OBJECTIVES: Missed appointments may contribute to high levels of resource waste across healthcare systems, yet there is paucity in studies that explore the processes or costs associated with patients missing appointments. This study aimed to determine the key workflow processes and costs associated with responding to missed appointments in a physiotherapy outpatient clinic using time-driven activity-based costing (TDABC).

METHODS: Missed appointment protocols and clinic personnel interviews were used to identify key workflow processes, corresponding process activities, activity time and frequency. The TDABC method was used to quantify costs of specific clinic activities relating to missed appointments by combining activity time (min) with its associated capacity cost rate ($/min). All costs are reported from a health service perspective.

RESULTS: Key workflow processes and associated activities were identified from the point of referral to the point in which a patient misses an appointment. The largest portion of activity time associated with responding to a missed appointment was spent converting face-to-face appointments to telephone appointments for eligible patients (average 20 minutes per case). Selected clinic personnel capacity cost rates were $1.5/min for physiotherapists and $1.0/min for administrative staff. Annual projected costs associated with responding to non-attendance ranged between $51,000-$115,000.

CONCLUSIONS: The use of TDABC may enable the identification of efficient and inefficient processes within healthcare clinics, of which may inform strategic planning towards improving operational efficiency and reducing resource waste.