Improving Net Promoter Score (NPS) in healthcare is a tough challenge. You’re working in a high pressured, complex work environment with little time to plan and implement changes.
In this article we seek to provide simple, proven tactics that can be embedded into daily workflows. These tactics are known to be effective and to matter to patients across the globe.
The focus is on simplifying the process of improvement and cutting straight to the chase. Let’s start with some background.
What is NPS and how does it help you?
The Net Promotor Score model was developed in the early 2000s as a simple measure of customer loyalty. It is underpinned by the premise that one’s likelihood to recommend a service, product or organisation to others, is a proxy for one’s loyalty.
Its widespread adoption by businesses was due to its simplicity as well as the increasing understanding of the importance of customer loyalty in business success. Loyal customers tend to spend more with a company, remain with them longer and refer others more actively. These are all great drivers of good commercial outcomes.
Over the past 20 years, other organisations have embraced NPS because it gives them a chance to benchmark themselves against others. Some experts have questioned the relevance of NPS in healthcare but it continues to be widely used across healthcare services in both the public and private sectors.
Learn more about what NPS is and how it’s calculated in our article here.
How NPS is Used
Many of our private healthcare clients use NPS as the primary metric for measuring the quality of their service. Leadership teams assess the performance of services and teams by looking at their NPS scores.
Senior executives and managers may also receive bonuses tied to their NPS scores. Because of these two use cases (a measure of quality and a metric for performance-linked remuneration), we often see NPS improvement efforts occurring in two ways.
Firstly, people with performance-based schemes linked to NPS may look for the easiest ways to nudge Passives up to Promotors – shifting a score of 7 out of 10 to 8 out of 10. To achieve this, people may target services that have high patient responses with an average NPS of 7-8, and work to improve experiences in these services.
Secondly, with a more quality-focused lens, people focus on the worst-performing services and ways to better meet the needs of these patients.
Both scenarios share the need to focus on proven drivers of the NPS rating—those service factors that, if improved, will cause NPS to go up. For example, even if you significantly improve the quality of food in an inpatient setting, the overall NPS rating may not change. Conversely, if you significantly improve the way staff communicate with patients, you are likely to find NPS shifting markedly. Why? Communication is always one of the key drivers of patient experience and NPS. We will go deeper into key drivers later in this article.
What NPS should I aim for?
100. Every patient matters. Our highest performing hospitals are consistently rating at 80 or above, and this is not a reason to stop improving. Is it ok that a substantial proportion of your patients are not having a good experience or are perhaps being harmed?
The move from 80 to 100 can only be achieved through strong leadership, an excellent culture, and a consistent, systematic approach. We actively support our clients in working towards 100 so that every single patient they serve can achieve the best possible outcomes.
How to Improve your NPS
For many decades, researchers have studied patients to understand what shapes their experiences and, hence, their willingness to recommend healthcare services. The rest of this article brings together some of our learnings, clients’ insights, and various studies to provide you with clear, actionable strategies to enhance patient experiences and improve NPS.
But first, let's start with the strategies behind improving NPS.
1. Understand your patient cohorts and their needs
To drive meaningful improvements, start by identifying and understanding your patient groups. Different patient cohorts—such as older adults, non-English speakers, or those with specific medical conditions—experience care differently and have distinct needs.
For example, communication is vital for all patients, but someone fluent in English will have different needs from a patient with limited English proficiency. Similarly, an older adult with cognitive challenges may require a different communication approach from a younger patient. Understanding these differences helps you tailor your strategies to improve experiences more effectively.
2. What are the drivers for your detractors, passives and promoters?
NPS segments patients into Promoters (high scorers), Passives (neutral scorers), and Detractors (low scorers). Examining what influences each group will reveal opportunities for improvement.
For instance, if Promoters give high ratings for “clinical staff being easy to understand,” it means this is a strength you should maintain. However, if Detractors rate the same factor poorly, it signals a gap in care that needs attention. Identifying these patterns helps you focus on areas that will make the biggest impact on patient's experiences.
3. Focus your attention
Lastly, avoid spreading efforts too thin. Instead of tackling multiple initiatives at once, choose one or two key areas to improve at a time.
