No-Show Reduction Mistakes
Many practices implement measures, but without a clear process. As a result, the effect is often smaller than possible. Typical mistakes include:
- Just a single reminder that's easy to miss
- Reminders without confirmation option (“for information” instead of “please respond”)
- Cancellations and rebookings only by telephone and only at certain times
- Missing waiting list, meaning that slots that become vacant at short notice are not used
- Unclear or overly aggressively formulated rules that annoy patients rather than motivate
- No overview of key figures, leaving no-show patterns (e.g. specific days of the week or patient groups) undetected
Reduce no-shows and automate practice processes with Nelly
If you want to reduce no-shows, you don't need additional telephone lists, but clear digital processes. With Nelly Central practical processes can be automated for this purpose, for example:
- Follow-ups and appointment reminders via SMS or emailSo that patients don't forget appointments
- digital documents and signaturesto reduce queries and paper processes
- digital anamnesis Before the AppointmentSo patients are prepared and less time is lost in receiving
- structured patient communicationSo that confirmations and responses do not have to be kept up manually
Nelly will advise you free of charge And shows which digital processes really make sense in your orthodontic practice and where the biggest effects can be achieved.
