Founder Letter: Ask and You Shall Perceive: Why Every Rehab Therapist Must Track NPS

Oh, the Net Promoter Score® (NPS®)—a simple customer loyalty metric that packs a meaningful punch. So, how likely is it that your patients would recommend your services to a friend? If you don’t know the answer to this question, then it’s safe to say you’re not tracking your NPS, which means you’re missing out on a veritable goldmine of mission-critical information about how your practice is performing from your patients’ perspective. And that’s a pretty darn important perspective to have, especially now that patients are more actively involved in their healthcare decisions than ever before. As WebPT’s former director of marketing once said, “The Net Promoter Score is the holy grail of satisfaction metrics.” I couldn’t agree more; it really pays to ask your patients—and your employees, but we’ll get to that a little later—this question, and then act on the information you receive. Here’s why every therapist must track NPS:

It’s so simple.

To begin tracking your practice’s NPS score, you’ll need to ask your patients one simple question: on a scale of zero to ten, “how likely is it that you would recommend [practice name] to a friend?” Piece of cake, right? You can do so using a free survey tool—such as SurveyMonkey or SurveyGizmo—or via paper (and then manually entering your data into a spreadsheet). Once you’ve collected everyone’s feedback, you’ll want to categorize respondents based on their answers:  

• Detractors (scores between zero and six) are unhappy or dissatisfied patients who may communicate their dissatisfaction to their friends and family members, thus detracting from your practice.
• Passives (scores of seven and eight) are satisfied, but not necessarily loyal. These patients may find another provider if they think he or she will be a better fit.
• Promoters (scores of nine and ten) are your practice’s enthusiasts. They’ll seek out your services, and encourage their friends and family members to do the same.

To calculate your NPS score, you’ll figure out the percentage of Detractors (the number of patients surveyed who rated your practice between zero and six divided by the total number of patients surveyed) and Promoters (the number of patients surveyed who rated your practice a nine or ten divided by the total number of patients surveyed). You can dismiss the Passives—at least for now. Then, subtract the percentage of Detractors from the percentage of Promoters. This is your NPS score—the higher the number, the more satisfied your patients are with your services. Check out this post for an example calculation.

Your score can serve as a benchmark.

The opinions about what constitutes a good score vary. As WebPT’s Charlotte Bohnett wrote in this post, some experts believe a score of 50 to 83 is “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.” So, what’s the takeaway here? Bohnett says that that “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.” With that perspective, “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.” Soon enough, NPS ratings may hold more weight with the healthcare community at large, too. After all, patient satisfaction levels are an important aspect of outcomes tracking—and we all know how crucial outcomes data is in a value-based payment environment.

The data is actionable—if you want it to be.

The whole point of collecting this information is to better understand your patients’ perception of your practice, and—unless your score is a perfect 100—use it to make improvements. However, one of the common objections to implementing NPS is that the data you receive isn’t directly actionable—by that, I mean that a number on a scale doesn’t necessarily tell you why your customers are less likely to refer you to a friend. That being said, here at WebPT, we’ve been able to garner plenty of actionable insights from our own NPS tracking. Here’s how we made NPS work wonders for us:

• Instead of sending our NPS surveys to all Members every six months—like we did when we first began tracking this metric—we now send an NPS survey to a small cohort of Members each week. While each Member still only receives the survey twice a year, we’re now able to gain valuable insight into our Members’ perception of us much more rapidly. As a result, we’ve been able to better track successes and diagnose problems in real-time—as opposed to learning about an issue months after it happened. We’re also better able to correlate scores with changes that are happening at the industry- or company-level.
• We included optional text boxes for comments. That way, if a Member would like to provide an explanation for his or her rating, he or she has the opportunity to do so. And, we read—and respond to—every single comment. In fact, each comment we receive gets assigned a color based on that respondent’s rating: gold (9–10), green (7–8), yellow (4–6), and red (0–3). Red and yellow comments trigger our CRM to automatically create a task and notify our customer service or product team to reach out to the Member to remedy the issue—or, when applicable, incorporate the feedback into our product roadmap. Green and gold comments go to our Member marketing specialist, who works to enroll those Members into our loyalty program, Rehab Nation.
• We send a weekly email to all managers and members of our executive team with that week’s NPS score as well as comparisons to the previous week and the same week of the last year. In this email, leaders also get to see Member comments, which, as I wrote in this blog post, “means that our Members are having a greater impact on decisions at the highest levels of the company. The value of this feedback extends well beyond improving our support and products; it’s critical information for every department to have and act upon.”

