Healthcare NPS: Using a Relational or Transactional Net Promoter Score

Ashley Worral
By Nikki Angeli MHA, BSN, RN, CPHQ
Patient Experience Strategist
August 7th

In healthcare, should you measure a relational or transactional Net Promoter Score?

The Net Promoter Score (NPS) is one of the most widely used metrics to keep up with consumer experience and better anticipate business growth.  In the healthcare sector, NPS has gained importance as it provides valuable insights into patient experiences, patient loyalty, and the perception of the quality of care provided.

Relational NPS vs Transactional NPS

Relational NPS

Relational NPS surveys are traditionally sent annually, semi-annually, or quarterly to assess changes in customer loyalty by measuring the overall perception of a brand.  Due to the nature of these surveys being sent on a routine basis and the average person having infrequent interaction with healthcare providers, it can be difficult to measure true overall experience.(1)

Transactional NPS

Transactional NPS surveys are sent out shortly after a patient has had an interaction with a healthcare provider.  This ensures that patient experiences are captured and acted upon promptly, achieving better service recovery. In addition, response rates are higher the closer the survey is sent to the interaction.  Regardless of the reason for the visit or discharge, studies have shown satisfaction rate decreases as the post-discharge period increases.(1)   This emphasizes the importance of ongoing engagement and follow-up with patients to improve satisfaction or maintain positive relationships with patients.  Our data has shown a 14% improvement in response rate when sending surveys out within a day of visit compared to surveys sent on a monthly basis.

It has been shown that patients tend to express higher satisfaction when they are specifically reporting on their individual visits, as opposed to giving generalized opinions about the care they receive from a healthcare organization.(2)

NPS as a Stand-Alone Metric

While NPS is a valuable metric for understanding patient loyalty and satisfaction, it may not be sufficient as a stand-alone measure. The statistics suggest that NPS should be used in conjunction with a larger survey to gain a more comprehensive understanding of patient experiences.  By combining NPS with other metrics related to patient safety and the quality of care, healthcare organizations can obtain a holistic view of the overall patient experience.(3)


Both transactional and relational NPS play a crucial role in measuring patient loyalty and satisfaction in the healthcare sector. Standardizing the timing of NPS surveys, addressing the decline in satisfaction as the post-discharge period increases, and considering the specific needs of different demographic groups are all essential aspects of utilizing NPS effectively.


1. Bjertnaes OA. The association between survey timing and patient-reported experiences with hospitals: results of a national postal survey. BMC Med Res Methodol. 2012 Feb 15;12:13. doi: 10.1186/1471-2288-12-13. PMID: 22335801; PMCID: PMC3298703.

2. Patient-reported indicators for assessing health system performance. (2019). Measuring What Matters: The Patient-Reported Indicator Surveys. Organization for Economic Co-operation and Development.

3. Adams, C, Walpola, R, Schembri, AM, Harrison, R. The ultimate question? Evaluating the use of Net Promoter Score in healthcare: a systematic review. Health Expect. 2022; 25: 2328- 2339. doi:10.1111/hex.13577