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No one likes to be admitted to the hospital. And going to a doctor’s appointment generally doesn’t land on many bucket lists. 

Yet the need for quality health care is a reality of life. And when patients do need care, it’s critical for the growth and reputation of your healthcare business that their experience is as successful and positive as possible. In fact, recent research from SurveyMonkey found that 88 percent of healthcare executives said that understanding patient experience is now somewhat or much more important than before the COVID-19 pandemic.

One of the most effective ways to consistently measure patient experience is by utilizing Net Promoter Score. Net Promoter Score® (NPS®) is a one-question metric that measures how your organization and its services are perceived by your patients. Data collected via Net Promoter Score can indicate how satisfied and loyal your patients are, and even provide indicators that are relevant to your future growth and success. Having a strong healthcare NPS shows that you are doing things right – and that your patients are taking notice.

A healthcare Net Promoter Score can also determine any issues in your organization that need to be addressed. In the healthcare industry, there’s not much room for poor patient service. Unsatisfactory patient care can result in mistrust and fewer referrals. For example, nursing homes, rehabilitation centers, and hospitals are at risk of losing the trust of their community if quality care isn’t administered to existing patients. A person might share their patient experience with others, and this can influence people’s choices on where they go for good healthcare. Good patient care is critical to every healthcare organization.

Created in 2003 by Bain and Company, NPS surveys are quick and straight to the point, asking one simple question: How likely are you to recommend (company X/product Y/service Z) to a friend or colleague? Using a rating system of zero to 10, customers fall into one of three categories:

  • Promoters (9-10): These customers rate their experience either a nine or 10. They are the most loyal and will continue to do business with you. Not only that, but they would recommend your organization and services to others, which ultimately contributes to your company’s growth.
  • Passives (7-8): Customers in this group are satisfied but not enthusiastic. They are a vulnerable group because even though they expressed a positive view of your company, they are still open to patronizing your competitors. They rate their experience a seven or an eight.
  • Detractors (0-6): This group includes the unhappy customers who would not refer a friend or colleague and could potentially hurt your company’s brand through negative word-of-mouth, online reviews, or comments. They rate their experience from zero to six.

While no one likes to receive negative feedback, consider it a positive that you have identified any problems and can now set goals—both internally and externally—to enhance and improve patient experiences.

A Net Promoter Score can help you keep current with how inpatient and outpatient services are doing. While patient satisfaction is important to every healthcare operation, it’s equally important to assess internal operations that can directly affect patients’ experience. 

Understanding employee satisfaction can be done through anonymous online questionnaires. There are several types of surveys to use. One could be submitted to the entire organization to get a general NPS. Another survey could be administered to each department to get a detailed view of the organization’s performance. An NPS can also help healthcare managers assess how well departments are working with one another.  

If patient NPS healthcare is high and employee NPS is low, it’s a good time to address staffing issues. You can solve problems before they become even larger or affect patient care (and possibly lower that NPS score).

Once you have collected the scores, it is time to calculate your overall score. Based on your calculations, you will receive a percentage for each set of respondents (Detractors, Passives, and Promoters). To calculate the percentage, follow these steps:

  1. Enter all survey responses into a spreadsheet
  2. Group the responses by Detractors, Passives, and Promoters
  3. Add up the total responses from each group
  4. To find the percentage, take the group total and divide by the total number of survey responses
  5. Subtract the percentage total of Detractors from the percentage total of Promoters. This answer is your NPS score.

The formula to calculate your percentage is:

(Number of Promoters – Number of Detractors) / (Number of Respondents) x 100

Here is an example:

Let’s say that you received 100 responses after you sent out your NPS survey. From those 100 responses:

  • 10 ranged from zero to six (Detractors)
  • 20 ranged from seven to eight (Passives)
  • 70 ranged from nine to 10 (Promoters)

So, when you calculate the percentages, you get 10 percent, 20 percent, and 70 percent.

Now, subtract the 10 percent (Detractors) from 70 percent (Promoters), which gives you 60 percent. Remember that NPS scores are given in integers and not percentages, so your score would simply be 60. This number would then fall on a scale of -100 to +100, the higher the number the better the score.
Let SurveyMonkey calculate your score for you with our Net Promoter Score Calculation.

NPS provides a score that is continually being updated as new responses are received so you can track patient perceptions; benchmark against internal and industry averages; and monitor progress over time with an eye toward making improvements that will boost your score.

At its core, the keys to growing your business are relatively straightforward: Retain as many patients as possible while consistently attracting new ones. NPS can be a key tool in that effort by providing a steady stream of feedback about how your customers feel about your company, so you can address any issues to improve satisfaction and loyalty.

Yet NPS’ ability to help attract new customers extends beyond growing your business through pure referrals. When you take actions that continue to improve your business, it can build buzz that draws even more customers. Further, NPS helps your executive team and department managers see the bigger picture in regard to how your company is doing in relation to its competitors.

