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How to use NPS in healthcare: A primer from MU Health Care’s CXO

Kevin Gwin, Chief Patient Experience Officer at University of Missouri Health Care, is a Net Promoter Score (NPS) evangelist. He’s seen first-hand how impactful measuring and generating patient loyalty can be in a healthcare setting.

In a recent webinar with NRC Health, Gwin explains what NPS is, how it works, and why it’s an important tool for health systems to use in order to improve their connections with their customers.

What is Net Promoter Score?

First, Gwin explains how NPS is derived.

It’s a gauge of the strength of our relationship with our patients. How loyal they are tells us a lot about how they’ll behave in the future. Will they be open to new marketing? How compliant will they be with their care plan? How powerful is their word of mouth?

Specifically, NPS is a loyalty metric that measures how customers answer a single question: “On a scale of 0–10, how likely would you be to recommend [SERVICE/PRODUCT] to a friend or family member?”

Based on their answers, consumers can be placed in categories as Promoters, Passives, or Detractors, with specific future behaviors.

“The threshold for Promoters is high,” Gwin says. “They have to provide a score of 9 or 10 on this question. These Promoters display all the behaviors that you want to see from your customers: they’re more likely to come back, they’re open to new services, they promote your system in a way that creates more Promoters, and their feedback makes you even better.”

NPS is calculated by subtracting the percentage of customers who are Detractors from the percentage who are Promoters. An NPS of 100 is a perfect score, which means that every single one of an organization’s customers is a happy promoter. An NPS of -100, on the other hand, means that every one of that organization’s customers is actively detracting from the organization. Most organizations will fall somewhere in between.

Why NPS matters

NPS sounds straightforward enough. Its simplicity, however, belies its predictive power.

Gwin observes that when they’re evaluating consumer attitudes, most healthcare organizations tend to focus on patient satisfaction with their care encounters. That level of satisfaction—captured by instruments like HCAHPS—can only get you so far. Research indicates that satisfaction is not the same as loyalty, and satisfied customers will still defect.

“We are about growth and improvement, and NPS begins to provide us the insight to do both,” Gwin says. “First, on the business front, customer retention, customer acquisition, and ultimately margin improvement have stronger links to loyalty than to customer satisfaction.”

The numbers bear this out. Research from Bain, a consultancy, found that a 5% increase in customer loyalty boosts profitability by 25%.

Gwin also shows how it’s not just the bottom line that benefits from NPS improvements. Clinical outcomes improve as well.

The numbers at the University of Missouri speak for themselves. “We took a snapshot of our Promoters and watched their behavior for six months,” says Gwin. “The results were striking.”

For patients who are Promoters (scoring 9 or 10 on NPS questionnaires):

– Average readmission rates are lower: 7.2%, compared with 11.9% for Detractors

– Average ED return rate is lower: 5.2%, compared with 12.9% for Detractors

– Average care compliance is higher: 68.2%, compared with 52% for Detractors

Making NPS work in healthcare

The case for using NPS is compelling. To make effective use of it in a healthcare setting, Gwin advises three important tactics.

1) Grow sample sizes

While the NPS model is statistically robust, it’s only as functional as its inputs. To increase its validity, hospitals will need to gather responses from lots of patients.

“You have to maximize response rates,” Gwin says. “Keep the surveys short, and get them to patients right after their care episodes. That’s how you get an adequate sample size, so you know your NPS reflects what’s actually going on in your organization.”

2) Connect NPS survey data with EHR and revenue-cycle data

NPS scores can be revealing on their own. But examining them in isolation means missing out on powerful insights.

“Look for correlations and patterns. They’ll show you where to direct your efforts,” Gwin says.

Comparing NPS scores to day-of-discharge data, for example, showed Gwin’s patient-experience team that patients who discharged over the weekend at one facility were some of the least satisfied patients in the University of Missouri system.

“That helped us give some special attention to weekend patients,” Gwin says. “We were able to communicate with them a little better about why they had to stay past Friday, and assure them they were being looked after. We saw very meaningful improvements after that.”

3) Use NPS to build a common language with staff

 Finally, Gwin emphasizes NPS’s power as an instrument of culture change.

“The concepts of NPS are easy to understand and communicate,” he says. “They help us talk about strengthening relationships and connections. That’s the key to improving the patient experience.”

Talking about Promoters, Detractors, and Passives brings NPS to the forefront of everyone’s concerns. It builds unity around earning consumer loyalty, which ultimately translates into more effective—and more empathic—care.

NPS: Part of a complete vision of care

That’s the fundamental insight Gwin wants leaders to understand: that loyalty is ultimately about how we serve, how we provide our care.

“If we can generate loyalty, then we’re creating customers—loyal customers who will help us improve, who will spread the word about the good work that we’re doing,” he says. “And because we’re generating loyalty, that means we’re delivering the best care in the best way to them. I think it’s one of the most important things we can do.”

Consumer loyalty and clinical service are inextricably intertwined. Healthcare leaders should commit to excellence in both.

These are just a sampling of the insights offered in Kevin Gwin’s recent webinar with NRC Health. To view the whole webinar, click here.