Your late cancellation policy may be causing late cancellations

I’ve been reading and enjoying Blind Spots, a 2011 book about why people make choices that go against their own genuinely-held values. It’s a good read, full of insights that I hope to bring to my work in ethics and policy going forward. One unexpected nugget for therapists: Your late cancellation fee might actually be encouraging late cancellations.

In the book, authors Max Bazerman and Ann Tenbrunsel explain how organizational policies aimed at deterring unwanted behavior can backfire, increasing the behavior they aim to reduce. This happens because the policy leads people to stop thinking about the behavior in ethical or relational terms. Instead of their choice being about the right thing to do, it becomes a cost-benefit analysis – a business decision.

A case example

They use the example of a child care facility that wanted to discourage parents from picking up their children late. Some parents had abused the graciousness of the child care staff, routinely stretching past the scheduled pickup deadline. The center determined that a new policy was necessary. They implemented a late pick-up fee and announced the new fee to all parents.

But the new policy didn’t do much to deter those who were already often running late; it didn’t change their circumstances. And worse, parents who previously had worked diligently to pick up their children on time (or at least close to it) now started to see the question not as one of being considerate to the staff, but instead as one of whether paying the late pick-up fee would be worth it for them to have some additional time at work. In many instances, they decided, it was.

“In effect,” the authors write, “late pick-up became just another service that the child care center offered.” Many parents, it turned out, wanted that service. Late pick-ups increased dramatically, as did the burden on the child-care staff.

Parents who previously perceived that they had broken a rule each time they picked up their child late now believed that picking up late and paying the fee was well within the rules of their relationship with the center. No longer were they doing something wrong. It wasn’t an ethical choice they were making. It was a financial one.

Should you have a late cancellation fee?

This is not to tell you that you shouldn’t have a late cancellation fee, or that such a policy would backfire in your practice. Different clinicians serve different populations, and relate to those populations differently. And of course, not all clients are motivated by the same considerations. With any policy, you’re likely to have a mix of client reactions.

I’ve heard many a horror story about a therapist who tried to hold a firm boundary when it came to their late cancellation policy (with or without a fee), only to have clients fight them on it relentlessly. I’ve also heard many stories about clients who abused a therapist’s grace when it came to late cancellations.

I would simply encourage some thoughtful consideration of 1) whether a policy is necessary for your practice, and 2) whether your policy will actually do (or is actually doing) what you want it to.

Figuring out the best policy for your practice

No policy, no matter how clearly disclosed and discussed in advance, is going to fully eliminate late cancellations. Clients have emergencies, illnesses, double-bookings, transportation issues, child care challenges, and a litany of other concerns that can arise at the last minute and make attending a scheduled therapy session impossible.

In such situations, clients may see a late cancellation charge as punishment for having normal human problems, hurting the therapeutic relationship. Interestingly, there is research evidence to suggest that if there’s going to be a penalty at all, harsher penalties work better than lighter ones at achieving the desired behavior. Though of course, harsher penalties also can shift the power dynamics in the client relationship.

So if you’re going to charge a late cancellation fee at all, keeping that fee small might be intended to show kindness. But for actually reducing late cancellations, there’s a good chance that having a small late-cancellation fee would turn out to be the worst option.

Having no fee at all makes cancelling late unappealing for those who see the decision as an ethical or relational one. Applying a severe fee makes cancelling late unappealing for those who would think of it as a strictly financial decision. Having a small fee may take the decision out of the moral or relational realm in the mind of a client, and make it a financial decision — one where eating a few dollars of expense doesn’t feel bad at all.

Rethinking late cancellations

If fully eliminating late cancellations is your goal, perhaps you should reconsider that goal. You may be better off simply accepting that a certain percentage of scheduled sessions won’t make, and building that into your business planning.

You might also find that late cancellations can be reduced more through relating than through a written policy or a fee. The research cited in Blind Spots makes clear that when clients are nudged in such a way that they think about a late cancellation as a simple business decision, they may be more likely to cancel a session. But if they understand it as an inconvenience to you and a failure to live up to the expectation in your professional relationship, late cancellations may be less likely.

That’s one of the more heartening takeaways from the book: With or without a policy encouraging them to do so, most people are strongly motivated to do what they see as the right thing. We want to be good to others.

As therapists, we’re sometimes better off relying on that innate goodness than trying to force desired behavior through punitive policies. Neither route will achieve perfect results, but one may work better for your practice than the other. It may feel more right to you, too.