In short
- NPS shows direction: how likely patients are to recommend you.
- It doesn't show what to improve - and happy patients rarely leave suggestions in surveys.
- Interviews run by a third party bring out what patients won't say directly to the team treating them.
Net Promoter Score (NPS) is probably the most widely used patient experience metric. Patients answer a single question - “How likely are you to recommend us to a friend?”, on a scale from 0 to 10 - and the score is the percentage of promoters (9–10) minus the percentage of detractors (0–6).
It's simple, comparable over time and easy to share with the team. And yet it has one important limitation.
When the numbers look excellent
In a premium dental clinic we work with, NPS after the first interaction rose over four rounds: 71, 74, 91, 100. In the final round, every patient in the sample was a promoter: zero passives, zero detractors, zero critical suggestions. One patient wrote: “Everything is by the book - so I have no suggestions!”
Had we stopped there, we'd have concluded there was nothing left to improve.
What the same patients said in interviews
When we changed the question from “How satisfied are you?” to “What would make you feel better next time?”, the answers were different. Around 70% of the patients interviewed wished they had been listened to more carefully before the medical recommendation.
They weren't questioning the doctors' expertise. They wanted the decision to be made together. That's something no score could have told us.
“How satisfied are you?” gets you a score. “What would make you feel better?” gets you a story.
Why patients tell a third party more
Protecting the relationship. In a medical setting, patients may have reasons to protect their relationship with the doctor. They may say everything was fine, even when there are things they wouldn't say to your face.
Distance. External research creates enough distance for feedback to become more honest and more useful - with nothing at stake in the conversation.
The question. Surveys measure what you've already decided to measure. Interviews uncover what you didn't know you needed to ask.
How to use NPS and interviews together
- Measure in rounds, not just once: the trend tells you more than a snapshot.
- Report the number of respondents next to every score. An NPS based on 14 responses reads very differently from one based on 400.
- Add a handful of interviews to every quantitative round - you don't need many for them to be revealing.
- Turn every insight into a behaviour: if patients want to be listened to, your consultation standard has to start with questions, not solutions.
A note on honesty: a high score isn't the finish line. It's a sign you've built a solid foundation - and the right moment to ask what comes next.
