Dale Carnegie said, “To be interesting, be interested.” This wisdom is the foundation of the net promoter score® (NPS). In the simplest of terms, NPS is a standardized customer loyalty metric. It rates how likely a customer is to recommend your brand, product, and/or service to a colleague or friend. NPS is a solid indicator of customer (i.e., patient) engagement and retention, because people typically only recommend brands, products, or services they feel are truly deserving of their love and loyalty. As Mike Manheimer writes in this blog post, “The Net Promoter Score (NPS) is the holy grail of satisfaction metrics.”

So, where does Dale Carnegie fit into this? Well, if you want your brand to be interesting—that is, something people care about and engage with—then you best get interested in your customers and find out where you stand. And NPS is a surefire way to just that.

PT Billing Secrets: 5 Things Payers Don’t Want You to Know - Regular BannerPT Billing Secrets: 5 Things Payers Don’t Want You to Know - Small Banner

How do I calculate my practice’s NPS?

To determine your practice’s Net Promoter Score, you must first ask your patients one simple question:

On a scale of one to ten, how likely are you to recommend [your business name here] to a friend or colleague?

The One-to-Ten Breakdown

  • Detractors: Those who answer with a number between one and six.
  • Passives: Those who give a number between seven and eight.
  • Promoters: Those who supply a nine or ten.

The Calculation

  1. Calculate your percentage of detractors. In other words, what portion of patients surveyed rated your practice with a number between one and six?
  2. Calculate your percentage of promoters (i.e., what portion of patients surveyed rated your practice with a nine or ten?)
  3. Disregard those patients who rated you passively with a seven or eight.
  4. Subtract the percentage of detractors from the percentage of promoters.
  5. High-five yourself, because you just determined your net promoter score.

A Simple Example

You survey 100 patients at discharge:

  • 20 rated your practice between a one and six.
  • 30 rated your practice with a seven or eight.
  • 50 rated your practice with a nine or ten.

Because you surveyed 100 patients, calculating the percentage of promoters and detractors is easy peasy, and you disregard the passives.

% of promoters (50) - % of detractors (20) = 30 NPS

What does the math mean?

The higher the NPS, the better—and if you try to get more specific than that, the advice gets a bit murky. This Direct Capital infographic will tell you that a score of 50 to 83 is considered “good”; According to this Inc. article, though, Fred Reichheld—the man who developed the NPS methodology—found that “the average Net Promoter Score among the companies he surveyed was 10–15, so by definition, if your score is north of 15,” then “you’re above average.” To make things even more confusing, Net Promoter Network says it’s all relative to industry. Moral of the story: NPS is less about what everyone else is doing, and more about what you’re doing. The key is to calculate your NPS regularly and use each rating as a benchmark for your business. The only way to go is up, and if that’s what you do, then it’s a reminder to keep up the great work and continually optimize processes and behaviors to further improve your ratings. If you tumble in ratings, you know you’ve got to right the ship before you lose (potentially more) patients.

It’s important to note that using NPS as a benchmark outside of individual practices is on the healthcare horizon. In the Advance article, authors Chris E. Stout, PsyD, Grace Wang, BA, and Julie Roper, PT, DPT, propose implementing NPS as a way to “create a level playing field across providers.” Essentially, they encourage the use of NPS as a way to establish benchmarks within healthcare professions. And while adoption of this metric in the rehab industry “has been slower” than in others, “National companies like Concentra and Select Medical, which provide rehabilitation, report that they use the metric.”

How do I implement NPS surveys?

As this WebPT blog post explains, “There are many methods to collect your NPS data.” Here are two popular methods:

  1. Use free tools like SurveyMonkey or SurveyGizmo to email the survey to your patients upon discharge.

  2. Ask patients to complete a paper exit survey upon discharge (remember, you need a checkout process) and then manually enter those responses into your patient/practice management system or into a spreadsheet.

Is NPS right for my private practice?

