Improving Patient Retention
Patient retention is a key metric used to assess care quality at Nourish. Fostering strong patient relationships is essential to delivering impactful, long-term care. When patients stay engaged over time, it allows you - as their dietitian - to build trust, tailor recommendations more effectively, and support real, lasting changes in health behaviors. High patient retention is not just a metric; it's a reflection of the value patients find in your care and the connections you build with them. It also helps support a smoother clinical workflow by reducing last-minute cancellations and no-shows.
At Nourish, we encourage RDs to aim for consistent engagement, with patients ideally attending at least 4-6 weekly sessions in line with our Standards of Care. While we know life happens and no single metric captures the full story of care, we’ve set internal benchmarks to guide and support your practice - not just to measure success, but to ensure patients get the full benefit of your expertise and support with behavior change.
You can view your current retention metrics - and how they align with our expectations - any time in the "Metrics" tab of your Provider Portal. Our goal is for RDs to consistently land in the light green zone across all time frames, reflecting meaningful, sustained patient engagement.
Strategies to Improve Retention:
Guide Your Care Using Our Standards & Best Practices
Nourish’s Clinical Standards of Care emphasize regular, structured visits to drive strong outcomes and foster lasting, meaningful patient relationships through consistent engagement. Starting with regular weekly visits, followed by consistent follow-ups, helps build routine, strengthen rapport, and provide the time needed to support meaningful behavior change. The Standards also outline best practices for different stages of care - including initial assessments, follow-up sessions, and between-session support - so you can deliver high-quality, patient-centered care every step of the way.
The First Appointment Checklist and Follow-Up Appointment Checklist are valuable tools to help structure your sessions and ensure you’re incorporating key best practices into your care. They’re designed to support your workflow, enhance patient engagement, and promote consistency across appointments. That said, these checklists are guidelines, they're here to complement your clinical expertise, not replace it. Use them as a foundation while adapting to each patient’s unique needs.
Scheduling Effectively
Book the patient’s next appointment in the current session to keep momentum going. Scheduling in-session increases the likelihood of follow-through, reduces no-shows, and keeps patients consistently engaged in their care. Whenever possible, avoid relying on patients to schedule on their own later, as this can lead to delays or drop-off in treatment.
Schedule a follow-up to occur within one week of the initial appointment. Patients who have an appointment the week after their initial appointment are far more likely to have high retention throughout their patient journey.
Confidently recommend weekly sessions early on in their journey to build strong habits and foster progress. Aim to get 4 future sessions on the calendar.
Here’s some helpful sample language you might use when encouraging weekly appointments:
" In my experience, weekly sessions, especially when we're just starting out, create the momentum you need to build lasting habits and reach your goals. When we meet just once or twice a month, it's actually harder to build that foundation and see real progress. As you get more comfortable and confident with the changes we're making, we can always switch to meeting every other week or monthly - whatever feels right for you. Would you be open to finding a regular day and time that works each week? That way, you don't have to stress about scheduling, and we can focus entirely on your progress. And don't worry - if something comes up, we can always be flexible!"
Reassure Patients on Insurance Concerns with Clarity
Patients sometimes cancel appointments or do not schedule a follow-up because of insurance concerns. You can help the patient feel confident that they can keep having sessions, as Nourish will never charge a patient for a denial, and will cancel a claim that goes to deductible if the patient so chooses. With the Nourish Guarantee, we offer a no surprise billing experience.
Identify Retention Gaps and Spot Trends Early
To improve patient engagement, it’s essential to regularly reflect on your retention metrics - not just as numbers, but as indicators of how patients are experiencing and valuing your care over time. We track average retention at 30, 90, 180, and 360 days. If one of these timeframes is consistently lower than expected, it may point to an opportunity to strengthen your approach during a specific phase of the patient journey.
Example: Are most patients attending the first 2-3 sessions? To check, look at your 30-day retention average. If in the red zone, this may signal there is a need to reinforce the value of long-term care earlier or strengthen scheduling practices early in the patient’s journey.
