Measuring Consumer Loyalty: Why the Net Promoter Score Is Not Enough

Added on Sep 24, 2019

By Diana Mahoney

2jennifer-burk-ECXB0YAZ_zU-unsplashMeasuring Consumer Loyalty: Why the Net Promoter Score Is Not Enough
By Diana Mahoney 

Sometimes, hope overpowers reason. That seems to be the case with the fast and broad acceptance of the Net Promoter Score℠ (NPS®), an increasingly ubiquitous tool for measuring consumer loyalty across industries, including health care.  

The “hope” that draws leaders and others to the NPS is that adoption of this simple metric, which is derived from a single question (“How likely is it that you would recommend our company/product/service to a friend or colleague?”), will change the growth trajectory of their businesses.

However, like most attempts to address a complex issue using a “quick and easy” approach, the NPS doesn’t live up to its billing. While it may be useful as a simple tool to get people interested and engaged in the data, the science behind it is lacking and the tool can easily be gamed for advantage, according to a recent article in the Wall Street Journal. In addition to being limited in its ability to predict consumer behavior, the NPS has taken on an inflated role in many organizations’ consumer acquisition and brand management strategies.

In reality, understanding what brings consumers through the door and keeps them coming back requires deep, evidence-based data that are collected at regular intervals. It also requires support and processes for deriving actionable insights from the data, using the insights to inform improvement, and monitoring the impact of the improvement efforts over time. With this realization, some organizations are jumping off the NPS bandwagon as quickly as they jumped on.

Dallas-based Tenet Health is one example. “To assess patient loyalty, we used to look at response rates and NPS, but the numbers didn’t tell us much beyond that patients found us convenient,” Dr. Scott Anders, chief medical officer of Tenet Physician Resources (TPR), said in a recent interview. This is not to say that the group doesn’t find value in the question behind the NPS. They do, but the answer is already available to them through their patient experience survey, so they are embracing the HCAHPS “Likelihood to Recommend” question as “an actionable attempt to understand patient loyalty and actually improve on it,” Dr. Anders said.

Earning patient loyalty requires more than measurement, Dr. Anders stressed. “You have to understand what the drivers of ‘Likelihood to Recommend’ are and where your organization is in terms of your peers. ‘Likelihood to Recommend’ is a lagging indicator, so it’s not enough to say, ‘Here’s your top-box score.’ You have to understand the underlying drivers of that score to help your workforce make it better,” he said. To this end, organizational leadership at TPR introduce and discuss the factors that drive “Likelihood to Recommend” so that staff see the metric is about cultural excellence, not a number. “Staff can better understand that strategic objective and why they need to work toward it,” Dr. Anders said.

This formula also provides a road map for physicians who are inspired to drive change efforts. “Understanding what a ranking in the 58th percentile for ‘Likelihood to Recommend’ means is not easy, but understanding the drivers of ‘confidence in provider’ is. It comes down to a few key points: namely, does the doctor talk to me, use language I can understand, include me in decision-making, and keep me informed about what’s going on. These are behaviors we can actually address and improve in our practices to keep patients happy and coming back to us,” Dr. Anders said.

In addition, benchmarking against peers is essential for pinpointing the greatest opportunities for improvement and acting on that information to achieve meaningful results as quickly as possible, Dr. Anders explained. “We break down the physician group into quarters to see where we need to allocate resources and support. For the practices in that bottom 25%, we have a lot of work to do in terms of direct conversations, improvement initiatives, and follow-up. At the other extreme, those in the top decile are where we’re going to find our champions and best practices for others to emulate and learn from,” he said.

When the objective is transformational change, simplicity is the wrong goal, Dr. Anders stressed. What is needed, he said, “is a robust data strategy and organizational commitment to being accountable for the results.”