Measuring and Managing the Cost of Broken Appointments with FTA KPI

The research journal of the Faculty of General Dental Practice (UK) back in 2000 published an interesting article [1] about managing broken appointments for a dental practice. The information looks like something that only professionals from a health care industry might need, but I’ve found there some lessons that any business owner could benefit from.

What is the problem of broken appointments?

The abbreviation FTA that stands for Failure to Attend is also in use.Managing the cost of broken appointments with FTAs KPI

In the dental practice when a patient books an appointment it means that actually valuable resources of the dental practice are booked as well. If a patient breaks or fails to attend an appointment, a dental practice loses not only the cost of the treatment that a patient would pay for, but the costs associated with the time of the specialists involved.

Authors of the research started with the fact that broken appointments in a dental practice lead to inefficiency and as a result lead to financial loss. Their research showed that there are some simple ways to improve the performance of FTA KPIs and decrease the number of broken appointments.

Any business where the cost of a failed appointment is significant should consider implementing the findings of this research.

How to decrease FTAs rate?

The first interesting fact is that the majority of patients that were failing to attend an appointment were unemployed. We could only assume why this happened. Unemployed people normally don’t have a work schedule where they could add information about an appointment. Probably this is one of the reasons they didn’t attend their appointments.

  • If it is possible in your business, it might be a good idea to profile your customers to find out what groups have the highest risk of failure to attend and introduce additional measures to decrease FTAs for this group.

Another interesting fact is that introducing simple recall methods allowed improvements to the FTA KPIs. Authors of the research tried to introduce recall letters and appointments cards and as a result, for the control group of patients the rate of failed appointments was significantly reduced.

  • Obviously, the type of recall method depends on your business. Here in Spain, dental practices normally call one day before the scheduled appointment to confirm it. Other businesses widely use SMS notifications. Even official services provided by governmental organizations send recall notifications by email and SMS.

As mentioned before, this lesson is useful for any business that deals with clients directly and where the cost of broken appointment is high. If you are in a dental care business, then you might be interested in researching more ready-to-use KPIs for dental practices on [2].

Let’s find out what KPI we might use to measure and later control the FTAs. I’m following BSC’s approach [3] to do an analysis and present the KPI. The benefit of BSC approach for the dental practice was already described in [4].

KPI to measure and control broken appointments

Target business:

Any business with client’s appointments that involve the high cost of broken appointment.

Strategic objective:

Financial perspective: Improve financial efficiency; Prevent financial loss;

Objective: Reduce the number of broken appointments

Description: one of the main reasons for service inefficiency is failure of the client to attend a scheduled service. The goal is to improve financial efficiency by decreasing the number of broken appointments.


  • Introduce simple recall measures, such as recall letters, emails, recall cards and recall phone calls, or SMS.
  • Do a/b testing for recall initiatives
  • Do clients’ profiling from the viewpoint of broken appointments


FTAs %. The percentage of failures to attend (FTAs)


FTAs % = (The number of not attended appointments * 100 %) / (The total number of appointments)

In BSC Designer Online:

Aligning FTAs to the cost information

Managers of your service will be more motivated to manage FTAs if you will align the number of broken appointments to the actual financial loss. To do this you will need to calculate an average financial loss that you have due to a broken appointment and multiply it by the number of broken appointments.


  1. ^ The Reduction of Broken Appointments in General Dental Practice: An Audit and Intervention Approach. Patel, Piyush; Forbes, Michael; Gibson, John. Primary Dental Care, Volume 7, Number 4, 1 October 2000, pp. 141-144(4)
  2. ^ Dental Practice Balanced Scorecard, Commercial library of KPIs.
  3. ^ Get the big picture about Balanced Scorecard, its connections and roles, Aleksey Savkin, 2013,
  4. ^ Balanced Scorecard and KPIs for a Dental Practice, Aleksey Savkin, 2013.

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Strategy and KPIs Scorecard Expert | Speaker | CEO. Aleksey Savkin (LinkedIn, @bscdesigner) is helping companies to better formulate their strategies and make the process of strategy execution more tangible with KPIs. His areas of expertise are Balanced Scorecard, Key Performance Indicators, business performance management. Aleksey is a frequent speaker at conferences; the author of a number of articles and books on Balanced Scorecard. New book by Aleksey: 10 Step KPI System

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