Time Control: Coping with Late Patients and No-Shows

In many private pediatric and family practices, as well as the Child Health Clinic at Children’s Hospital Colorado, providers and staff talk about the challenges of working with patients and families who show up very late for appointments – or no-show entirely

A Cross-Cultural Perspective

Remember that people’s sense of time and time management is very much culturally based. A minute is a minute anywhere in the world, but not all people manage their time in quite the same way Americans do. When it comes to strict time management, the health care profession in the U.S. is appointment driven to an extreme – time is money. In America, you can be inconsiderate of another person’s time. In many cultures, this concept would not make much sense to people.

People who are new to our health care system will operate based on what they know – very possibly a system that works without set appointments. In many places in the world, if you need to visit a doctor, you try to show up at the community clinic when the line of patients will be the shortest. Maybe early in the morning is a good time to arrive so your name will be first on the list. Perhaps late in the day is a good time because there won’t be as many people waiting.

Adapt Your Care

It is a good idea to use the term clocktime when scheduling appointments with patients and families who are new to this country, who may not speak English fluently, and/or may be habitually late to appointments. Also, it is important to explain and emphasize that showing up late may mean a wasted trip for them. Practices should explain their cancellation and no-show policies clearly. Posting these policies may be helpful for patients and families who can read and understand the signs, but many people won’t be able to. Realistically, how many languages, other than English and Spanish, can you use to post important messages about these policies? Depending on your patient population, two languages just won’t be enough. The best approach is to explain your policies during new patient orientations. Someone on staff should be comfortable discussing policies with a wide range of people across cultures, language proficiencies, and levels of literacy. This orientation must be a dialogue where understanding is confirmed. Simply listing policies verbally is no better than giving them out in written form without conversation. The spoken and written should go hand in hand. If your practice can not offer written versions of policies in every language – who can? – then make them available in English at a minimum. People often have friends or relatives more fluent in English who can translate.