Collect & Value Patient Feedback
Creating space for open, honest feedback not only deepens trust - it helps you tailor your care in ways that keep patients engaged and invested in the process. Patients are more likely to stay on track when they feel heard, supported, and like a true partner in their care journey.
Remind patients that this is a collaborative process, and that their input matters. Encouraging feedback - especially in the first few sessions - can help uncover small disconnects before they become drop-offs.
Example Verbiage to Use in Session:
“I want to make sure this process feels helpful and relevant to you - how are things feeling so far?”
“Is there anything we’ve done that you’ve found especially helpful… or maybe not as useful?”
“I would love to check in on your motivation. On a scale of 1-10 how motivated are you feeling towards your goals?” (If they say 6 for example) “What could help to increase that to a 7-8?”
“Everyone’s different - what kind of support or communication works best for you between sessions?”
“Sometimes people worry about being honest if something isn’t working - I really appreciate open feedback so I can adjust things to better support you.”
“Would you like more structure and planning, or more open conversation? I can tailor things based on your preferences.”
Outside of session, review patient feedback in your dashboard. You can regularly review your Net Promoter Score (NPS) and written feedback in your Provider Dashboard. Look for:
Trends in what’s working well (e.g., “makes me feel heard,” “gives practical advice,” “easy to talk to”)
Signals for improvement (e.g., “felt rushed,” “unclear next steps,” “didn’t address my main concern”)
Set Clear Expectations for the Initial Appointment
The initial appointment is a foundational moment in the patient journey. Setting clear expectations upfront not only helps patients feel more confident and supported - it directly improves engagement and retention. Many patients have never worked with a dietitian before, and even those who have may not be familiar with Nourish’s unique, personalized approach to care. This proactive communication also gives the patient a clear reason to return, reinforcing the value of ongoing support.
How to Set Expectations Effectively in the First 5-10 Minutes:
Explain the Purpose and Structure of Today’s Appointment
“Today’s session is all about getting to know you - your health background, lifestyle, and what you’re hoping to accomplish. I’ll ask some questions, listen closely, and we’ll create a short-term action plan together before we wrap up.”
Share What Makes Nourish Different
“At Nourish, we use a whole-person approach. That means we focus not just on food, but also your energy, mood, digestion, labs, and what feels sustainable. My job is to help make nutrition feel realistic and tailored to your life.”
Set Expectations for Goal Setting and Education
“By the end of this session, we’ll identify a few small action steps you can try this week. In future sessions, we’ll build on this to create a more detailed, long-term plan together.”
Clarify the Follow-Up Schedule and Communication Flow
“We typically meet weekly for the first few appointments, as we see that leads to reaching your goals most effectively. I’ll help you schedule your next few visits before we finish today, and you can also message me in the app between sessions if you need anything.”
Ask the Patient About Their Expectations
“Before we dive in, I’d love to hear what you were hoping to get out of today - or anything that would make this feel most helpful for you?”
Assess Stages of Change to Determine Interventions & Goals
Another powerful tool you have for improving retention is assessing a patient’s stage of change - this helps ensure that the goals and strategies you use are relevant, realistic, and appropriately challenging for their current mindset. Patients are more likely to stay engaged when goals feel achievable, personalized, and connected to their deeper motivations. On the other hand, goals that feel too ambitious - or not meaningful - can lead to early disengagement.
For example: A patient in the contemplation stage may benefit more from education, discussion, and identifying motivations than from behavior-focused action plans. A patient in the action stage may be ready for more structured SMART goals and accountability check-ins.
Steps to Set Realistic Goals:
Assess your patient’s Stage of Change at the start and revisit it regularly.
Collaborate - let patients lead in identifying what matters to them.
Use SMART Goals to ensure goals are Specific, Measurable, Achievable, Relevant, and Time-bound.
Always explore the patient’s “why” - what’s motivating this change?
Ask about confidence level (scale of 0-10) in achieving goals and any barriers they foresee. Adjust goals as needed.
