A visit to The North American Veterinary Conference gave me the opportunity to hear an interesting lecture by Karyn Gawzer & Gary Edlin. They showed fantastic results with >80% response rates based on a system with 11 reminders before they let go of clients. Back in Denmark and Norway I discovered that the results are poor compared to the US. This inspired me to find out how to improve the numbers in poorly performing practices. This talk is based on a project where I have worked with optimizing the reminder system of a group of Danish and Norwegian clinics. By the time of handing in these proceedings, we are still in the process of getting more data. You can find these data www.praqtice.dk

The Cultural Background

Before you compare your result with clinics from other countries, I suggest that you tap into https://geert­hofstede.com/countries.html (VIN editor: link could not be accessed on 5/16/18). I often do this before comparing result as there can be big cultural differences. This is a result of a cultural comparison between Denmark, Norway and the United States:

In Denmark power distance is low and the same applies for uncertainty avoidance. I believe that if these two factors are low, you will never be able to create the same results as for instance in the US. Thus, the numbers I discover working in DK and NO will always be low compared to what you would see in the US.

Know your real numbers — they could be worse than expected.

First step if you decide to improve your reminder system is to work out how well you are performing. This is not always an easy task and in some system, you have to work out your ratios manually. What I would like to know first is:

• What is the share of active clients that are set up for a reminder in the future? Cats? Dogs? Total?
• What are the response rates on your reminders? For vaccinations? For dentals? For other procedures?

As an interesting example to share from one of the clinics surveyed we found that less than 10% of the active cat clients were set up for reminders (only 50% in total) and that their response rate on dental reminders was 9%. We also found out that the quality of the reminders was very bad.

If your system is not able to provide the data, I suggest that you manually make a sample of 200 random active clients and work out the results for your own clinic. It might take a few hours, but it is worth the effort.

What Statistics Would We Like to Follow?

To keep attention to the reminders I suggest that you keep following up month after month. We found that it has been hard to improve the numbers quickly and that continuous measuring is essential. In our study we have followed up on the following:

• % clients with active reminders. We measure it as the percentage of clients that has been in the clinic in a given month and has an active reminder when they leave.
• Response rate. How big a share of the reminders end up in the client showing up. This number is interesting for vaccinations, dentals and other procedures.
• Response rate on 1st, 2nd, 3rd ….reminder.

Our Reminder Scheme and First Findings

When we first started the project, we set up this scheme:

1.  First reminder is sent as text message and e-mail three weeks prior to vaccination due date
(Content will be explained later)

2.  Second reminder (same as the first) is sent one week prior to vaccination due date

3.  Third reminder is a text message sent 1–2 weeks after due date

4.  Fourth reminder as a postcard

5.  Fifth reminder as a phone call

Phone Call>Text Message>E-mail>Postcard

Data from a Norwegian clinic showed that phone calls are definitely the best way of getting clients in for all procedures. By phoning clients, they went as high as a 90% response rate, though this is not a representable finding. In our study, text messages were the most effective as clients often rang back immediately, followed by e-mail and then postcards.

In Scandinavia, most clinics only send out one or max two reminders. It was therefore interesting to learn that in our study 28% of the clients came in due to the 3rd reminder.

A learning/mistake we made was that our third reminder stated (in a polite way) that "We have sent two reminders. If you don't want to receive more reminders or have had your pet vaccinated elsewhere, then please give notice." The response rate was high, but half of them said that they did not want to receive more reminders. This should instead have been a phone call, where the veterinary nurse could talk them in.

Outlay of our Reminders

Based on looking at many reminders and having a few group discussions, we agreed that a reminder should have the following characteristics: It should be relatively short, as clients do not want to read a lot of text. It should also include the following:

• An introduction showing the name of the clinic so that the client immediately can spot that the SMS is from the clinic
• A link to a landing page at the practice website explaining why the procedure is important
• A link to online booking (although the majority of clients called instead of booking online)
• A phone number that they can click on directly to get in touch with the clinic

The Human Factor

As a part of another project we have been video filming many consultations and vaccinations. This gave us some interesting observations. The quality of the performance by the different veterinarians shows a huge difference. By watching the videos, it became very clear why some clinics have a high number of vaccinations and other clinics the opposite. There will be a huge potential in educating the veterinarians in performing a good health check and making sure that the clients understand the importance of vaccinations, health checks and dentals.

Forward Booking and Prebooked Appointments

In the US there is an initiative in teaching clinics to implement forward booking. This meaning that you ask the client to book an actual appointment a year in advance. I have tried to implement this in DK and NO, but without any success. However I still have a suspicion that it has been based on the performance of the veterinarian testing the approach. I still believe it is worth looking into.

In Norway, many practices, based on a recommendation from a software provider, have started to make prebooked appointments. It seems to have a positive effect. However in my two clinics in Norway we experience that some client left the clinic that started with prebooked appointments and shifted to our other clinic.

Start with a Direct Marketing Campaign

I have surveyed the reminder system of five practices and made an interesting finding. If a practice has 2.000 active clients, it will on average have 1.500 clients who have been to the practice between 12–24 months ago, but not visited within the last 12 months. This means that there is a huge potential to address those clients. During my talk I will show some of the direct marketing campaigns that we have performed in order to start up the reminder programme.