The Net Promotor System (NPS) and Healthcare Marketing


As a healthcare provider, you want to give the best care and service to your patients. Your goal is not just to attain an excellent health outcome to address their health concerns, but also achieve great patient satisfaction, which can be measured in patient reviews. And these reviews lead us to discuss healthcare marketing and The Net Promoter System (NPS).

Healthcare professionals like you build trust and rapport with your patients in many ways. You perform a thorough history and targeted physical examination, order relevant diagnostic work, come up with a diagnosis, and make a plan for the best health outcome. This is the heart and core of your mission that marks your excellence.

But you won’t always have rave reviews. And one dissatisfied patient can pull your score down.

The problem with patient satisfaction scores is that they rely too much on emotion. A patient who answers a survey right after the visit can give a different score if he answers it after a week or month. Even how you write the questions and what kind of questions you ask can affect the replies and may prove useless in the end. And with a very long survey, the respondents tend to dwindle, giving you limited information.


Getting objective data from patients

How can you get the data you need, in a way that your patients will answer frequently and honestly? There’s a deceptively simple answer to that question.

To get more meaningful data from customer surveys, Fred Reichheld, with the help of Satmetrix Systems and Bain, developed a tool. This tool can predict how customers would behave based on their satisfaction level. That tool is the Net Promoter Score System, commonly shortened to NPS.


What is The Net Promoter Score?

The search for a simple, effective system to gauge customer sentiment has been a long one. It’s common knowledge that having satisfied customers who return to your practice or business again and again is great for your bottom line – the cost of acquiring a new patient or customer is high.

Can your practice break even on people who only come into your practice once? Likely not – you need patients to return next month and next year. But how can you measure how likely they are to do that?

This is where the Net Promoter Score comes in.

Fred Reichheld, the creator of NPS, would describe The Net Promoter Score as the one number that could predict business growth and customer loyalty. In an article he wrote for Harvard Business Review in 2003, “The One Number You Need to Grow,” he revealed how Enterprise Rent-A-Car inspired this scoring system.

During a forum, Andy Taylor, then CEO of Enterprise, showcased his company’s simple survey consisting of only two questions to measure customer loyalty:

  • How do the customers rate the quality of their rental experience?
  • How likely are they to rent a car again?

The short survey had these advantages:

  • It yielded a high response rate.
  • The results were predictive of profits and growth.
  • It identified the key driver of growth, i.e. the enthusiastic customers.

Reichheld decided to shorten this survey even further, to just one question that measures customer loyalty while predicting growth. But the search for a simple question was a long and complicated journey – it took him two years of research to find the perfect question.


Why did it take so long to research the idea of customer ratings?

He realized that:

  • Customer loyalty was more than retention rate. Some stick it out just because! Retention rate alone doesn’t translate to growth.
  • Customer loyalty could not be measured by customer satisfaction alone. Take Kmart for instance, he says. Despite its great customer satisfaction rating, it went bankrupt.
  • Survey tools could be rigged. Plugging in questions that suggest the answers and nudge the customers to reply positively could give a falsely high rating.


How did he come up with that one question?

With the help of Satmetrix, a software company that dealt with real-time data analytics, and the Bain team, who helped him design the Loyalty Acid Test comprising of 20 questions, that one question emerged by studying the behavior of more than 4,000 responders and linking their survey responses with actual referral and repeat purchase of the product. This question provided the best statistical correlation between emotion and action.


What is that one question?

“How likely is it that you would recommend our company/product/service to a friend or colleague?”

This one question assesses customer loyalty that can predict business growth.

But asking this question is not enough. For the data to become useful, they created the following scale:

  • 10 – extremely likely to recommend
  • 5 – neutral
  • 0 – not at all likely

To his surprise, the customer referral and repurchase behaviors clustered into three, which he labeled as follows:

  • Promoters – those who gave a rating of 9 or 10; these loyal people promoted the business to their families and friends and brought in 80% of the referrals.
  • Passively satisfied – those who gave a rating of 7 or 8; these people are easily wooed away by the competitors.
  • Detractors – those who gave a rating of 0 to 6; these people badmouthed the business 80% of the time and brought down the morale of the employees as well as the reputation of the company.

Afterwards, Reichheld and the team compared the percentage of promoters and detractors and came up with The Net Promoter Score.

% Promoters – % Detractors = Net Promoter Score

By conducting further research and increasing his sample size, Reichheld and the team found a strong positive correlation between the net promoters and the company’s growth rate in terms of revenue. That one question generated a useful predictive value that businesses could use.