Encourage patients to attend follow-up appointments, whether or not their goals have been met, as these visits provide valuable opportunities to continue addressing barriers, celebrate progress, and support ongoing problem-solving together.
Prioritize Rapport Building
Every patient enters care with a unique background - some are ready to open up, while others may be more guarded. Retention often hinges on the quality of the provider-patient relationship. If a patient doesn’t feel connected or understood, they’re less likely to see value in returning. That’s why building trust from the very first session is key to long-term engagement.
Spending even a few intentional minutes to build rapport can make a meaningful difference in how comfortable and invested a patient feels.
Watch: Building Bridges: Strengthening Patient Rapport to Boost Retention: This recorded Lunch and Learn session walks through practical strategies you can use to create stronger patient connections - especially in the virtual setting.
Strategies to Build Trust & Connection:
Create a Warm, Human First Impression
A little small talk goes a long way. Comment on their pet in the background, where they live, ask how their weekend went, or simply acknowledge the effort it takes to show up.
Focus on What Matters to Them
Learn your patient’s core values and goals. Ask about their “why” - why they’re seeking support now and what success looks like to them. Continuously come back to their why when educating and setting goals.
Establish Credibility, Without Overwhelming
Patients want to know they’re in good hands. Briefly share your expertise and experience when appropriate, especially early on, to build confidence in your recommendations.
Stay Curious, Not Prescriptive
Avoid assumptions. Use open-ended questions to explore your patient’s perspective and priorities before diving into education or planning.
Be Authentically You
Professionalism is essential - but so is authenticity. Definitely practice new verbiage, but keep in mind patients connect more deeply when they feel they’re working with a real person, not a set script.
Find the Right Balance in Patient Led Sessions
Think of each session like a road trip: your patient is in the driver’s seat, deciding the destination and pace. You, as the dietitian, are the GPS - there to provide directions, offer alternative routes, and help them stay on course.
Patient-led counseling is collaborative. It builds trust, increases autonomy, and leads to better engagement - because patients are far more likely to stay on the journey when they feel in control of the wheel but know there is guidance when needed.
How to Guide Without Taking the Wheel:
Meet Them Where They Are
Meeting patients where they are at means respecting the patient’s current habits, readiness to change, and personal challenges while offering realistic, empathetic guidance that empowers gradual progress rather than imposing rigid expectations. For example, if a patient eats fast food daily due to a busy schedule, the dietitian might first suggest choosing grilled options or adding a side salad, rather than expecting immediate elimination of fast food altogether.
Validate and Reflect
Acknowledge their experiences and emotions when appropriate. Reflect back what you hear to show you’re truly listening.
Encourage Collaborative Goal Setting
Ask: “What would feel most helpful to focus on today?” or “What’s one small thing you’d like to work on between now and our next session?”
Tune Into Their Why
Explore what’s driving their desire for change. Values-based questions like “Why is this important to you now?” can deepen motivation and make goals more meaningful.
Offer Guidance When They’re Unsure
If they’re uncertain, that’s your cue to offer route options.
→ “Would it be helpful if I shared a few directions we could take based on what you’ve told me so far?”
Educate to Empower
Share relevant information so the patient can make informed decisions - not so you can steer for them.
Deliver Clear, Relevant Nutrition Education
Many patients come to Nourish eager to learn—but how education is delivered can make or break their experience. When education is clear, personalized, and immediately applicable, it builds trust, increases motivation, and reinforces the value of returning for follow-ups. In telehealth, education needs to be intentional and interactive to stick.
Strategies to Provide High-Impact Education in Telehealth:
Assess First, Then Educate
Before diving into any material, ask:
→ “How familiar are you with [topic]?” or “Have you heard of [concept] before?”
This ensures you’re not repeating what they already know - or overwhelming them with too much at once.
Keep It Clear, Concise, and Actionable
Break complex topics into bite-sized, digestible pieces. Avoid jargon and always tie education to the patient’s personal goals.
→ Instead of “Let’s review macronutrient distribution,” try:
“Let’s talk about how adding protein to your snacks can help you feel fuller longer.”
