NPS in healthcare stands for Net Promoter Score, a single-number metric that measures how likely patients are to recommend a provider, clinic, or hospital to someone they know. It’s calculated from one question, typically phrased as “On a scale of 0 to 10, how likely are you to recommend us to a friend or family member?” The average NPS for healthcare organizations sits around 31 in 2025, with scores above 50 considered exceptional.
How NPS Is Calculated
The math behind NPS is straightforward. After patients answer the 0-to-10 recommendation question, they’re sorted into three groups based on their response:
- Promoters (9 or 10): Loyal patients who would actively recommend you
- Passives (7 or 8): Satisfied but unenthusiastic patients who are essentially neutral
- Detractors (0 to 6): Unhappy patients who could discourage others from choosing your practice
The final score equals the percentage of promoters minus the percentage of detractors. If 60% of your patients are promoters and 20% are detractors, your NPS is +40. Passives aren’t factored into the equation directly, though a large passive group signals room for improvement. The score can range anywhere from -100 (every patient is a detractor) to +100 (every patient is a promoter).
What Counts as a Good Score
For healthcare organizations, an NPS between 30 and 45 is considered good. Top performers reach 50 or higher. That might sound modest compared to consumer brands, but healthcare scores tend to run lower because patients often don’t choose their providers freely, and their experiences are shaped by pain, anxiety, and outcomes they can’t fully control. For context, financial services averages around 37.
Telehealth visits tend to score slightly higher than in-person care. A study of a pediatric neurology clinic found telehealth encounters averaged an NPS response of 9.7 out of 10, compared to 9.5 for in-person visits. The gap is small but consistent, likely reflecting the convenience factor of not traveling to a clinic.
How NPS Differs From HCAHPS
If you work in or around hospitals, you’ve probably encountered HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), the standardized patient experience survey that the Centers for Medicare and Medicaid Services introduced in 2006. HCAHPS is a multi-question survey covering specific domains like nurse communication, pain management, and discharge information. It’s required for hospitals participating in Medicare, and results are publicly reported.
NPS, by contrast, is a single question. It’s voluntary, proprietary in origin (developed by Bain & Company), and not tied to any government program. HCAHPS gives you a detailed picture of where care breaks down. NPS gives you a quick pulse check on overall patient loyalty. Many organizations use both: HCAHPS for the granular, mandated data, and NPS for fast, ongoing tracking between formal survey cycles.
Why Healthcare Organizations Use It
The appeal of NPS is speed and simplicity. One question is far easier to deploy than a 30-item survey, and response rates tend to be higher when you’re asking patients to answer a single thing. For practices, urgent care centers, and outpatient clinics that aren’t required to run HCAHPS, NPS offers a low-barrier way to track patient sentiment over time.
There’s also a financial case for paying attention to patient experience metrics broadly. Research published in the European Journal of Health Economics found that hospitals with better patient experience scores in a given year attracted a higher proportion of elective patients the following year and had lower operating costs. For private hospitals specifically, better experience scores were associated with higher revenue in subsequent years. NPS isn’t the only way to track experience, but it’s one of the most accessible entry points.
The best time to send an NPS survey is within 24 hours of a patient interaction, whether that’s a clinic visit, a telehealth appointment, or a procedure. Waiting longer risks lower response rates and fuzzier recall.
Limitations Worth Knowing
NPS has real shortcomings in healthcare, and a systematic review in the journal Health Expectations laid them out clearly. The core issue is that patient experience is complex and multifaceted, and condensing it into a single number loses important nuance.
The recommendation question itself can confuse patients. In studies of primary care clinics, patients were frequently unsure how to answer because they had little or no choice in selecting their doctor. Recommending a provider implies alternatives exist, and in many healthcare systems, they don’t. This makes the question feel irrelevant, which skews results.
NPS scores also shift based on variables that have nothing to do with care quality. Age, type of condition, cultural background, and even the specific procedure a patient underwent all influence scores. Patients with mental health conditions score differently than those recovering from joint replacement surgery. Comparing NPS across departments or specialties without accounting for these differences can be misleading.
Perhaps the biggest practical limitation: NPS tells you whether patients are happy or unhappy, but not why. Healthcare practitioners have reported that patient NPS responses lack the specific, actionable detail needed to actually improve services. You might learn that 25% of your patients are detractors, but the score alone won’t tell you whether the problem is wait times, communication, billing, or clinical outcomes. The systematic review concluded that NPS has limited ability to support healthcare improvement on its own and works best as a high-level overview that flags areas needing deeper investigation.
How It Compares to Other Patient Experience Measures
When researchers directly compared NPS against other ways of summarizing patient experience data, NPS came up short. A study in Health Expectations found that NPS showed weaker associations with detailed patient experience survey results than either a simple global rating (“How would you rate your care overall?”) or an overall score calculated from multiple survey items. In other words, a straightforward “rate your experience” question actually captured patient sentiment more accurately than the recommendation-based NPS question.
This doesn’t mean NPS is useless, but it does mean organizations relying on it as their sole metric are likely missing important signals. The consistent recommendation from researchers is to use NPS alongside more comprehensive survey tools rather than as a replacement for them. It works best as one data point in a broader patient experience program, not the entire program itself.