Making Sense of Patient Feedback Without Chasing Numbers

By Thomas Howell, MD, Physician Advisor, NRC Health 

If you’ve worked in healthcare long enough, you’ve probably lived through the meeting where someone says, “We need to improve the scores.” It’s usually followed by a dense deck, a handful of targets that look suspiciously like moving goalposts, and a quiet sense among clinicians that the conversation missed the point. Patient experience is not about chasing numbers. It’s about improving experiences for human beings. And when we do that consistently, the numbers follow. 

In fact, we don’t have to pit Net Promoter Score℠ (NPS ®) against HCAHPS. Used together, they are complementary signals that help leaders act faster, engage clinicians more authentically, and ultimately protect both reputation and reimbursement. That’s the essence of NRC Health’s analysis: near‑real‑time feedback anticipates future HCAHPS performance and accelerates improvement when teams close the loop. It’s not measurement or momentum; it’s measurement for momentum. 

When I sit down with physicians, I don’t start with a dashboard. I start with the why behind the work: What do you value in your practice? What would a great day look like for your patient and for you? Only then do we translate those values into what to improve and how to measure progress. Data is a tool, not a verdict. That order matters because it keeps intrinsic motivation front and center and avoids weaponizing metrics. 

When I was leading patient experience at Mayo Clinic Health System, we found that activation, the felt meaning and purpose of the work, correlates positively with patient experience measures like confidence in and recommendation of the provider. Meanwhile, certain facets of decompression (for example, fully “disconnecting” from work) demonstrate small, negative associations with those same patient perceptions. In short: when clinicians feel that their work makes a difference and is meaningful, patients feel it, too.

Another persistent myth: “If I see more patients, my experience scores will drop.” My 2024 research on primary care productivity showed the opposite. Physicians in the top quartile of productivity (by average monthly visits) were more likely to earn top‑box “likely to recommend the practice” scores than peers in lower quartiles; there was no penalization for the physician’s own recommendation score based solely on volume. In other words, the most productive clinicians can also deliver strong patient experience, often because systems around them are functioning effectively.  

Why does this matter for NPS and HCAHPS? Because real‑time patient feedback shines a light on those system drivers, teamwork, communication, access, and responsiveness—while there’s still time to adjust. Then HCAHPS reflects those changes downstream. When leaders pair immediate signals with standardized, consequential outcomes, the organization breaks the score‑chasing cycle and gets back to improving care. 

NPS and HCAHPS: Connected Signals of the Same Experience 

Here’s how I explain it to clinical teams: 

• NPS is early, broad, and continuous. It captures voices you’d otherwise miss and gives you a near‑real‑time signal of how care is landing—good, bad, or unclear. That’s invaluable for service recovery and for shrinking the PDSA cycle from months to days. 
• HCAHPS is standardized, visible, and financially consequential. It’s the scoreboard the community and CMS see. 

When we improve for all patients in real time, we tend to see those behaviors show up later in HCAHPS. The relationship can be noisy in short windows (small samples, natural variation), but a rolling view brings the signal into focus. The point isn’t to force perfect alignment every month; it’s to simplify, signal, act, and then let long‑term trends tell you if the work is sticking. 

This approach also respects how clinicians experience data. No nurse or physician comes to work energized by the prospect of earning back value‑based purchasing dollars. They do, however, care about fixing the thing that frustrated today’s patient and knowing that their effort made a difference, because meaning and momentum go together. Feeling one’s work is meaningful is positively associated with better patient experience measures. 

1) Artificial Targets 

Setting an across‑the‑board 90th-percentile target sounds decisive, and is often statistically impossible. It invites excuses (“my partner was out,” “phones ring for 30 minutes,” “I lost nursing support”) instead of improvement. Replace it with continuous improvement: be better this month than you were the last, and protect excellence where it already exists. 

2) Analysis Paralysis 

Organizations drown in dashboards because they’re trying to reconcile every metric for every audience. You don’t need perfect alignment to move. Pick the fewest measures that reliably inform action (NPS for fast signals, HCAHPS for accountability), then get disciplined about closing the loop with patients and with staff. Recognition, coaching, and rapid fixes build belief that this work matters.

Treat data differently for improvement vs. research.
For improvement, bias is acceptable, increments are small, and learning is sequential (think run/control charts). For research, hypotheses are fixed, bias is minimized, and statistics are formal. Confusing these purposes slows action and fuels skepticism. Keep the method fit to purpose.  

Elevate the “activation” of clinicians.
Remind people, in specific terms, how their work changes lives. Purpose is not a platitude; it’s a driver of better patient experience. Our 2020 work found positive associations between clinicians’ sense of meaning and patients’ evaluations of provider behaviors, confidence, and likelihood to recommend. That’s your cultural flywheel. 

Fix systems, not souls.
Where patients feel friction with access, wait times, and communication, so do clinicians. Improving those systems reduces burnout and improves loyalty. In our productivity study, the most productive physicians likely benefited from better logistics and team function—exactly the levers that NPS reveals early and HCAHPS affirms later. 

Normalize real‑time service recovery.
Not every disappointed patient needs a committee. Many need a timely call, a clear explanation, or a simple fix. Ironically, a well‑handled service lapse can increase loyalty beyond that of patients who never had an issue, precisely because it shows you listen and act. Near-real‑time feedback makes this possible; standardized surveys alone do not. 

A Quick Field Guide for Leaders 

• Lead with WHY. Tie patient experience to mission and meaning first, then define the WHAT (behaviors) and HOW (measures). 
• NPS helps you navigate in real time; HCAHPS offers a broader checkpoint along the journey. 
• Look long. Act fast. Make decisions from rolling trends; make fixes from today’s comments. 
• Close the loop relentlessly. Do this both with patients, and with staff who need to know that their effort changed something. 
• Invest in activation. Celebrate stories where care was personal, effective, and human-centered. The data will follow.  
• Stop chasing the 90th. Chase better systems that let teams do their best work consistently. It’s similar to how a good English teacher would answer their 8th grade class request for “what is going to be on the test, we need a study guide.” What the students need to do is work on reading and understanding, but also, what does this passage/book/poem mean to you? How does it resonate and relate to what is important to you? When they do that, the scores will follow. Another way to say it: do your homework, the test will be fine.

The fastest path to better HCAHPS is not a tighter grip on HCAHPS. It’s a tighter grip on Human Understanding, which uses real‑time patient feedback to see problems early, support teams meaningfully, and rebuild the relational core of care. When you do that, you’ll notice something familiar: NPS and HCAHPS begin to move together over time. Your clinicians feel more activated. And your patients feel more seen. 

That’s not a coincidence. It’s momentum.

Related Work by the Author 

• Howell TG. Primary Care Productivity and Patient Satisfaction in Community Practice: What Is the Relationship? Patient Experience Journal. 2024;11(2):27–35. doi:10.35680/2372-0247.1948. [https://pxjournal.org/cgi/viewcontent.cgi?article=1948&context=journal]

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