Therefore, a company’s goal is to have a positive net score: more promoters than detractors. That’s the best predictor of loyalty and growth, all from just one question.



Is this question applicable to all industries?

Reichheld noted that there were some exemptions, such as:

  • When the customers are mere end-users with no choice about the use of the service or product. For example, the use of a specific database software offered by companies to their employees. In this situation, asking the question is irrelevant.
  • When one player dominates the industry.
  • When the company operates in a very particular niche.

In the above cases, it’s better to ask the customers these two other questions:

  • “How strongly do you agree that company/product/service sets the standard for excellence in its industry?”
  • “How strongly do you agree that company/product/service deserves your loyalty?”


But is asking that one question enough? How can healthcare organizations improve without knowing the reasons for their ratings?


The Value of the Net Promoter System in Healthcare Marketing

The Net Promoter System entails digging into the root cause of the low rating and asking the detractors more questions with one goal in mind: to address their issues and improve the system.

In recent years, many players in the health care industry have used The Net Promoter Score to improve quality of care. To assess patient satisfaction, they only needed to ask that one question.

There are many ways to use the data:

  • Use process and performance improvement approaches and tools such as Root Cause Analysis, Pareto Chart, Fishbone Diagram, and the like to address the detractors’ issues
  • Highlight and promote the promoters’ reasons for their enthusiasm and use in marketing strategies (testimonies on your website landing page, for example)
  • Analyze how to convert the passively satisfied to a promoter through the Plan-Do-Study-Act method

Using the Net Promoter System is a useful but largely untapped tool. And as a tool, healthcare marketing can use it in the strategy to achieve high healthcare quality and drive growth.

Based on the research conducted by Accenture Consulting, healthcare providers have lower NPS (9%) compared to the other industries like hotel & lodging, banking, retail, consumer electronics, wireless services, and insurance.

And this is despite the fact that 44% of patients choose their providers based on personal recommendations. The Net Promoter System, when used strategically, can close that gap.


NPS is About More Than Just a Number

Just measuring your NPS at one point in time doesn’t tell you everything you need to know to grow your healthcare practice. It’s a starting point: it measures where you are, tells you where you need to go, and how to find the right way to get there.


Your Roadmap to Increasing Your Score in the Net Promoter System

To start using the NPS system to gauge your customer loyalty and potential for growth, you need a strategy for your healthcare practice. Begin by planning how you will regularly measure your Net Promoter Score with your new and existing patients.

An easy and effective way to start is to send out an email asking that one question – how likely are you to recommend our practice to your friends and colleagues? You should send an email after every appointment where a patient has come into your office or had a telemedicine appointment. After each interaction, are they likely to recommend you – or to tell their network how unsatisfied they are?

You should also send a survey out to all your patients twice a year, not tied to any recent appointments. This will give you a high-level look at how satisfied patients are when they haven’t just had an interaction with you or your team.

Chart these responses over time and note any patterns. Is your NPS going up – or coming down? Once you have at least a few months of this data collected, you’re ready to begin taking action to improve your score and start seeing growth.


Improving the NPS for Your Healthcare Practice

Bringing up your NPS for your practice means taking action on your weak spots, and capitalizing on what’s already working well.

To start, take a look at the data you’ve collected. Are you dealing with a high percentage of detractors? Do you not have enough Promoters to cancel out the Passives?

Let’s take a look at how to improve each category.


Promoters: Find and Nourish Them

Promoters are the best patients. They return regularly, they love to see you, and they tell their friends and family how wonderful your healthcare practice is for them. But to properly make use of their loyalty, and reward them for it, you need to first find out who they are.

To find them, just check your NPS survey results. Then begin your campaign to nurture them and get them to spread the word about your practice. You can send them occasional emails asking them to leave a review on a healthcare review site, like Healthgrades.

Don’t send these requests to everyone – only to your Promoters. You only want to encourage the patients who adore your practice to leave you reviews. This is one of the best ways to raise your online reputation.


Reward loyalty

You can also take steps to reward their loyalty – after all, you want to encourage them to keep coming back and keep spreading the word. A referral program or bonus is a very effective way to do this.

In the healthcare industry, this can take a few forms. You can:

  • Offer them a discount on their next aesthetic procedure for every friend they refer.
  • Ask them to send a referral to a friend once every few months in exchange for a discount on both their next service and their referral too.
  • Create content, like short videos or blog posts on your website, that highlight the wonderful patient experience they had and share it as part of your content marketing strategy.

Finding your Promoters can also help you spot the patterns that are leading to their loyalty.