Now, there are some drawbacks to NPS:

  1. As Scout Research explains, the equation forces you to toss out all your passive customers: “While sampling provides a good representation of the whole base, [NPS] does not provide specific insight into every individual customer.”
  2. As Mike Manheimer notes, “...it doesn’t explain why you have the results that you do.” And this article in Advance supports that argument: “Customers have no opportunity to explain their reasoning, which leaves companies wondering why they received a particular score.” In other words, you’re unable to suss out what specifically caused your patients to rate you the way that they did.
  3. As this WebPT blog post states, “NPS doesn’t offer you any advice on what to do next.” Advance article authors Stout, Wang, and Roper put it plainly: “A simple numerical score is not actionable.”
  4. Lastly, “Not all outcomes in healthcare are provider-dependent,” explains Advance article authors Stout, Wang, and Roper. “For example, those patients who are non-compliant, are neglectful of home exercises, or do not follow through with the physical therapist's interventions or recommendations, may not achieve an expected outcome.” And regardless of whether it’s the provider’s fault, that’s where many patients will place the blame.

For all of these reasons, experts recommend that NPS be one of several satisfaction or engagement metrics you use. “Paired with additional questions to augment a better and fuller understanding, it becomes a much more useful and actionable approach,” states the above-cited Advance article. Additionally, I recommend including an optional comment box below the NPS question. While not everyone will provide feedback, those on the far right or left will strong opinions and are, therefore, likely to add comments—thus giving you greater insight into their ratings.

Lastly, conduct the NPS survey at different points within patients’ episodes of care (e.g., at initial evaluation, at every third visit, and at discharge). “By tracking the patient’s NPS throughout the episode, you can see where the score changes and analyze what happened between the two measurement events,” explains Mike Manheimer. Through this method, you can hone in on different aspects of the patient experience and pivot appropriately to improve scores.

 And now it’s on you. The first step to NPS is actually implementing NPS. Nervous about your ratings? Don’t be. To circle back to the great Dale Carnegie, “Develop success from failures.” No matter your NPS score, you can improve it, and through improvement, you’ll find success. After all, to continue quoting Mr. Carnegie, “Action breeds confidence and courage,” so if you want to succeed, “...do not sit home and think about it. Go out and get busy.” Or in this case, administer that NPS.

  • The Initial Visit is Everything Image

    articleOct 12, 2015 | 4 min. read

    The Initial Visit is Everything

    Patient engagement isn’t just about being friendly and nice. It’s about giving your patients the information they need for their treatment to be successful. That’s why it’s so important to prepare your patients for their first visits—in an effort to both set appropriate patient expectations and improve patient retention. Therapy Expectations If a patient has never been to PT before, expect lots of questions. Better yet, preempt those inquiries by sending patients information on how to prepare …

  • Stalled Out: 5 Reasons Your Patients Aren't Progressing (and What to Do About Them) Image

    webinarDec 22, 2017

    Stalled Out: 5 Reasons Your Patients Aren't Progressing (and What to Do About Them)

    If life is a highway, then it’s a wild, bumpy one. And while our patients want to ride it (all night long), with all those twists, turns, and potholes, they’re bound to get banged up. Fortunately, you’re here to help get them back in top form. But, helping patients achieve their goals is hard work—for you and for them—and while everyone strives to be a Ferrari, it’s common to plateau at Pinto. And that’s when the risk …

  • Think Big, Think Differently: 6 Bits of Inspiration from Ascend 2017 Image

    articleOct 5, 2017 | 11 min. read

    Think Big, Think Differently: 6 Bits of Inspiration from Ascend 2017

    The overarching theme of Ascend 2017 —the fourth-annual installment of rehab therapy’s premier business summit—was, quite simply, “Think big.” But, based on what we learned from our esteemed group of speakers over the course of two inspiration-filled days in Washington, DC, a more accurate tagline for this year’s conference might have been, “Think differently.” After all, in a field as complex as health care, grand aspirations are not enough. To solve the problems plaguing this industry, we …