Work with your team to design practical ways to integrate changes into daily workflows.
Track progress over weeks or months to assess effectiveness before introducing new initiatives.
Focus on consistent, measurable improvements rather than broad, unfocused changes.
What Matters To Patients
In the following sections, we highlight three recent research studies. While there are many others we could discuss, these three are very consistent with the wider body of evidence on what determines a great patient experience. By focusing your improvement efforts in these areas, you can drive the greatest impact on your patients’ overall satisfaction and Net Promoter Score (NPS).
The three pillars of patient experience
In a report published in January 2024, an analysis of patient experience comments from a public hospital in Australia identified three main drivers of patient experience.
These specific aspects are:
Safe, timely and effective treatment
Caring and attentive staff
Comfortable and healing environment
1. Delivering safe, timely, and effective treatment
A key theme in patients’ experiences was the need to feel safe throughout their hospital stay. Comments emphasised the importance of specific moments in the patient journey, such as transitions of care through the admission and discharge processes.
The following sub-themes were identified:
Feeling safe in hospital
Ease of hospital transitions
Effective treatment that meets patient expectations
Effective management of pain
“The staff made me feel safe just before and after the surgery and I knew I was in safe hands.”
2. Fostering human connections with caring and attentive staff
Positive patient experiences were strongly linked to compassionate interactions with staff who demonstrated genuine care and attention to the patient's needs.
This included the sub-themes of:
Being informed
Being listened to and valued
Responsiveness to patient needs
Providing consistent quality care
“I enjoyed that each nurse made the point of connecting with me in their own way.”
“The [medical] team were very responsive and informative. I felt I knew what was happening every step of the way.”
3. Providing a comfortable and healing environment
Patients appreciate a clean, well-maintained facility with features that promote rest and recovery, such as access to natural light, views of nature, and adequate control over factors like noise levels.
Sub-themes included:
Having a clean and functional room
Promoting sleep and rest
Providing nutritious food and dietary options
One of the most interesting observations from this study was that patients value effort over outcomes, with satisfaction hinging more on the visible effort staff make to address their concerns than on the complete fulfilment of all their needs.
While these insights are from just one study, they are very consistent with much of the available literature from other experts and from our experience across our client base.
One of the most interesting observations from this study was that patients value effort over outcomes, with satisfaction hinging more on the visible effort staff make to address their concerns than on the complete fulfilment of all their needs.
While these insights are from just one study, they are very consistent with much of the available literature from other experts and from our experience across our client base.
How to make passives promoters
Key driver analysis is a statistical technique used to identify the factors that most influence a specific outcome or result. Recently, we applied this technique to a private hospital group's extensive dataset and uncovered the key drivers of overall patient experience ratings across three critical domains:
For general care and treatment, the key driver was ‘being treated with dignity and respect’.
For communication, the key driver was ‘enough time with staff’.
For experience with consultants, the key driver was being ‘easy to understand.’
When these elements are executed well, patients are far more likely to report excellent experiences. Alternatively, when they fall short, their overall experience can suffer.
An additional analysis was conducted to understand the key differences between Passive and Promoter experiences. They wanted to know, ‘what are the key ingredients of an excellent patient experience where patients are likely to recommend our services?’
Here’s what we discovered…
1. Bring attention to detail into every patient interaction
Promoter feedback highlighted the critical role of personalised care in creating an excellent patient experience. Patients are more likely to recommend a facility when they feel special.
For instance, one highly satisfied patient felt as if they were "the only one in the room" because staff went the extra mile by tailoring care specifically to them, paying attention to small details from conversations, and demonstrating they were listening.
In contrast, a passive patient mentioned a sore throat to a nurse and received dry toast shortly after, which diminished their experience. These small details collectively contribute to a high-quality patient experience.
2. Streamlined administrative processes
A significantly higher proportion of Detractor and Passive patients reported errors or miscommunications during their experience compared to Promoters. They also frequently mentioned their dislike of waiting. To improve patient satisfaction, successful Promoter experiences can guide the prevention of administrative roadblocks.
Key strategies include:
Ensuring excellent team communication when transferring patient information and updates.
Booking follow-up appointments before patients are discharged.
Being well-prepared and ensuring appointment times are accurate.
