A gap nobody budgets for

For a long time I treated a cancelled appointment as a one off problem. Something came up for the patient, the slot went empty, and the day’s takings were a little lighter than planned. I didn’t think about it as a pattern because on any given day it genuinely did look random.

It was only when I started looking at the diary as a whole, week after week, rather than day by day, that I noticed the gaps weren’t scattered evenly. They clustered around certain times of day, certain points in a course of care, and certain kinds of appointment. That was the first thing that surprised me. A cancellation is rarely just bad luck. It’s usually telling you something about the booking itself.

Why I stopped blaming patients

My first instinct, like most owners I suspect, was to see a late cancellation as a patient problem. They forgot, they deprioritised it, they didn’t value the appointment enough to keep it. Easier to think that than to look at my own diary and ask whether we’d set the appointment up to fail.

What I actually found, in our own numbers, was that a lot of the gaps sat at points where we’d booked someone back in without really checking whether that time still suited them, or where we’d booked a long way ahead without any contact in between. The patient didn’t do anything wrong. We’d booked a slot and hoped it would hold rather than doing anything to help it hold.

What actually changed in how we book

The change wasn’t clever. It was mostly about reducing the distance between when someone agrees to come back and when we actually confirm it’s still a good time for them. The appointments that used to quietly fall over were often the ones booked furthest in advance with nothing in between to keep them real.

We also started looking harder at the first few visits of any course of care, because that’s where most of our drop off sat. If someone doesn’t feel progress early, or doesn’t understand why a second or third visit matters, a cancellation there isn’t really about the diary at all. It’s about whether the plan made sense to them in the first place.

The part I still haven’t solved

I’d be overstating it to say we’ve fixed cancellations. We haven’t, and I don’t think any practice ever fully does, because people’s lives are genuinely unpredictable and that’s not something a booking system can account for. What changed is that I stopped seeing a cancelled slot as noise and started treating it as a small signal worth reading.

The honest version of this is: most of what I thought I knew about our diary, I hadn’t actually looked at closely. Once I did, the fix was less about clever scheduling and more about paying attention to the handful of moments where a booking quietly stops being real to the person who made it.

We’ve written up the structured version of how we approach the diary and cancellations, including the parts I didn’t cover here, on the diary and cancellations page of the playbook.