Serious about improving care? Then use the net promoter score

Ruth Evans, director of the Patient Experience Network, believes 2012 should be the year an evaluation system that meets with the universal approval of the NHS and private health providers is adopted, thereby enabling healthcare teams to better understand and increasingly meet the needs of their patients.

The network would like to see a system such as the net promoter score (NPS) adopted widely. The organisation believes the system is consistent and simple and has the ability to reduce the complexity of implementation and analysis frequently associated with measures of satisfaction.

According to PEN, for many organisations – including many health providers in the US – NPS has provided a stable measure of organisational performance that can be compared across business units and even across industries.

“If the NHS and the private health sector is serious about raising the patient experience bar, then we need something like Net Promoter measuring and evaluating what we are doing on behalf of patients,” says Ms Evans.

It has been argued that such measures have limited use in healthcare. But PEN disagrees.

“It’s time for the healthcare professional to act decisively and for senior managers to adopt a consistent well-tried metric such as net promoter as their preferred measurement and evaluation methodology,” Ms Evans continues.

“I am sure such a move would be greeted with enthusiasm and support from all sectors of society, particularly those people who have need of hospital services.”

The net promoter score is obtained by asking customers the question: “How likely is it that you would recommend our company to a friend or colleague?” Scores are recorded on a 0-10 rating scale, where 10 is “extremely likely” and 0 is “not at all likely”.

Attracting fans

Last month, NPS was adopted by the strategic health authority cluster NHS Midlands and East in an attempt to “make it clear who is delivering excellent patient care, and those who need to improve”.

Ali Parsa, chief executive of Circle, a private healthcare organisation which has taken over responsibility for Hinchingbrook Health Care Trust, supports the call by PEN for the adoption of a robust measurement framework. He comments that “in the absence of comparisons many patients may be nudged to score their experience too highly, providing a justification for hospitals to do little to improve.”

The company asks its patients three simple questions: What did we do well? What could we do better? and would you recommend us to family and friends? It regularly reviews the feedback in its clinical units and hospitality team and follow-up actions are quickly implemented to improve patient experiences. 

Nottinghamshire Healthcare Trust is also considering using NPS. Paul Sanguinazzi, head of involvement, at the trust says: “We are looking at using Net Promoter Score as an additional question to those we use already to measure people’s experience.

“For it to drive change, though, it needs to be adopted at a team level and for people to be asked for comments such as why they would or would not recommend the service. Also, while we see value in a universal measure we have concerns over whether it will be used too crudely to compare very different services and whether it is an appropriate question for some services such as secure mental health services”

Ashford and St Peter’s Hospitals Foundation Trust has adopted NPS within the last year. In the last six months, the trust has seen a significant improvement in its overall NPS, which has been matched by improved numbers of positive comments on sites such as NHS Choices.

Suzanne Rankin, chief nurse at the trust, comments: “The score alone gives a useful indicator of patient loyalty and combined with other key measures provides important intelligence about the quality of patient care, treatment and experience. Nevertheless it is essential to support this data with qualitative feedback from patients in order to understand the underlying issues of poor and/or great experience.”

In future Ashford and St Peter’s plans to collect real-time feedback from patients about why they have given their score. This will enable frontline staff to engage with patients to gain qualitative insight into what they are doing that is driving patient experience.

Ms Evans concludes: “Greater transparency and accountability is an important part of the process that leads to a heightened and better patient experience. And that’s what a measure such as NPS delivers. Isn’t that something we should be embracing with open arms?”