Assessing treatment outcomes using a single question: the net promoter score.

Satisfaction with care is important to both patients and to those who pay for it. The Net Promoter Score (NPS), widely used in the service industries, has been introduced into the NHS as the 'friends and family test'; an overarching measure of patient satisfaction. It assesses the likelihood of the patient recommending the healthcare received to another, and is seen as a discriminator of healthcare performance. We prospectively assessed 6186 individuals undergoing primary lower limb joint replacement at a single university hospital to determine the Net Promoter Score for joint replacements and to evaluate which factors contributed to the response. Achieving pain relief (odds ratio (OR) 2.13, confidence interval (CI) 1.83 to 2.49), the meeting of pre-operative expectation (OR 2.57, CI 2.24 to 2.97), and the hospital experience (OR 2.33, CI 2.03 to 2.68) are the domains that explain whether a patient would recommend joint replacement services. These three factors, combined with the type of surgery undertaken (OR 2.31, CI 1.68 to 3.17), drove a predictive model that was able to explain 95% of the variation in the patient's recommendation response. Though intuitively similar, this 'recommendation' metric was found to be materially different to satisfaction responses. The difference between THR (NPS 71) and TKR (NPS 49) suggests that no overarching score for a department should be used without an adjustment for case mix. However, the Net Promoter Score does measure a further important dimension to our existing metrics: the patient experience of healthcare delivery.

[1]  Bruce Cooil,et al.  A Longitudinal Examination of Net Promoter and Firm Revenue Growth , 2007 .

[2]  N. Clement,et al.  Primary total knee replacement in patients with mental disability improves their mental health and knee function: a prospective study. , 2013, The bone & joint journal.

[3]  F. Reichheld The one number you need to grow. , 2003, Harvard business review.

[4]  C. Graham,et al.  Overarching questions for patient surveys: development report for the Care Quality Commission (CQC) , 2012 .

[5]  A. Carr,et al.  Questionnaire on the perceptions of patients about total hip replacement. , 1996, The Journal of bone and joint surgery. British volume.

[6]  A. Simpson,et al.  Is patient reporting of physical function accurate following total knee replacement? , 2012, The Journal of bone and joint surgery. British volume.

[7]  C. Howie,et al.  What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement , 2013, BMJ Open.

[8]  S. Stulberg,et al.  THE JOHN INSALL AWARD: Pain and Depression Influence Outcome 5 Years after Knee Replacement Surgery , 2007, Clinical orthopaedics and related research.

[9]  J. Lewsey,et al.  The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. , 2007, The Journal of bone and joint surgery. British volume.

[10]  C. Terwee,et al.  Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients. , 2006, Journal of clinical epidemiology.

[11]  F. Reichheld,et al.  The microeconomics of customer relationships , 2006 .

[12]  Amy Lynn Sorrel Magic number. , 2013, Texas medicine.

[13]  C. Howie,et al.  What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement , 2013, BMJ Open.

[14]  Debra Dunn,et al.  Microcapitalism and the mega-corporation. , 2003, Harvard business review.

[15]  A. Carr,et al.  Assessing patients for joint replacement: can pre-operative Oxford hip and knee scores be used to predict patient satisfaction following joint replacement surgery and to guide patient selection? , 2011, The Journal of bone and joint surgery. British volume.

[16]  Charles Spinosa,et al.  Using commitments to manage across units , 2005 .

[17]  P. Shekelle,et al.  Correction: Patients' Global Ratings of Their Health Care Are Not Associated with the Technical Quality of Their Care , 2006, Annals of Internal Medicine.

[18]  A. Carr,et al.  Questionnaire on the perceptions of patients about total knee replacement. , 1998, The Journal of bone and joint surgery. British volume.

[19]  Cathal Doyle,et al.  A systematic review of evidence on the links between patient experience and clinical safety and effectiveness , 2013, BMJ Open.

[20]  R. Hammersley,et al.  Patients' own assessments of quality of primary care compared with objective records based measures of technical quality of care: cross sectional study , 2006, BMJ : British Medical Journal.

[21]  G Robin Henderson,et al.  Comparative outcomes of total hip and knee arthroplasty: a prospective cohort study , 2012, Postgraduate Medical Journal.

[22]  R. Coombes,et al.  Ahead of the game , 2008, BMJ : British Medical Journal.

[23]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[24]  D W Murray,et al.  The use of the Oxford hip and knee scores. , 2007, The Journal of bone and joint surgery. British volume.

[25]  José Joaquín Mira,et al.  Predictors of patient satisfaction in surgery. , 2009, Surgery.

[26]  T. Keiningham,et al.  The value of different customer satisfaction and loyalty metrics in predicting customer retention, recommendation, and share‐of‐wallet , 2007 .

[27]  K Kroenke,et al.  Predictors of patient satisfaction. , 2001, Social science & medicine.