Concept Architecture
Concept
Theoretically, Net Promoter Score (NPS) is a customer and patient experience metric that measures the likelihood that individuals will recommend a healthcare organisation, service or intervention to others. It is based on the premise that willingness to recommend reflects overall satisfaction, loyalty and perceived quality. The concept was developed as a management performance indicator and is widely applied in healthcare to monitor patient experience and organisational performance.
Mathematically, Net Promoter Score is calculated by classifying respondents into three categories according to their response on an eleven-point recommendation scale (0?10): Promoters (9?10), Passives (7?8) and Detractors (0?6). The score is obtained by subtracting the percentage of Detractors from the percentage of Promoters. The resulting value ranges from ?100 to +100.
In practice, NPS is measured using patient surveys administered following healthcare encounters, episodes of care or service interactions. Responses are aggregated at the provider, department or organisational level and tracked over time to evaluate patient experience initiatives, benchmark performance and support healthcare quality improvement.
Purpose
Used to measure patient loyalty and experience, evaluate healthcare service quality, benchmark organisational performance, monitor quality improvement initiatives and assess changes in patient satisfaction over time.
Mathematical Formulae
Primary Formula
NPS = % Promoters ? % Detractors
Supporting Formulae
% Promoters = (Number of Promoters � Total Respondents) ? 100
% Detractors = (Number of Detractors � Total Respondents) ? 100
Related Mathematical Methods
- Descriptive statistics
- Proportion estimation
- Percentage calculation
- Benchmarking analysis
- Trend analysis
Example
A hospital surveys 500 discharged patients regarding their likelihood of recommending the organisation.
- Promoters (scores 9?10): 320
- Passives (scores 7?8): 110
- Detractors (scores 0?6): 70
% Promoters = (320 � 500) ? 100 = 64%
% Detractors = (70 � 500) ? 100 = 14%
NPS = 64 ? 14 = 50
The hospital therefore reports a Net Promoter Score of 50.
Excel Implementation
| Function | Example Formula | Health Economics Application |
|---|---|---|
| COUNTIF | =COUNTIF(A2:A501,">=9") | Count Promoters. |
| COUNTIF | =COUNTIF(A2:A501,"<=6") | Count Detractors. |
| COUNTA | =COUNTA(A2:A501) | Count total survey responses. |
| Formula | =((COUNTIF(A2:A501,">=9")/COUNTA(A2:A501))*100)-((COUNTIF(A2:A501,"<=6")/COUNTA(A2:A501))*100) | Calculate the Net Promoter Score. |
| AVERAGE | =AVERAGE(B2:B13) | Monitor average monthly NPS. |
VBA (Optional)
Automate calculation of Net Promoter Scores across departments, reporting periods and patient groups while generating patient experience dashboards.
Sources
- Reichheld FF. The One Number You Need to Grow. Harvard Business Review. 2003.
- Reichheld FF, Markey R. The Ultimate Question 2.0. Harvard Business Review Press.
- Agency for Healthcare Research and Quality. CAHPS Improvement Guide.
- OECD. Health Care Quality Indicators Project.
- Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes.
Related Concepts (2)
Library
Publications
1
Health at a Glance 2023: OECD Indicators — Organisation for Economic Co-operation and Development, 2023 Edition ed., 2023 (OECD Publishing)
OECD’s comprehensive biennial compendium of comparative indicators on population health and health-system performance across member and partner countries — health status, risk factors, access, quality, resources and spending — the standard cross-country benchmarking reference.
Frequently Asked Questions (6)
What is the Net Promoter Score?
A customer loyalty metric based on likelihood to recommend, adapted in healthcare to measure patient satisfaction and provider recommendation likelihood.
Source: Reichheld 2003
What is the Net Promoter Score based on?
The Net Promoter Score is based on likelihood to recommend, so as a customer loyalty metric it uses how likely people are to recommend a provider, adapted in healthcare to measure patient satisfaction and provider recommendation likelihood. This basis in recommendation defines it. So the Net Promoter Score is a customer loyalty metric based on likelihood to recommend, adapted in healthcare to measure patient satisfaction and provider recommendation likelihood.
Source: Reichheld 2003
How is the Net Promoter Score adapted in healthcare?
The Net Promoter Score is adapted in healthcare to measure patient satisfaction and provider recommendation likelihood, so the loyalty metric is applied to patients, gauging how satisfied they are and how likely they are to recommend a provider. This healthcare adaptation defines its use here. So the Net Promoter Score is adapted in healthcare to measure patient satisfaction and provider recommendation likelihood, a customer loyalty metric based on likelihood to recommend.
Source: Reichheld 2003
What kind of metric is the Net Promoter Score?
The Net Promoter Score is a customer loyalty metric, so it gauges loyalty through likelihood to recommend, and in healthcare it is used to measure patient satisfaction and provider recommendation likelihood. This status as a loyalty metric defines it. So the Net Promoter Score is a customer loyalty metric based on likelihood to recommend, adapted in healthcare to measure patient satisfaction and provider recommendation likelihood This measurement of satisfaction and recommendation is what the metric is used for in the healthcare setting.
Source: Reichheld 2003
What does the Net Promoter Score measure in healthcare?
In healthcare, the Net Promoter Score measures patient satisfaction and provider recommendation likelihood, so it captures how satisfied patients are and how likely they would be to recommend the provider. This measurement in the healthcare setting defines its application. So in healthcare the Net Promoter Score measures patient satisfaction and provider recommendation likelihood, a customer loyalty metric based on likelihood to recommend This grounding in likelihood to recommend is what makes the score a loyalty-based view of patient satisfaction.
Source: Reichheld 2003
How does the Net Promoter Score relate to patient satisfaction?
The Net Promoter Score relates to patient satisfaction as one way of gauging it: patient satisfaction is how content patients are with their care, and the Net Promoter Score, adapted in healthcare, measures patient satisfaction and provider recommendation likelihood through likelihood to recommend. So the Net Promoter Score is a metric for patient satisfaction, connected as a loyalty-based way of capturing how patients regard their provider.
Source: Reichheld 2003
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British health economist
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Verification date: 26 Feb 2026
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