Process improvement for behavioral health

Double-book Time Slots


When clients don’t show up for scheduled assessments, too many time slots go unused.


Schedule two clients for the same assessment time slot.

Featured Stories

Women’s Recovery Association in Burlingame, California, increased admissions from 2 to 8 per month (300%) by double-booking assessment appointments. They included counselors in the decision to double-book, then trained the staff, role-played the procedure, and pilot-tested the process.

Mid-Eastern Council on Chemical Abuse in Des Moines and Iowa City, Iowa, reduced the impact of no-shows and increased counselor productivity by scheduling 9 admission appointments during 6 hours of available counselor time.

Sinnissippi Centers in Dixon, Illinois, reduced the impact of no-shows for assessment appointments by double-booking assessment appointments when the request for counselors exceeded the available time slots. They tried a number of variations, including booking 2 appointments for a single counselor and booking 3 appointments for 2 counselors. Staff resisted the idea at first, but became more supportive when it became clear that it was rare for all of the clients to show up for a double-booked time slot.

Lessons Learned

  • Analyze the most common times for no-shows so you can identify the best times to double-book clients.
  • If two clients booked for a single time slot show up, they can take turns seeing a counselor and a financial counselor.
  • Instead of double-booking time slots, schedule multiple clients and offer an assessment group for all of the clients that show up. Then meet briefly with each client individually while the others are participating in group learning sessions.
  • Double-booking is the first step toward offering walk-in service.

Tracking Measures

Cycle Measure

Number of days to the next available assessment appointment

Next Available Appointment Tracking Spreadsheet



1. Determine which time slots to double-book.

2. Collect baseline data for the number of days until the next available assessment appointment.


3. Select two or three counselors and double-book a limited number of their assessment time slots for the next two weeks.

4. Re-check the number of days until the next available appointment.


5. Check the fidelity of the change. Was the change implemented as planned?

6. Evaluate the change:

    • When double-booked, how often did clients show up for their appointments?
    • When both clients came for their appointments, were they both given the appropriate attention and care?
    • Did the number of days until the next available assessment appointment decrease?


7. Adjust the number of counselors or the number of double-booked time slots per counselor and re-test this promising practice for an additional two weeks.