Unlocking the power of NPS in healthcare

Net promoter score (NPS) is a widely used behavioral metric in the business world, measuring customer loyalty, satisfaction, and how likely someone is to recommend a company or brand. In healthcare, NPS can unlock powerful insights into the relationship between patients and the brand of an organization. But use of NPS has evolved, as has the understanding that it’s not the only metric needed for a comprehensive, well-rounded understanding of patients.

What is the net promoter score (NPS)? 

Net promoter score is a simple yet effective metric that measures how likely a person is to recommend a company or product to others. It’s based on a 0–10 scale of stated intent to recommend, where those who leave a 0–6 score are considered detractors, 7–8 passives, and 9–10 promoters. The end NPS score is calculated by subtracting the percentage of detractors from promoters, resulting in a score from -100 to 100. At its core, NPS is a measure of likelihood to recommend, but with a particular method for representing the scores as the balance of promoters vs. detractors. 

A brief history of NPS: Business strategist and consultant Fred Reichheld introduced the concept back in 2003 in a Harvard Business Review article called “The Only Number You Need to Grow.” It’s since gained widespread popularity across several consumer-focused industries for its simplicity and singular focus on customer loyalty and satisfaction. The C-suite was quick to embrace this groundbreaking concept, which arguably sparked a new era in consumer experience (CX) and voice of customer (VoC) research.

NPS revolutionized CX by:

• Shortening surveys
• Prioritizing qualitative feedback
• Adopting an open-source approach
• Encouraging a more action-oriented focus

What does NPS mean for healthcare organizations?

In the healthcare context, net promoter scores can be a valuable tool for measuring overall patient experience and loyalty. But how can—and should—healthcare organizations use the NPS measure?

While transactional NPS (t-NPS) is sometimes used, NPS is most effective in measuring long-term relationships. Other metrics—like customer ease, satisfaction, and service quality—are better suited for individual transactions.

Transactional measurements of NPS focus on a particular experience at a point in time and the intent to recommend because of that experience. But this can provide a short-term view of customer loyalty. In contrast, true NPS measurement gauges the health of a relationship with a brand, independent of one particular transaction. Relationship metrics open the aperture to the experience, summarizing a holistic picture of the patient journey. Relationships are built over time, and reinforced by concepts around trust, brand image, and the customer or patient experience.

For example, think about a patient’s relationship with their primary care physician.  This important relationship is often developed and strengthened through multiple interactions over the years. There’s trust, there’s respect, there’s a connection and rapport—all the things that keep patients loyal and coming back.

To assess the health of these relationships, you can conduct an NPS survey that focuses on the overall clinical experience, rather than a single visit. One bad experience (like a long wait time or an adverse reaction to a medication) generally won’t tarnish the relationship immediately; there’s too much history, and the relationship is resilient. But if, over time, that patient has a series of negative experiences, the patient-physician relationship will no doubt decay.

Asking intent to recommend questions as part of evaluating a particular visit is important to understanding how processes and events impact loyalty, but they’ll yield different results than measuring true relationship NPS for the brand. Relationship NPS might be considered analogous to measuring the health of a marriage, whereas transactional NPS asks how much you’d recommend your partner based on how they’re acting on any given day.

I’d be remiss not to note that a single incident can still fundamentally affect an ongoing relationship. Two classic examples from the non-healthcare world are the Exxon Valdez oil spill of 1989 and Johnson & Johnson’s response to the Chicago Tylenol murders in 1982. Exxon’s handling of the environmental catastrophe was largely criticized as slow, opaque, and insufficient. As a result, public opinion of the company suffered. Compare that to Johnson & Johnson. When Tylenol capsules were found to be tampered with, the company swiftly pulled every bottle from the shelves to prevent more deaths. Although their market share initially took a hit, the decline was temporary, and their actions in the face of crisis ultimately bolstered consumer confidence.

This is, in fact, one of the foundational concepts of brand equity and corporate reputation: Organizations that have developed reputational capital are better prepared to withstand inevitable bumps in the road. The same is true in healthcare.

Should your hospital or healthcare organization measure NPS?

So, is net promoter score the right metric for your healthcare organization? Before executing and deploying an NPS survey, ask yourself two important questions.

1. Will NPS show us what we’re looking to learn?

Analyze your existing loyalty data alongside financial and operational data to determine which metric will best shed light into future patient behavior. Key performance indicators (KPIs) can offer a comprehensive overview into performance, predict trends, and provide insight into the most effective areas for improvement—i.e., those that will make the greatest impact on driving the desired healthcare consumer and patient behavior.

Most organizations use an intent-to-recommend question as a part of their ongoing transactional surveys to measure loyalty based on particular experiences. Though calculating a t-NPS score from these surveys is possible, it will yield similar insights to existing “Likelihood to Recommend” (LTR) measures, and will require context-specific benchmarking to interpret. A true relationship NPS measurement should be used when your goal is to understand the full relationship with your brand and how that relationship may be changing over time within your community.

2. Do we have an established relationship with the patient?

Some interactions are just that: interactions—transactions or individual events that may require trust but don’t, by themselves, imply an existing relationship.

Of course, that isn’t to say organizations shouldn’t measure patient perceptions and intent to recommend specific transactions or events. But converting a recommendation question into a transactional NPS score won’t provide a complete picture of the relationship overall. To understand the overall health of your brand within your community, measure relationship NPS, independent of transactions.

At Press Ganey, we offer customized, flexible, relationship-oriented surveys that make your data more valuable and actionable. Our extensive database provides unmatched, reliable benchmarking on LTR, which can complement NPS while giving you direct insight into your organization’s performance. We also offer comprehensive options to measure NPS across your brand and various touchpoints, and provide industry as well as non-healthcare benchmarks to help you interpret your results and make data-driven decisions. By understanding NPS and its nuances more holistically, your organization can then tailor its measurement strategy to your specific needs. 

To learn more about our comprehensive patient experience capabilities, reach out to a member of our team, and we’ll be in touch.