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.

### How do I calculate my practice’s NPS?

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.

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