The Net Promoter System and Healthcare Marketing

August 8, 2019
net promoter system

As a healthcare provider, you want to give the best care and service to your patients. Your goal is not just to attain an excellent health outcome to address their health concerns, but also achieve great patient satisfaction, which shows in patient reviews. And these reviews lead us to discuss healthcare marketing and The Net Promoter System.

You build trust and rapport, perform a thorough history and targeted physical examination, order relevant diagnostic work, and come up with a diagnosis and plan for the best health outcome. This is the heart and core of your mission that marks your excellence.

But you won’t always have raving reviews. And one dissatisfied patient can pull your score down.

The problem with patient satisfaction scores is that they rely too much on emotion. A patient who answers a survey right after the visit can give a different score if he answers it after a week or month. Even how you write the questions and what kind of questions you ask can affect the replies and may prove useless in the end. And with a very long survey, the respondents tend to dwindle, giving you limited information.

To get more meaningful data, Fred Reichheld, with the help of the Bain Team and Satmetrix, developed a tool that can predict how customers would behave based on their satisfaction level.


What is The Net Promoter Score?

Reichheld would describe The Net Promoter Score as that one number that could predict business growth and customer loyalty. In an article he wrote for Harvard Business Review in 2003, “The One Number You Need to Grow,” he revealed how Enterprise Rent-A-Car inspired this scoring system.

During a forum, Andy Taylor, then CEO of Enterprise, showcased his company’s simple survey consisting of only two questions to measure customer loyalty:

  • How do the customers rate the quality of their rental experience?
  • How likely are they to rent a car again?

The short survey had these advantages:

  • It yielded a high response rate.
  • The results were predictive of profits and growth.
  • It identified the key driver of growth, ie, the enthusiastic customers.

Reichheld decided to come up with only one question to measure customer loyalty that predicts growth, and make it even simpler. But that one question did not come as fast and simple. It took him two years of research.

Why did it take so long to research the idea of customer ratings?

He realized that:

  • customer loyalty was more than retention rate. Some stick it out just because! Retention rate doesn’t translate to growth.
  • customer loyalty could not be measured by customer satisfaction alone. Take Kmart for instance, he cites. Despite its great rating, it went bankrupt.
  • and survey tools could be rigged. Plugging in questions that suggest the answers and veer the customers to reply positively could give a falsely high rating.


How did he come up with that one question?

With the help of Satmetrix, a software company that dealt with real-time data analytics, and the Bain team, who helped him design the Loyalty Acid Test comprising of 20 questions, that one question emerged by studying the behavior of more than 4,000 responders and linking their survey responses with actual referral and repeat purchase of the product. This question provided the best statistical correlation between emotion and action.


What is that one question?

“How likely is it that you would recommend our company/product/service to a friend or colleague?”

This one question assesses customer loyalty that can predict business growth.

But asking this question is not enough. For the data to become useful, they created the following scale:

  • 10 – extremely likely to recommend
  • 5 – neutral
  • 0 – not at all likely

To his surprise, the customer referral and repurchase behaviors clustered into three, which he labeled as follows:

  • Promoters – those who gave a rating of 9 or 10; these loyal people promoted the business to their families and friends and brought in 80% of the referrals.
  • Passively satisfied – those who gave a rating of 7 or 8; these people are easily wooed away by the competitors.
  • Detractors – those who gave a rating of 0 to 6; these people badmouthed the business 80% of the time and brought down the morale of the employees as well as the reputation of the company.

Afterwards, Reichheld and the team compared the percentage of promoters and detractors and came up with The Net Promoter Score.

% Promoters – % Detractors = Net Promoter Score

With further research and increasing his sample size, Reichheld and the team found a strong positive correlation between the net promoters and the company’s growth rate in terms of revenue. That one question generated a useful predictive value that businesses could use.

Therefore, a company’s goal is to have a positive net score, ie, more promoters than detractors.


Is this question applicable to all industries?

Reichheld noted that there were some exemptions, such as:

  • When the customers are mere end-users with no choice about the use of the service or product. For example, the use of a specific database software offered by companies to their employees. In this situation, asking the question is irrelevant.
  • When one player dominates the industry.
  • When the company operates in a particular niche.

In the above cases, it’s better to ask the customers these two other questions:

  • “How strongly do you agree that company/product/service sets the standard for excellence in its industry?”
  • “How strongly do you agree that company/product/service deserves your loyalty?”


But is asking that one question enough? How will the organization improve without knowing the reasons for the low rating? This is where The Net Promoter System comes in.


The Value of the Net Promoter System in Healthcare Marketing

The Net Promoter System entails digging into the root cause of the low rating and asking the detractors more questions with one goal in mind: to address their issues and improve the system.

In recent years, many players in the health care industry have used The Net Promoter Score to improve quality of care. To assess patient satisfaction, they only needed to ask that one question.

There are many ways to use the data:

  • Use process and performance improvement approaches and tools such as Root Cause Analysis, Pareto Chart, Fishbone Diagram, and the like to address the detractors’ issues
  • Highlight and promote the promoters’ reasons for their enthusiasm and use in marketing strategies (testimonies on your website landing page for example)
  • Analyze how to convert the passively satisfied to a promoter through the Plan-Do-Study-Act method

Using the Net Promoter System is a useful but largely untapped tool. And as a tool, healthcare marketing can use it in the strategy to achieve high healthcare quality and drive growth.

Based on the research conducted by Accenture Consulting, healthcare providers have lower NPScores (9%) compared to the other industries like hotel & lodging, banking, retail, consumer electronics, wireless services, and insurance. And this is despite the fact that 44% of patients choose their providers based on personal recommendations. The Net Promoter System, when used intuitively, can close the gap.


How about your practice? Do you know your Net Promoter Score? Follow our blogs to learn more on how to translate Net Promoter System principles to drive growth into your practice. If you’re not sure where to start, contact us here for a free practice strategy session.

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Reichheld F. The One Number You Need to Grow. Harvard Business Review. Dec 2003. Accessed 6 Aug 2019.

Measuring Your Net Promoter Score. Bain & Company Net Promoter System. 2019. Accessed 6 Aug 2019.

Patient Engagement: Think your patients are loyal? Think again. Accenture Consulting. 2016. Accessed 6 Aug 2019.

Pelletier LR, Beaudin CL, eds. HQ Solutions: Resource for the Healthcare Quality Professional. 4th ed. Philadelphia, PA. National Association for Healthcare Quality; 2018.

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