Studies have shown that there is a correlation between NPS scores and increased business growth. The London School of Economics studied this relationship and discovered that “an average NPS increase by seven points correlates with a 1 percent growth in revenue.”

Another study performed by Temkin Research showed that promoters are 4.2 times more likely to buy from the same company again, 5.6 times more likely to forgive a company after a mistake, and 7.2 times more likely to try a new offering compared with detractors.

NPS surveys can help reveal ways you can improve customer retention, acquisition, and loyalty.

Promoters—those repeat customers who are most likely to recommend you to friends and family—are likely to remain loyal. And they can help bring new, potentially loyal patients into the fold. In fact, research suggests that promoters may account for up to 80% to 90% of all referrals.

Identifying these valuable promoters provides the opportunity to let them know that you appreciate their loyalty. It may also open the door to asking if they would be willing to provide a testimonial or share the story of their positive experience in marketing materials, such as case studies or videos. 

NPS is a great tool to measure how your patients feel about your organization. However, there are some key things to keep in mind as you review results and make related decisions to act on feedback.

One key consideration: patient satisfaction does not always translate to patient loyalty. An article in Healthcare Finance explains that “satisfaction is based largely on expectations, and those expectations can be low.” For instance, a patient who is in for a hospital stay may have the baseline expectation of leaving the hospital feeling better than when they were admitted. If that outcome occurs, they may respond that they are satisfied, but that doesn’t necessarily mean they are loyal to your healthcare organization for future care.

Loyalty, on the other hand, indicates whether a person is likely to repeat business, and importantly, to recommend a brand or organization to someone else. This is where NPS questions prove most valuable by gaining insight into whether the experience was positive enough for them to recommend your organization to a friend or family member.

Another thing to keep in mind is that patient satisfaction data can be prone to bias.

Healthcare Finance notes that bias can be partly attributable to something called the "ceiling effect," which is essentially a problem in the sampling data. Many patient satisfaction surveys are administered toward the end of care, and because of this, satisfaction scores tend to be high because the patient likely has experienced a positive outcome.

Some types of patient surveys can also be susceptible to what is known as “environmental bias,” which can occur when a patent is asked to fill out a survey in the presence of the healthcare provider. In those instances, people may indicate they were more satisfied than they actually are, to prevent offending the person in front of them.

This issue can be largely addressed by finding ways to have the patient complete the questionnaire in privacy or after discharge.

It turns out that a higher NPS score isn’t only beneficial for your healthcare organization, it also is good for your patients’ health. Kevin Gwin, Chief Patient Experience Officer at University of Missouri Health Care, is a strong proponent of the value of NPS for healthcare organizations.  

University of Missouri Health Care tracked the behavior of Promoters for six months and ended up with what Gwin considered to be “striking” results.

For patients who are Promoters (scoring 9 or 10 on NPS questionnaires):

  • Average readmission rates were lower: 7.2%, compared with 11.9% for Detractors
  • Average ED return rate was lower: 5.2%, compared with 12.9% for Detractors
  • Average care compliance was higher: 68.2%, compared with 52% for Detractor

Regardless of what industry you’re in, it’s important to remember that you’re engaged in customer service. In healthcare of course, those customers are typically patients, and you are “selling” optimal care that is delivered in a way that is as seamless and effective as possible. With that mindset, you can use NPS data to find ways to improve the customer experience, whether it be improving the way in which they are greeted at intake all the way to making the discharge experience hassle-free and even, in some instances, celebratory.

The steady measurement provided by NPS scores can offer a pathway to greater profitability. The reason is pretty simple. If you’re taking steps to assure that patients have a positive experience, then that’s been found to ripple through to your bottom line. 

In fact, a report by The Deloitte Center for Health Solutions has demonstrated that hospitals with high patient-reported experience scores have higher profitability. This research suggests that while there is increased costs associated with investing in improving the patient experience, revenue increases even more. In other words, the old maxim, you have to spend money to make money holds true for healthcare organizations committed to improving patient experience.

Businesses in every industry need to be keenly aware of their online reputations. However, it is particularly critical in healthcare. When it comes to people’s health and the care they receive, the stakes are higher than, say, a consumer panning a new chocolate bar introduced by a candy company.

NPS scores allow you to consistently track how your patients view your healthcare organization. If you start to see negative trends, you can quickly start instituting changes to address issues that may be leading to negative reviews. Conversely, you can swiftly capitalize on more positive feedback to encourage new and returning patients, which can lead to increased revenue.

NPS in and of itself offers valuable feedback. Yet in healthcare it can be leveraged in ways that provide added value, particularly when it comes to adding the “human touch” to interacting with patients by demonstrating that their feedback was heard and matters. By learning where there is room for improvement, you can make organizational changes and then follow up with the patients who filled out your surveys to notify them of improvements. With the personal nature of healthcare, demonstrating to these patients that you responded to their feedback can be a powerful tool in building loyalty and affinity for your brand.

