How NPS and HCAHPS Work Together to Transform Patient Experience

As health systems increasingly rely on patient feedback to guide improvement strategies, many face a familiar challenge: their real‑time patient feedback doesn’t always line up with their HCAHPS results. This discrepancy can lead to confusion, stalled progress, and even financial risk. 

Building on data and strategy from NRC Health’s latest nSight, a recent webcast takes a deeper dive into how Net Promoter Score (NPS) and HCAHPS can, and should, work together. Sarah Fryda, M.S., Research Team Manager, and Jason Messerli, Strategic Advisor for Customer Strategy walked through the correlation between the two measures, the pitfalls of relying on short-term data, and why timely and representative feedback is essential for improving both patient experience and outcomes. 

If your organization is striving to make sense of patient experience data and drive meaningful improvement, this webcast delivered practical insights and evidence‑backed strategies.  Watch the full session on‑demand for the complete discussion. 

Many health systems wrestle with what Fryda described as “conflicting stories” between real‑time patient feedback and HCAHPS scores. But according to the NRC Health research team, these metrics aren’t contradictory at all, they are deeply connected. 

“We know that NPS and HCAHPS are strongly related,” shared Fryda. “And we can actually predict what future CMS HCAHPS scores will be.” 

Using longitudinal data, NRC Health has found that hospitals performing well on HCAHPS typically perform well on NPS, and vice versa. Even when the metrics diverge in the short term, long-term patterns show strong alignment across every major HCAHPS dimension. 

This is critical because organizations sometimes treat the two measures as separate or even competing. Fryda emphasized that they “actually do support each other,” and failing to effectively use one can lead to missed insights and missed revenue. 

The bottom line: NPS captures immediate patient perceptions, while HCAHPS reflects whether positive behaviors are consistently applied over time. Together, they paint a fuller, more actionable picture of experience. 

How Short‑Term Data Can Mislead  

Many health systems feel pressure to evaluate patient experience on a month‑by‑month basis. But as Messerli cautioned, this is one of the most common and damaging mistakes organizations make. 

Short-term fluctuations often disguise true performance, causing leaders to question their approach or pivot strategies prematurely.  

Messerli recalled a recent conversation with a CMO. “I showed him a year‑over‑year trend where they improved every single year for five years,” he recalled, “and he said, ‘I had no idea we were improving like this.’” 

This experience highlights a widespread issue: organizations become so focused on monthly peaks and dips that they lose sight of steady progress. To address this, Messerli encouraged leaders to rely more heavily on rolling 12‑month trends, which provide a clearer view of whether behaviors are truly improving. 

“These long‑term relationships help get rid of some of the noise,” said Messerli, “and are much better representations of our performance over time.” 

By stepping back and viewing performance through a broader lens, leaders can avoid unnecessary shifts in strategy and instead refine what’s already working. 

Fryda discussed the real organizational risks that arise when NPS and HCAHPS are not used together, or when short‑term data influences decisions too heavily.  

These include: 

• Analysis paralysis: Teams freeze when metrics don’t align perfectly, delaying decisions or avoiding action entirely. 
• Overemphasis on HCAHPS: Because HCAHPS is public and tied to reimbursement, many organizations fixate on it at the expense of actionable feedback coming from contemporary channels. 
• Financial penalties: Organizations that fail to understand what drives patient experience risk both underperformance and lost revenue opportunities. 

“Performance on the HCAHPS survey accounts for one‑quarter of a hospital’s total performance score,” said Fryda. “Hospitals can lose or earn back up to 2% of Medicare inpatient payments.” 

One of the most compelling insights from the webcast centered on the speed and representativeness of feedback. 

HCAHPS responses overwhelmingly come from older adults, a demographic that evaluates care differently than younger generations do.  

“Roughly 63% of all HCAHPS responses come from those 65 and over,” Messerli explained. “And in some cases, I’ve seen it as high as 80%.” 

This creates an imbalance that can mask issues experienced by younger or more diverse patients. Modern outreach methods help organizations capture feedback from a broader population, painting a more accurate picture of patient needs and expectations. 

Timely feedback also enables: 

• Faster coaching and recognition 
• More agile improvement cycles 
• Early identification of loyalty drivers 
• More effective service recovery 

Real-time alerts allow teams to intervene early, boost trust, and even strengthen loyalty, sometimes more than if nothing had gone wrong. 

How Real‑Time Feedback Accelerates HCAHPS Improvement 

Fryda shared data demonstrating that organizations using real-time feedback consistently and effectively are improving more quickly on HCAHPS.  

NRC Health customers saw measurable gains across all 10 HCAHPS dimensions between 2022 and 2024, including Staff Responsiveness, Overall Hospital Rating, and Hospital Quietness. 

“Experience performance doesn’t just recover, it accelerates,” said Fryda. 

The reason? When organizations use real-time feedback to reinforce key behaviors, those same behaviors eventually show up in HCAHPS performance. 

Strategies for Smaller Hospitals 

Not all hospitals have the patient volume to fully leverage real-time feedback in inpatient settings. But smaller organizations still have powerful options. 

Fryda recommended focusing on the emergency department, where a large percentage of inpatients begin their care journey. “How they are treated in the ED does impact their experience,” she shared. “One way you can really impact HCAHPS is by using real-time feedback to evaluate those emergency department experiences.” 

Improving the ED experience influences both real-time satisfaction and future HCAHPS responses once patients transition to inpatient care. 

A standout theme from the webcast was the role leadership plays in elevating experience.  

“The best way I’ve seen to create a culture of accountability is to have effective executive leadership rounding from a supportive standpoint,” said Messerli. 

Executives should round not to evaluate staff performance, but to understand challenges and offer solutions. Messerli described a powerful example: 

When leaders are visible, engaged, and supportive, frontline teams feel valued and empowered, fueling better patient interactions and improved outcomes. 

Watch the full webcast for more insights and download the recent nSight report to dive deeper.