Nfld and Labrador Health Services charts path to near-zero no-shows

ST. JOHN’S – Newfoundland and Labrador (NL) Health Services has been implementing a new approach to address missed appointments. NL Health Services partnered with patient engagement specialists, TxtSquad, to introduce two-way patient communication by text – paired with AI voice outreach to land-line phones – to drive no-shows down to the sub-four percent range.

“This small pilot quickly evolved into a multi-site initiative that has enhanced the patient experience, reduced no-show rates, and improved workflow efficiency and satisfaction for our front-line clerical teams,” said Megan Carey, director (interim) primary healthcare with NL Health Services. “TxtSquad has been an exceptional partner and has become integral to how we engage with patients across nearly all of our primary healthcare sites.”

Currently active in 30+ clinics across the province, TxtSquad is used to manage over 20,000 appointments for 70,000 patients and the number is growing.

TxtSquad is a Canadian-made patient engagement platform that is compliant with the Canadian Personal Information Protection and Electronic Documents Act (PIPEDA) and the American Health Insurance Portability and Accountability Act (HIPAA).

It combines two-way texting with features such as appointment reminders, broadcast notifications, and a full phone system with automated calling, AI agents, call and voicemail transcription and summaries that work with a clinic’s existing phone system.

After seeing dramatic and immediate results in primary care, NL Health Services identified other program areas that could benefit from using the TxtSquad solution. The provincial breast screening program experienced similar early wins.

“It has significantly reduced the time staff spend calling patients and responding to voicemail,” noted Greg Doyle, provincial manager of the breast screening program with NL Health Services. “It allows the program to reallocate time to other clinical and administrative tasks. As well, patients are finding it much easier to contact the clinic, ask questions, and book or adjust their screening appointments.”

Two-way texting, supported by AI, and practical integrations that reduce friction: “The mechanics are straightforward – make reminders actionable,” explained Josh Taylor, founder and CEO of TxtSquad.

“Even SMS can underperform if it’s treated as notification-only. A one-way text reminder may increase awareness, but it doesn’t remove the key problem: many patients hesitate to cancel (they don’t want to “lose” their spot) or they don’t have time to call their clinic.

Or they have the best of intentions but can’t get through when they do call. Two-way texting changes that dynamic by making rescheduling the easy path.”

Rather than a one-way, “Don’t forget your appointment” notification, two-way SMS opens a conversation that lets patients confirm, cancel, reschedule, or ask a quick question.

Where the model becomes especially effective, according to the NL Health Services experience, is when texting is paired with voice automation for the remaining hard-to-reach patients, such as those without a mobile number on file; patients who don’t text, don’t see texts, or prefer to talk to a person directly; and patients who routinely miss reminders and require follow-up.

Voice AI can do initial outreach to a large number of patients at once – capturing whether patients wish to confirm, cancel or reschedule their appointments and escalating exceptions back to staff. This is the piece that, in practice, helps move from “big improvement” to “nearly eliminating preventable no-shows.”

Patients report confidence, staff report ease and stronger engagement: Beyond attendance metrics, NL Health Services’ post-pilot surveys suggest the approach is resonating with both patients and frontline teams.

On the patient side, 83 percent of respondents said texting the clinic was easy, while 81 percent reported feeling very confident using text to communicate with their clinic.

Staff feedback mirrored the patient experience with 92 percent of staff reporting that TxtSquad was easy to use, and 87 percent said the text platform worked well.

Overall staff satisfaction reached 87 percent, including 71 percent who described themselves as very satisfied. When rating quality, 88 percent rated TxtSquad “very good” or “excellent.”

Perhaps most telling for operational leaders, 96 percent agreed that texting had a positive to very positive impact on patient engagement compared to the usual communication process.

Voice AI then extends the same model to patients who don’t engage by text – supporting reception-like workflows such as reminders, confirmations, basic intake questions, and routing to the right place.

Taylor describes a rapidly evolving system that adds an “AI reception layer” that can answer common questions (pre-visit instructions, clinic policies, “what do I bring?”); triage requests (administrative vs. clinical routing); support appointment workflows (confirm/cancel/reschedule); reduce voicemail backlog with transcription and summarization; and hand off cleanly to staff when needed: “We want to move from reminders to conversations – and from conversations to AI-supported reception and triage.”

Luke Callanan is a project manager with TxtSquad.