Use Visual Aids and Digital Tools
Share screen to walk through a handout, label, or food tracking app. Reference saved materials or visuals in your Nourish toolkit. PDF handouts, virtual white boards, and google docs are all great examples you could utilize.
→ “I’m going to pull up a quick guide to plant-based proteins - let’s look at a few you might already be eating.”
Introduce a Small Educational “Nugget” in the First Session
Even a quick win (e.g., a simple tip or myth-busting fact) in the first session builds credibility and shows patients they’re in capable hands.
→ “A lot of people think carbs are the enemy - want to hear why your body actually needs them?”
Tie Education to SMART Goals
Make sure the patient has a clear way to apply what they’ve learned. Turn information into behavior. If we set a goal with a patient we want to ensure we have educated them on the topic thoroughly.
→ “Now that we’ve talked about fiber, would you be open to trying one high-fiber breakfast this week?”
Prepare Ahead of Time
Review relevant resources and anticipate the education needs that might come up based on the patient’s goals or condition..
Strengthen Motivational Interviewing Skills
Motivational Interviewing (MI) is a cornerstone of effective, patient-centered care. It helps build trust, supports autonomy, and encourages lasting behavior change - all of which drive stronger patient engagement and retention.
Even experienced RDs benefit from regularly sharpening these skills. Small, consistent practice makes MI more natural and effective over time.
Resources to Refresh Your MI Foundation:
Strategies to Practice MI in Your Day-to-Day Easily:
Set One Intentional MI Goal Each Week
For example:
→ “This week, I’ll practice using reflections at least 2x per session to build deeper understanding.”
→ “I’ll challenge myself to pause and use open-ended questions instead of jumping to educate.”
Take Moments to Reflect on Sessions
Reflect on a recent session and ask:
→ “Where could I have asked more open questions?”
→ “Did I affirm the patient’s strengths or just their behaviors?”
Keep MI Prompts Visible
Keep a quick list of go-to reflective prompts visible:
→ “What’s most important to you about this goal?”
→ “How would making this change affect your day-to-day life?”
Consider keeping this as a smart phrase, in a notes app, or google doc.
End Sessions with Patient-Led Summaries
→ “Can you tell me what feels most important from today’s session?”
This reinforces autonomy while giving you insight into what resonated.
Maintain Connection and Momentum Between Sessions
Use in-app messaging to deliver short, personalized check-ins that align with the patient’s goals. Comment on logged meals (“Noticed the balanced lunch - great protein choice!”) or follow up on action steps (“Curious how the mindful eating strategy felt this week?”). These brief messages reinforce behavior change, build trust, and help patients feel seen and supported - without adding appointments.
Aim for authentic, encouraging touch points that connect back to their care plan. Schedule dedicated times for these check-ins to keep out of session to at a minimum and improve workflow.
Reach out to Patients That Have Not Rescheduled
Patients may forget to book, feel unsure about next steps, or lose motivation - your outreach can make the difference in bringing them back into care.
Use the Nudge feature in your Provider Portal to identify individuals who have cancelled or not rescheduled their next appointment. There is a message template you can see if you click ‘Nudge’ next to a patient’s name on your patient list. Personalizing the message further though can go a long way in reinforcing connection and showing you care.
Example Reach-Out Messages:
“Hi [Patient Name], I really enjoyed working with you and wanted to check in. If you’re ready to schedule your next session, I’d love to continue supporting you toward your goals! Let me know if you have any questions or need help finding a time.”
“Hey [Patient Name], just a quick note to say I’ve been thinking about our conversation around [topic you discussed]. If you’d like to pick back up where we left off, feel free to schedule a time that works for you - I’m here when you’re ready!”
“Hi [Patient Name], I’m so sorry to hear your insurance coverage was denied for our sessions. I’ve enjoyed supporting you on your health journey and working towards XYZ. My virtual door is open anytime you want to reschedule.”
See the Retention Strategy Checklist for a Quick Summary