  • Common Questions from Our Physical Therapy Patient Retention Webinar Image

    articleMar 28, 2018 | 12 min. read

    Common Questions from Our Physical Therapy Patient Retention Webinar

    Strive Labs co-founders Ryan Klepps and Scott Hebert recently joined WebPT president Heidi Jannenga for an insightful webinar about improving patient retention and reducing early patient drop-out. We know this is a super-relevant topic, especially because the cost of diminishing patient visits represents a $6 billion problem that not many people in the industry are talking about—at least not yet. As a result, we received a slew of great questions that we couldn’t get to live on …

  • Knock Out Patient Dropout: 8 Ways to Increase Retention and Revenue Image

    webinarFeb 12, 2018

    Knock Out Patient Dropout: 8 Ways to Increase Retention and Revenue

    In one corner, we have a highly skilled rehab therapy provider known for delivering amazing clinical outcomes through noninvasive, movement-based treatment. And in the other corner, we have a discouraged, disengaged patient whose quality of life has taken a major hit due to musculoskeletal pain and dysfunction. [video://fast.wistia.net/embed/iframe/d11isduky2]   If you’re a rehab therapy provider, you’ve probably seen this battle play out more times than you can count—and we’re betting that more often than not, your therapy …

  • Are Your Patients Really Satisfied? 5 Metrics to Find Out. Image

    articleAug 21, 2014 | 10 min. read

    Are Your Patients Really Satisfied? 5 Metrics to Find Out.

    Physical therapy can be a long, hard, difficult—and yes, sometimes unenjoyable—experience. So what, then, keeps patients coming back for more? Well, it’s probably safe to assume that it’s not the sweat-inducing gym sessions or the wince-eliciting manual therapy. Rather, I would argue it’s the feeling your patients have when they leave your clinic at the end of their visits. How are they feeling as they walk to the parking lot? Satisfied? Happy? You might not realize it, …

  • Untapped Potential: The Art of Discovering and Selling Your PT Value Image

    webinarApr 3, 2018

    Untapped Potential: The Art of Discovering and Selling Your PT Value

    As the old saying goes, “In the absence of value, price is always an issue.” In other words, people aren’t going to pay for something they don’t consider valuable—whether that’s a car, a software, a new haircut, a piece of art, or even a healthcare service. Unfortunately, healthcare providers in general—and physical therapists in particular—tend to overlook the value issue, instead focusing solely on the price problem. What they may not realize, though, is that price and …

  • Common Questions from Our Stalled Patient Progress Webinar Image

    articleFeb 7, 2018 | 9 min. read

    Common Questions from Our Stalled Patient Progress Webinar

    Earlier this week, Dr. Heidi Jannenga, PT, DPT, ATC/L, the president and co-founder of WebPT, teamed up with Charlotte Bohnett, WebPT’s director of demand generation, to host a webinar on common barriers to patient progress —and strategies for overcoming them. During the question-and-answer portion of the presentation, we received quite a few audience questions on the nuances of fostering patient engagement and moving patients toward their therapy goals as efficiently as possible. We’ve compiled the most frequently …

  • NPS® in Health Care: Leveraging Loyal Patients to Drive New Business and Improve Revenue Image

    articleApr 6, 2018 | 8 min. read

    NPS® in Health Care: Leveraging Loyal Patients to Drive New Business and Improve Revenue

    Most rehab therapy business owners, executives, and administrators understand the value of happy, loyal patients—especially given that a patient’s attitude toward, and relationship with, his or her provider can majorly impact the outcome of that patient’s treatment. But, did you know that you can use Net Promoter Score® (NPS®) tracking to systematically identify your already-pleased patients and leverage them to drive new business and improve your revenue? This powerful metric can also help you learn about, prioritize, …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.