One of the great benefits of NPS is that once you have established the practice of sharing the questionnaires with patients, you can gather feedback on an ongoing basis. By collecting these scores at scale, you can receive feedback from a larger share of your patient base and easily collect scores at scale. By asking customers the Net Promoter question, you can receive feedback from a large share of your customer base, quickly.

You can amplify the value of NPS survey data by connecting it to EHR and revenue cycle data. For instance, through review of your revenue cycle data you may find that patients who gave low NPS scores to your organization tend to delay paying bills as quickly as more satisfied patients. Through that insight, you could take targeted action at providing feedback and improving the patient experience for that group with the hope of both boosting their perception of your organization—and leading to more on-time bill payment. 

The clarity and simplicity of NPS make it an ideal way to rally your staff around the effort to continually improve patient experience. Sharing the concept of Promoters, Detractors, and Passives drive home the usefulness and value of NPS and get people throughout your organization communicating in a common language about improving patient satisfaction and loyalty. That creates a strong sense of shared vocabulary that can translate to better care, outcomes, employee engagement and profitability.

Typically, NPS surveys collect some basic data about the respondent, such as age bracket or income level. This, and other relevant patient data can be integrated into NPS results to segment respondents into groups to determine if your company and services are perceived in different ways among different segments. This can unearth trends that allow you to directly address issues that might be affecting a certain group more significantly than others.

Once you’ve got your NPS, you can set an initial internal benchmark, then repeat the survey regularly to see whether your score is moving in the right direction—and make changes accordingly.

Yet one of the most valuable benefits of NPS is the ability to see beyond your internal benchmarks to see how your healthcare organization stacks up against the competition. Because hundreds of companies use NPS, you have a yardstick to measure and track your performance internally and against external NPS benchmarks.

While you’re continuously monitoring your customer loyalty ratings with NPS to make internal changes to your organization, you can also get external NPS benchmarks to understand if your Net Promoter Score is good or bad.

For example: If your Net Promoter Score is 36, what does that really mean? A score of 36 may not seem great to you. But an NPS of 36 could actually be a strong score when compared with the average Net Promoter Score for organizations in your industry.

With SurveyMonkey Benchmarks, you can get context for your Net Promoter Score. Hundreds of companies use our NPS template to measure customer loyalty and improve business outcomes. Our data is diverse, covering everything from small organizations to large corporations and a broad range of industries.

Short, sweet, and to the point. That should be your mindset when crafting an effective NPS questionnaire. It’s important that you provide relevant context so potential respondents understand why they are being asked to complete the questionnaire.

Be upfront that the questionnaire is designed to capture feedback aimed at making sure patients have the best experience possible when interacting with your healthcare organization.

From there, get right to the point by posing the hallmark NPS question. Providing respondents the opportunity to share any additional thoughts with a question such as “what does our organization do really well?” is also a great way to get a valuable perspective about your results. SurveyMonkey makes things easy with a Net Promoter Score template.

The power of NPS lies in large part in its simplicity. With that in mind you want to make your questionnaire as straightforward and as easy to complete as possible. This increases your chances of participation, which gives you a larger, more relevant sample size.

At its core, NPS aims to capture one key metric. Resist pressure to reach much beyond that. You don’t want to fall into the trap of survey creep—adding questions and complexity that could reduce response rates and muddy up your results. Make it clear to all relevant parties in your organization what NPS is, how it is administered, and the value of the results.

Considerable attention is rightly focused on how NPS ultimately will benefit your patients. However, the internal impact should not be overlooked. Because it is simple and straightforward, NPS can serve as a measurable rallying point for your organization. By explaining how NPS offers an ongoing snapshot of patient satisfaction, you can align everyone in your organization around the goal of improving NPS. You can track, share, and celebrate progress, while also having measurable data to justify any changes that might need to occur to improve patient experience.

NPS results should be reviewed on a consistent basis. When establishing NPS you should consider the most relevant people in your organization who would benefit from consistently reviewing your NPS scores and provide easy access to the data and insights. Beyond that, consider developing a consistent cadence and approach for reporting the insights on a regular basis so everyone in your organization has clear visibility into which direction the score is tracking and what issues need to be addressed.

It’s often said, what gets measured gets done. And few metrics can match the ease, consistency, and effectiveness of Net Promoter Score. Introducing NPS into your organization is a great way to improve the overall health and prosperity of our business. To learn more, check out SurveyMonkey’s “Everything you need to know about Net Promoter Score”. To get started reaping the value of NPS visit SurveyMonkey Enterprise.

NPS®, Net Promoter® & Net Promoter® Score are registered trademarks of Satmetrix Systems, Inc., Bain & Company and Fred Reichheld.

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