The Integrated Therapies Team in Children’s Services was experiencing a significant number of missed appointments. These included cancellations by healthcare professionals and a high rate of Was Not Brought (WNB) or Did Not Attend (DNA) instances by parents and carers. The issue was particularly pronounced during school holidays, leading to longer waiting times, wasted clinic slots, and reduced service efficiency.   

The aim  

The project aimed to improve the actualisation of appointments by 5% within the Integrated Therapies Team in Barking & Dagenham by November 2024. This goal was set to enhance service delivery and patient experience by reducing missed appointments and improving communication.  

Change ideas and interventions  

Several interventions were introduced to tackle the root causes of missed appointments:  

• The availability of phone lines was extended from two hours to a full working day, allowing parents and carers more flexibility to communicate  

• SMS reminders were scheduled to be sent at least 48 hours before appointments to ensure better attendance  

• A consistent communication approach was implemented across Occupational Therapy, Physiotherapy, and Speech and Language Therapy services  

• The team also began offering more flexible appointment options during school holidays and used the RiO system to allow cancellations on behalf of families  

• Additionally, a list was created of families who were open to last-minute appointments, helping to fill gaps more efficiently  

• Gaining feedback from parent/carers on the reasons for the DNA/WNB to help facilitate learning and improvement  

Learning

Although the data has not yet shown measurable improvement, the project has generated valuable insights. It became clear that data needs to be contextualised to reflect the challenges accurately. The team plans to continue implementing Plan-Do-Study-Act (PDSA) cycles to refine their interventions.  

Jagdish Kaur, Head of Service, Integrated Care, Children’s Services explains

“ We also learnt the changes in processes required from administration and clinical services to support the children and young people and their families. Additionally, exploring other health clinics to operate the services from – we reviewed the data to see where we can facilitate a pilot site for one clinic session. The pilot was a success and now there are clinics running at Beam Park, 5 days a week. ”  

Impact  

The project has already begun to influence patient care by offering more flexible appointment options and extending contact hours to improve accessibility. Communication with families has improved, particularly around school holiday scheduling. From a service delivery perspective, the initiative has led to more fulfilled clinical activity, reduced appointment wastage, and better coordination from the administration function. These changes are expected to contribute to shorter waiting times and a more efficient service overall.