As a result of these improvements, our score has gone up by 26.8 points since March 2016. We’ve also seen a 78% increase in response rate and a 71% increase in promoters.

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It’s great for employees, too.

Employee NPS—or eNPS, as the cool kids are calling it—is another incredibly beneficial metric for practices of all size to track. After all, as this Bain & Company Net Promoter website explains, “Very few companies can achieve or sustain high customer loyalty without a cadre of loyal, engaged employees.” Furthermore, “Employee promoters power strong business performance because they provide better experiences for customers, approach the job with energy－which enhances productivity－and come up with creative and innovative ideas for product, process and service improvements.” That’s one of the reasons why we here at WebPT put such a strong emphasis on hiring the right people from the get-go—and giving them the tools, autonomy, and purpose-driven workplace necessary to do their jobs well. We know doing so not only creates a stellar company culture, but also improves the experience of our customers (i.e., you). It’s also why we suggest all therapy practices do the same; your customers (i.e., your patients) will thank you.

While eNPS is as simple as the customer-facing version, there are some important differences to note:

1. You may need to tweak the question.

According to the system developers, eNPS-tracking companies such as Rackspace and Apple ask their employees: “On a scale of zero to ten, how likely is it you would recommend this company as a place to work?” However, they’re quick to point out that “eNPS is an emerging science.” Thus, the perfect question is still a work in progress: “In some cases, Bain & Company has found that a second question can yield an even more accurate gauge of the health of the employee relationship.” That “second question is typically a variant of this: ‘How likely would you be to recommend this company’s products or services to a friend or colleague?’ (In some settings, this question may need to be modified to include only appropriate friends or colleagues—those who might be qualified to buy such a product or service.)”

2. Confidentiality is a must.

While you may be able to reach back out to a patient for follow-up questions after he or she completes a survey, you won’t be able to do that with your employees. According to Bain & Company, “Employee surveys must be kept confidential to encourage honest feedback.” That means that if you’d like to collect any follow-up information or comments from your employees, you’ll need to do so in the first pass. Just remember that the “primary purpose of these surveys is not merely to help headquarters identify and solve everyone’s problems. Instead, they are designed first and foremost to help teams and team leaders recognize and prioritize issues.” They’re also usually “much shorter than the typical annual employee survey.”

3. Scores could be lower than you expect.

Bain & Company warns that “employee Net Promoter Scores can be substantially lower than customer scores.” That’s because “employees often hold their company to even higher standards than do customers.” With that in mind, before you implement any eNPS program, prepare yourself “to process some tough feedback and respond with appropriate action.” So, what constitutes a good eNPS score? According to this resource, “a good score is anything positive,” and “if you’re able to get anything above 40 or 50, you should consider yourself very lucky.” WebPT’s score is 55, and we’re thrilled—although we’re still not sitting on our laurels, which brings me to my next point. Instead of comparing your eNPS score against another company or a national average, it’s best to find your own baseline and then take action to improve it. According to the author of this article, “When all is said and done, the most insightful eNPS benchmark a company can focus on is its own progression over time. And simply measuring the score over time is meaningless without any commitment to actually using employee feedback to take actions to improve.”

That advice stands whether we’re talking about implementing NPS for employees or customers. If you’re asking for feedback, you’re probably going to get it—and some of it may be hard to hear. But, knowledge is power. Once you know what your practice’s challenges are, you’ll be in a much better position to make changes that positively impact your patients, staff members, and bottom line.

Are you ready to implement NPS in your practice? Or, have you done so already? If so, what have you learned that’s helped shape the trajectory of your business? Share your thoughts in the comments section below.