Reducing Patient Tardiness: From Experiment to Implementation

Abstract

In this paper, we explore the effectiveness of late penalties in reducing patient tardiness. Specifically, we evaluate two types of penalties: the last-place penalty (i.e., assigning late-arriving patients to the end of the queue) and the fixed-place penalty (i.e., moving late patients back by a fixed number of positions), under two conditions—absence of a time recommendation and presence of an explicit time recommendation. We conducted a randomized controlled trial involving 9,573 patient visits at a partner hospital in Asia. Our findings indicate that the fixed-place penalty has no significant impact on patient tardiness. In contrast, the last-place penalty significantly reduces patients’ late rate and encourages earlier arrival, particularly when no time recommendation is provided. When combined with a time recommendation, the last-place penalty continues to lower the late rate but does not further shift arrival times earlier. We also find that the last-place penalty is effective in increasing the patient’s compliance with the time recommendation. We further implemented the last-place penalty in the partner hospital across a broader dataset involving 61,829 visits, yielding consistent results.