Proof points
The Results at a Glance
Within months of launch, NLHS saw measurable drops in no-shows and call volume, results that have held up as the program scaled province-wide:
- 80%
- Reduction in no-shows
- 50%
- Fewer phone calls to clinics
- 5X
- Staff efficiency increase by eliminating manual workflows
- 2,000+
- Positive patient reviews
- 30+
- Clinics now active across NL
- 70,000
- Patients managed on the platform
- <4%
- Current no-show rate (sub-four percent range)
About NL Health Services
NL Health Services is the provincial health authority for Newfoundland and Labrador, created through the consolidation of four legacy regional health authorities into a single organisation to modernise healthcare delivery across the province.
As part of that transformation, NLHS established roughly two dozen Family Care Teams (FCTs), interdisciplinary primary care groups that bring together family physicians, nurses, and allied health professionals to deliver coordinated, team-based care to communities.
The Problem: No-Shows, Phone Overload, and Staff Burnout
A no-show occurs when a patient misses a scheduled appointment without cancelling or rescheduling in advance. For healthcare centres, no-shows create a triple cost: a lost appointment slot, added administrative load to rebook and follow up, and delayed care that can potentially worsen patient outcomes.
For NLHS, these five connected challenges emerged:
High no-show rates
No-shows at newly formed Family Care Teams (FCTs) exceeded the national average of 5-8% for specialty care, with higher rates in publicly funded primary care settings. Every missed slot was a block of clinician time that couldn't be reclaimed, and a patient who didn't receive care.
High call volumes
Clerical staff faced an overwhelming volume of inbound and outbound calls, many related to reminders, confirmations, and rescheduling, limiting time for more complex patient needs. The phone lines were doing the work that a few automated messages could have handled in seconds.
Manual workflows
Reminders and follow-ups were handled one by one, often resulting in unanswered voicemails or delayed call-backs. With each task done manually, the backlog grew as more appointments were booked.
Low patient engagement
Existing phone-based communication methods weren't consistently reaching patients. Many people simply don't pick up calls from unknown numbers anymore, so reminders went unheard, and appointments were missed.
Frustrated staff and patients
As demand increased and more FCTs came online, front desk teams were left managing hundreds of patients by phone, while no-shows continued to erode effective capacity, creating mounting administrative strain and frustration across sites. What started as a workflow problem was turning into a staffing and morale one.
Why Text? The Case for a Channel Patients Already Use
Text messages have a 90% read rate, are typically opened within minutes, and don't require patients to download an app or create an account. For health systems reaching tens of thousands of patients across dozens of clinics, that level of reach is hard to match with phone calls or client portals.
TxtSquad is a Canadian-made patient engagement platform that combines two-way SMS with automated reminders, broadcast messaging, and AI voice outreach, delivered through the messaging app patients already use. The platform is PIPEDA and HIPAA-compliant, enabling secure rollout across Canadian clinics.
The Pilot: Three Components, Four Clinics
How did NLHS reduce no-shows? They launched a pilot across four Family Care Team clinics to test whether TxtSquad could reduce missed appointments without adding to staff workload before scaling province-wide.
The pilot focused on three core capabilities:
1. Automated appointment reminders
Patients received multiple opportunities to confirm, cancel, or reschedule appointments with reminders sent 7 days, 3 days, and 1 day before each scheduled visit.
2. Two-way SMS communication
Patients could text clinic staff with questions or scheduling requests, while teams used templated responses to handle frequently occurring questions and issues.
3. Broadcast messaging
Clinics could send and schedule messages to several patients at once, reducing the need for individual calls or emails.
To build trust before launch, NLHS and TxtSquad ran a PR campaign using posters and flyers in clinics to explain the new texting service and opt-out process. Messages were kept simple and clearly branded so patients would recognize texts as coming from their clinic and not mistake them for spam.
“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. TxtSquad has been an exceptional partner and has become integral to how we engage with patients across nearly all of our primary healthcare sites.”
The Outcome: 80% Fewer No-Shows, and Much More
The results of the initial pilot were strong enough that NLHS expanded the program well beyond the original four clinics, as the numbers back this up:
- 80%
- reduction in no-shows
- 50%
- fewer phone calls to clinics
- 5X
- staff efficiency increase
- 2,000+
- positive patient reviews
- 83%
- of patients found texting the clinic easier
- 81%
- felt very confident communicating with their care providers by text
- 92%
- of staff found TxtSquad user-friendly
- 87%
- staff system satisfaction
- 96%
- of staff agreed that texting had a very positive impact on patient engagement
Unexpectedly, reducing call volume also improved staff job satisfaction and reduced confrontational interactions about missed appointments.
