Is NPS Legitimate?

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Net Promoter Scores only scratch the surface of understanding whether your patients are your practice’s promoters, passives, or detractors

By Brian Gallagher, PT


That’s the question we ask in marketing as we consider the validity of the Net Promoter Score (NPS). This customer satisfaction method’s efficacy has been debated in business for years and, as is often the case, there’s more to the story than meets the eye. So, let’s break it down.


The NPS is a popular customer loyalty and satisfaction measurement tool that is calculated by asking your customers one simple question: “On a scale from 0 to 10, how likely are you to recommend our company, products or services to a friend or colleague?”


Data collected from this one simple question can help physical therapy private practice owners improve their products, services, support, delivery, and much more.

People who score 9 or above are considered to be “promoters”

7 and 8 are considered “passives”

6 or below are considered “detractors”

The goal is to sift through the loyal advocates of your brand, those who are indifferent to you, and those who are so unhappy that they need immediate attention lest they begin to loudly criticize you and/or your services.

It comes together in a formula like this:

  • NPS Formula = (# of Promoters Scores/Total Number of Respondents) – (# of Detractors Scores/Total Number of Respondents)
  • NPS Calculation = % Promoters – % Detractors =
  • NPS Score

The NPS is generally considered to be a valuable business metric as it helps companies focus on what many believe to be the most important asset: the development of loyal customers who are enthusiastically willing to spread the word of their company and brand.


As valuable as NPS is on a strategic level, the score alone may not be enough to give you the full picture. Here are some reasons why:

People may be less likely to say something negative when being personally surveyed.

There may be the consideration of anonymity, as in they don’t want their name associated negatively with the brand or group in question, therefore are reluctant to answer honestly. It’s understood in human nature that most people like to avoid confrontation and conflict whenever possible.

Solution: Coach the patient to understand that their honesty is more valuable than their social politeness when being surveyed for NPS.

The person conducting the survey might influence the response.

In physical therapy, the patients often become attached to their caregiver and their true feelings may go unexpressed due to their affinity towards them. Or the therapist may influence their patient with leading suggestions with the intention of getting good scores, which might be pertinent to them maintaining their position in the clinic.

This is not unlike when you buy a new car and the dealership tells you that you will soon be getting a phone call from the manufacturer, so if you could please give them 10s across the board, as anything less will be considered a poor review. This can be manipulative and can cause you to receive a good NPS only out of the customer’s obligation.

Solution: Encourage your physical therapy staff and therapists to not pressure or influence their patients when discussing the survey. Have them keep it neutral, yet appreciative.

Your survey timing may be off, giving you a false perception.

A good example of this may be during the holidays, where people are generally busy and distracted. Or perhaps it’s delivered right at the end of their session when they’re trying to get out of the office and off to another appointment.

Solution: Be conscious of when you ask for people’s time and attention. The NPS method is a reminder that there is a time and place for everything.

It lacks the specificity to tell you what area of your practice you need to address in order to turn things around.

Say you receive a “6” as the NPS from a patient. This is on the border of passive and detractor territory, but what exactly does it tell you? That the service was so “OK” that it was almost bad? What do you do with this information? Without knowing if it was the front desk coordinator, the therapists, the techs, or the color of the walls, you don’t know how to improve from this feedback.

Solution: A good NPS survey must ask follow-up questions to understand why, for example: “In what area of business do you feel we could improve?”


Getting the NPS is only half the story in terms of customer satisfaction. It may be more important to invest your time, energy and effort towards measuring actual patient/customer behavior instead, or in addition (depending on your budget, etc.).

Nonetheless, hearing your patients’ words and feedback directly from them is no doubt valuable.. When doing this, it’s important to discover the when, how or why behind the feedback. The power of surveying lies in the direction it leads you in terms of what needs to be done to improve your patient experience.

Based on my experience in rehabilitation and business management consulting, here are my recommendations for conducting surveys in your physical therapy office to obtain the most helpful and accurate NPS:

Have your patient care representative do the survey with the patient and have them ensure the patient that their honest opinion matters most, whether good or bad.

Schedule it to be done halfway into the patient’s care and at discharge, but never at the last minute of their session. Once gathered, follow up with three separate questions to shed more light on the reasoning behind their score.

Prepare for success ahead of time by making sure that every patient gets a tour of the facility, meets all the staff, and is explained their responsibilities in the practice so they feel like they are a part of the family and of their plan of care.


The short answer: Yes.

We want to be able to measure and record this voluntary feedback, but bear in mind that this may only scratch the surface of understanding if your patients are truly your physical therapy practice’s promoters, passives, or detractors.

Within the profession of physical therapy, we are highly reliant on our referral sources. The bottom line: to grow your private practice, you need satisfied customers or “promoters” who talk about you enthusiastically and send referrals your way.

If a friend highly recommends a restaurant to you, you’re more likely to start there than at ground zero with a basic Google search, right?


It’s all about our patients, our community, and our staff.

This is likely why you and I went to physical therapy school in the first place: to help others. Humans are often more complex and difficult to coldly lump into categories of a “promoter” versus a “detractor,” but good business is founded upon trust between people.

Recording and reacting to your NPS gives you a clear gauge of this trust between you and your valued patients. At the end of the day, measure your promoters by checking how many people scored you at a 9 and 10 in an NPS survey, then make sure to gather specifics and put protocols in place to handle situations where you rank any lower than that.

By going beyond the NPS question, you can easily transform a survey participant into a brand advocate. 

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Brian Gallagher

Brian Gallagher, PT, is a PPS member and President and Founder of MEG Business Management. He can be reached at and found on Twitter @MEGbusiness, FaceBook @MEGBusinessManagement, LinkedIn @MEG Business Management, and Instagram @megbusinessmgmt.

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