Ask for additional feedback in a phone call or a yearly deeper survey to spot what’s working well:

  • Do they love the personalized reminder and follow-up emails or calls they get after every visit?
  • Do they praise your friendly nurses or reception staff?
  • Is your practice especially proactive in working with insurance companies to make sure billing is fair and accurate?


Building on your strengths to boost your NPS

Once you know what your most loyal customers regard as your strengths, you can start to build on them. How to start?

  • Integrate that positive feedback into your digital marketing. Create ads highlighting your strengths!
  • Don’t forget to include those positive customer testimonials on your website to bring in even more business.
  • And make sure you’re using those strengths throughout every part of your business – if one doctor in your practice is doing something Promoters love, every doctor should know about that and incorporate it into their patient interactions too.


Detractors: Closed-Loop Feedback

Closed-loop feedback consists of looking at interactions with a patient from start to finish. It can help you get clarity on exactly what is creating issues with retaining and delighting your patients.

To set up a closed-loop system, you will need to set up a process for your healthcare organization to:

  • find and review any negative feedback
  • talk to the dissatisfied patient
  • address what went wrong


Actionable steps

First, you will need to set up a process to collect NPS feedback after every visit or interaction. Your general email survey that’s set up via automation is your most useful tool here.

Next, when you get a response that falls into the Detractor category, you will need to immediately flag that patient for a follow up and ask to contact them. This can also be done through email automation – sending an auto-response to negative feedback that apologizes for the experience and asks if the patient would be open to a follow-up phone call.

If the patient agrees – and most patients with a negative experience will – then you can talk to them to learn what when wrong and why they were upset. Sometimes just acknowledging their feelings will be enough to raise their satisfaction with your practice.

And often, they will have concrete feedback about something that you can fix. This doesn’t just help that one patient – it can improve the patient experience for every future patient as well.

Finally, when you make changes based on closed-loop feedback, like a new and improved email confirming appointments with clearer directions or an adjusted policy to speed up prescription refills, let that patient who started it all know what you’ve done to change. And thank them for their honesty and their commitment to making your practice better for everyone who walks through your door.


Passives: Find the Missing Piece

Not all low Net Promoter Scores in healthcare organizations are from too many Detractors.

For many practices, it can be an excess of Passives. While they might not seem like they’re doing immediate harm to your practice, over time, patients in the Passive category are easily swayed away from your practice by a better price or an additional service.

Loyalty is what brings in big growth for the healthcare industry – and Passives aren’t in love with your practice enough to stay with you for the long haul. But turning them around into Promoters can reap big rewards.

Patient feedback is the key to your success here. You can monitor your NPS feedback closely, looking for any trends in positive feedback that you can chose to expand on. Maybe you get quite a few comments that one particular receptionist is really helpful – ask what they’re doing and train your other receptionists on those processes.

You can use the closed-loop system here as well, but with a twist. Talk to the Promoters to see what is working really well and make sure that happens with every relevant interaction.

Or check with the Passives themselves in a follow-up call if they’re willing to talk, and check what would take their satisfaction to the next level.


Knowledge is Power

Closed-loop feedback is a powerful tool to improve your Net Promoter Score – it can turn Detractors to Passives or even Promoters, and it can identify systematic issues that are detracting from your overall patient satisfaction too.

If all you know is that your patients are unhappy, you aren’t in a strong position to change that. Knowing what’s working – and what’s not – gives you the power to make a change.

You may only need to take one step – or you may need to tackle all three categories. If you aren’t sure where to start, getting regular NPS data and implementing a closed-loop feedback system can help you get a clearer idea of exactly what needs improvement in your relationship with your patients.


NPS Improves with Targeting the Right Patients

One important factor in your patient satisfaction and loyalty levels is ensuring that your digital marketing strategy is bringing in your ideal patient.

If your Facebook ads are all about discounts on your services and they’re bringing in one-time patients who are Passives (or worse – Detractors), stop targeting ads to them!

Instead, focus your marketing efforts on the types of patients who become your most passionate Promoters. That doesn’t mean you need to bar the door to everyone else – but make a more concerted effort to attract the patients you can truly help, who will remain loyal to you and promote you in the long run.

Bringing in more people who are likely to love what you do and how you do it isn’t just great for your Net Promoter Score – it’s the key to building a healthcare practice that brings in patients and profits for years to come.


How about your practice?

Do you know your Net Promoter Score?

Follow our blogs to learn more on how to translate Net Promoter System principles to drive growth into your practice. If you’re not sure where to start, schedule your free practice growth session today.


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The Net Promotor System (NPS) and Healthcare Marketing
What do you know about objective patient feedback and NPS? See how the net promoter system can help your practice reach your ideal patients.

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