“Kudos to the team for creating such a user-friendly interface.”
Beyond Primary Care: Six New Applications
Following the success of the pilot, NLHS expanded TxtSquad beyond primary care, applying the platform across a range of clinical, research, and public health use cases. These applications showed that the same communication infrastructure could meet different operational needs.
“We have found TxtSquad to be beneficial for study recruitment.”
Pertussis Outbreak Response
During a pertussis outbreak, NLHS deployed a TxtSquad-powered bot in under 24 hours, enabling rapid outreach to potentially exposed individuals and demonstrating the platform's value in time-sensitive public health emergencies. This allowed public health teams to screen, inform, and respond at scale without relying on manual call campaigns.
AIM Viral Research Study Recruitment
Researchers at Memorial University of Newfoundland and Labrador used TxtSquad to support participant recruitment, replacing phone and in-person outreach with text communications to reach eligible candidates more effectively. Text-based outreach reduced friction for participants and sped up recruitment timelines.
Endovascular Surgery Reminders
For time-sensitive endovascular procedures, TxtSquad's automated reminders helped ensure patients arrived prepared and on time, reducing the risk of missed or delayed surgeries. This improved schedule reliability for surgical teams and minimized costly last-minute gaps.
Bariatric Surgery Post-op Follow-up
TxtSquad supported post-operative follow-up by allowing bariatric care teams to stay in touch with patients throughout recovery, enabling questions and routine check-ins by text without unnecessary visits or calls. This helped teams address concerns earlier while reducing avoidable in-person follow-ups.
Refugee and Newcomer Multilingual Clinics
By using TxtSquad's multilingual capabilities, clinics communicated with refugee and newcomer populations in the patients' preferred language, something that would be difficult to achieve through phone calls. This improved clarity and access for populations that often face communication barriers.
Provincial Breast Screening Program
The provincial breast screening program adopted TxtSquad to manage appointment communication at scale, allowing patients to ask questions and flag concerns by text without calling clinics or booking follow-up visits. The result was more efficient coordination across a high-volume, province-wide program.
“It has significantly reduced the time staff spend calling patients and responding to voicemail. 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.”
Where NLHS and TxtSquad Are Now
TxtSquad is now active across 30+ clinics in Newfoundland and Labrador, managing communications for over 70,000 patients across the province.
Within primary care alone, the platform supports more than 7,000 appointments each month for approximately 20,000 active primary care patients. No-show rates have consistently remained sub-4%, well under the national average for specialty care.
Beyond two-way messaging, the partnership has expanded to include TxtSquad's AI-powered voice outreach, adding an automated, patient-first channel that complements SMS communication. This capability reduced the admin load by allowing parts of outbound calling workflows to be handled without requiring staff to make individual calls.
In March 2026, the Newfoundland and Labrador government invested $124,000 through its Business Growth Program to support TxtSquad's market expansion, signalling confidence in both the platform and the results it has delivered for the province's health system.
What Can Health Systems Learn from the NLHS Experience?
While developed within Newfoundland and Labrador's healthcare system, the NLHS approach offers practical lessons for other health systems looking to improve patient communication and ease administrative strain.
1. Start with a small pilot
Launching with a limited rollout makes it easier to evaluate impact, build internal support, and establish a clear path to scale.
2. Build patient trust before launch
Clear posters, flyers, and simple messaging help patients understand what to expect, driving adoption, building trust, and reducing confusion from day one.
3. Move beyond one-way reminders
Stock, one-way appointment reminders are far less effective than a fully two-way communication channel. NLHS showed that allowing clinics to customise message content and cadence (based on appointment type and timing) drives higher engagement and better outcomes.
4. Use familiar two-way channels
Two-way SMS enable patients to quickly confirm, cancel, reschedule, or ask follow-up questions directly from the reminder. The speed of text also allows last-minute cancellations to be filled on the same day by notifying waitlist patients.
5. Measure operational and staff impact
Tracking effects on both patient access and staff workflows reveals how communication changes influence daily clinic operations. Fewer calls, less phone tag, and fewer no-show-related conversations can improve staff satisfaction as well as operational metrics.