Improving Patient Retention
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Patient retention is a key metric used to evaluate care quality. Consistent follow-up enables better health outcomes through long-term, personalized care plans. High retention also benefits providers by reducing last-minute cancellations and no-shows, creating more predictable schedules.
At Nourish, dietitians are expected to maintain high patient retention, with a goal of patients attending at least 8 weekly, recurring sessions. Ideally, retention extends to 12 sessions or more for optimal outcomes.
While no single metric tells the full story, retention generally reflects how much value patients see in their care. Life happens, and we recognize that barriers come up—our benchmarks account for this.
You can find retention metrics and performance expectations under the Metrics tab in the Provider Portal. Our goal is for all dietitians to stay within the light green zone across all time frames.
Strategies to Improve Retention:
Schedule weekly, recurring sessions
Set up weekly recurring appointments from the start. Eight sessions are the minimum expectation, with clinical outcomes improving further at twelve. You can always adjust the frequency later based on patient progress.
Assuage the patient on insurance concerns
Many patients skip sessions due to concerns about their insurance. Reassure them:
Nourish will never bill for a denied claim.
Patients can cancel claims that go to deductible.
With the Nourish Guarantee, there is no risk for surprise bills.
Help patients feel confident continuing care.
Schedule an immediate follow-up for the initial appointment
Patients are much more likely to stay engaged if they have a follow-up the week after their first session. Always schedule the next session before ending the first appointment.
If the patient is unable to commit to a follow-up time during the first session, dietitians are expected to follow up to schedule a second appointment for the following week to maintain momentum, build trust, and ensure continuity of care.
Assess which retention metrics are low & look for trends
Review your performance metrics regularly and assess your retention. Ask yourself:
How many sessions do patients attend (on average) prior to canceling/no-showing/refusing to schedule a f/u?
Are certain specialties or conditions tied to lower retention?
Identifying patterns helps you adjust your approach.
Ask for & assess patient feedback
Value honest feedback! Encourage honest feedback during sessions—remind patients you're working together and they are welcome to share how they are feeling about the process each step of the way.
Review your NPS scores and comments in the dashboard. Celebrate what’s going well, and look for areas to improve.
Set clear expectations for the initial appointment
The initial appointment sets the tone for the rest of the work you will do with a patient. It’s vital to set clear expectations. Some patients may have worked with a dietitian in the past, while for many, it is a completely new experience. Being intentional to minimize surprises or misunderstandings establishes trust and outlines the care journey.
Explain purpose and structure of initial assessment
Explain Nourish’s approach to care
Set expectations for goal setting and education
Set expectations for ongoing scheduling and communication
Ask patient what their expectations are
Assess Stages of Change to determine interventions & goals
Goal setting is an important part of nutrition counseling sessions—it can make or break retention. If a goal feels unattainable, it may be discouraging to the patient, whereas if a goal is too small, it may feel frustrating to the patient. Setting goals that are relevant, realistic and achievable is imperative.
Assess the patient’s stage of change.
Collaborate with patients on goal setting.
Let patients take the lead in creating goals, but guide them towards making realistic SMART Goals.
Understand patient’s motivations & connect with their why.
Assess patient’s confidence level & barriers to change.
Prioritize rapport building
Every patient comes in with different experiences. While some patients will be very open, others will not be. Retention suffers if patients don’t trust their provider, and building trust takes time. Spending time in session to build rapport can help patients feel more comfortable with their provider, therefore resulting in higher value from sessions and increased retention.
Make small talk to create a comfortable environment and put patients at ease. Show genuine interest in your patient’s life. This could be asking about their weekend before jumping into session or commenting on their dog sitting in the corner of the room.
Focus on Connection. What are your patient’s values? What is their ‘Why’?
Establish yourself as an expert. It’s important patient’s feel confident in the recommendations being provided to them. Share your experience and expertise when introducing yourself.
Be curious. Avoid making assumptions about patients. Notice if questions are leading. Start with open ended questions.
Be yourself! It’s paramount to maintain professionalism at all times with patients, but letting your personality shine through is essential to building genuine rapport.
Hold patient-led sessions & know when to guide
Patient-led counseling is critical. It empowers patients to share in the decision making process and builds trust, therefore improving patient satisfaction.
Meet the patient where they are at. Be aware of the patient’s stage of change. Support the patient on what they are willing to work on and change.
Validate your patient’s feelings and experiences when clinically appropriate.
Use active listening and reflection to encourage open communication and demonstrate to the patient that their input matters.
Collaborate with patients in the decision making process. Ask patients what they want to focus on & what goals they want to set.
Understand your patient’s motivations. Really get curious about your patient’s values and the ‘why’ behind their goals.
If a patient is unsure of what they want to work on, suggest options that align with their preferences and provide them with education so they can make informed choices.
Provide quality education
Many patients are excited to learn about nutrition! It’s important that education is delivered clearly and effectively.
Assessing a patient’s education enables you to effectively educate and ensure you are providing them with new, relevant information.
Have resources ready when helpful or necessary.
With any habit, education is the start. Make sure you are setting SMART goals that allow the patient to practice and apply skills in everyday life.
Review education materials prior to sessions
Try to include educational tidbits (however general) in the first session to try to build the trust that you know your stuff!
Brush up on motivational interviewing skills
Motivational Interviewing is foundational to behavior change. Utilize the guide below to continuously improve your MI skills.
Reach out to patients that have not rescheduled
Use the Nudge feature in your Provider Portal to reach out to patients who haven’t booked their next session. A simple reminder can make a big difference.
Retention Checklist:
Have I reviewed the Nourish Standards of care?
Have I assessed which retention metrics need improvement?
Have I reviewed and asked for patient feedback?
Am I scheduling most follow-up appointments within a week of the initial appointment? Am I setting clear expectations for the initial assessment?
Am I setting clear expectations for working with a dietitian at Nourish?
Am I assessing the patient’s stage of change to determine interventions and goals?
Am I prioritizing building rapport in sessions?
Am I holding patient led sessions? Do I know when to step in and help guide the patient? Am I prepared to effectively educate the patient in session?
Have I brushed up on motivational interviewing skills recently?
Have I reached out to patients who have not rescheduled using the ‘Nudge’ feature?