Keeping patients informed about timelines during discharge, especially for those needing to be picked up.
3. Ensure patients feel they’ve had enough time with relevant staff
A consistently common theme in open-ended comments, especially from Detractors, is the need for adequate time with staff and great communication. Addressing this not only prevents dissatisfaction but also makes patients feel catered to and well looked after.
Positive feedback from promoters often highlights staff who:
Go beyond by providing extra information.
Provide information in a format that can be referred to later.
Check in with patients frequently.
Make patients feel unique
Looking at this evidence, and data across our clients globally, it is clear that the quality of human interactions between patients and staff is at the heart of excellent patient experience.
This, too, was found by NRC Health, which found that the number 1 Key Driver of NPS was the extent to which patients felt that everyone treated them as unique. So much so that they found the odds of being a Promoter were 12 times higher when patients reported that everyone treated them as unique.
What does ‘treated as unique’ mean in the context of healthcare?
Participants in a series of focus groups conducted by the NRC Health Human Understanding Institute discussed behavioural signs of what being treated as unique means in the real world—and their views could be summarised as Connect with me, Listen to me, and Partner with me.
1. Connect with me
Building a personal connection helps patients feel valued as individuals. Research by Dr. Gregory Makoul shows that even a brief, 29-second conversation about personal topics like work or family can significantly enhance how well patients feel their provider knows them. This connection should extend beyond initial encounters to foster long-term rapport.
2. Listen to me
Listening goes beyond just hearing. It involves:
Orienting oneself toward the patient
Making eye contact
Leaning forward
Responding to what is said without interrupting
These are all indicators of active listening. Focusing on the patient and any companions in the room ensures that they feel heard and valued.
3. Partner with me
Some ways to demonstrate partnership:
Checking understanding
Engaging in shared decision-making
Following up after an encounter.
Encourage questions during the conversation.
4. Empathise with me
Empathy is a continuous thread that runs through connection, listening, and partnership. While it may seem unrealistic to expect providers to consistently convey empathy, Dr. Gregory Makoul and Dr. Carma Bylund offer a practical approach.
They found that patients primarily seek three things when it comes to empathy...
Acknowledgment: Recognising that the patient has expressed an emotion, progress, or challenge.
Openness: Demonstrating openness to hearing more about the patient's experience.
Confirmation: Validating that it is legitimate for the patient to have feelings about their situation.
Simple exercises that practice acknowledgement, openness, and confirmation with patients help to make them feel unique, elevating their experience.
Summary
Improving NPS in healthcare is challenging due to the complex work environment and the difficulty of implementing changes. Cemplicity believes that focusing on simple, proven tactics that can be integrated into daily routines, one at a time, is the most effective approach.
There is worldwide consistency in the things that are important to patients. When planning your improvement priorities, try to understand the differences between your Promotors, Passives and Detractors and then tailor your improvement efforts to the specific needs of your target patients.
There are a range of things you might choose to work on:
Helping patients feel safe.
Providing timely treatment.
Encouraging staff to be caring and attentive; ensuring that they have adequate time to provide extra information and written information and to check in regularly with patients.
Working with staff to improve empathy.
Understanding what being treated with dignity and respect means to people, and ensuring staff understand how important this is.
Tackling administrative hiccups and miscommunications across the care journey, from pre-admission to discharge.
Overall, patients want to feel they are treated as unique and not just another number.
Feeling overwhelmed? Start small. Focus on one or two key areas where you can make the biggest impact. Patients value the visible effort staff put into addressing their concerns, even if every issue isn’t resolved immediately. By making genuine strides in just a few areas, you’ll begin to see meaningful improvements in patient experience right away.
References
1. Adams, C., Walpola, R., & Iqbal, M. P., et al. (2024). The three pillars of patient experience: Identifying key drivers of patient experience to improve quality in healthcare. Journal of Public Health (Berlin). https://doi.org/10.1007/s10389-023-02158-y
2. Beckers Hospital Review. (2022). NRC Health uncovers Human Understanding as the #1 driver of NPS. Beckers Hospital Review. https://www.beckershospitalreview.com/strategy/nrc-health-uncovers-human-understanding-as-the-1-driver-of-nps.html