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Melissa Anderson, PT

Many of us spend hours looking for ways to improve the quality of care we provide.  We know the best way to determine client satisfaction is to ask our clients what they think of our service- but how do we ensure we are getting the right information from the right questions?

The answer is easy- ask the Ultimate Question.  This question is simple, yet provides valuable, sometimes profound, advice in how to give clients what they truly want.  This question was designed and tested by customer service experts, and gives a “score”- because, as physiotherapists and physiotherapist assistants- we all know that you can’t improve what you can’t measure.

There are a couple of reasons why this question is so useful.  The first is the way it is worded.  Instead of just asking what you think about a service, the question actually asks you to put your integrity on the line.  The second reason it is useful is because it asks the respondents to come up with the answers for your customer service dilemmas.


So, what is the Ultimate Question?


How likely would you be to recommend this clinic to a friend or family member?

0              1              2              3              4              5              6              7              8              9              10

Why did you choose this response? ______________________________________


It is that simple.  By asking how likely you are to recommend this clinic to a friend or family member, we are asking each person to judge the value of the service they have received.  If they perceive good value and good service, they would not have any difficulty with recommending this to their family.  However, if they have received poor service, they cannot, in good conscience, recommend this to others.  Then by following up with “why”, you are providing the opportunity for specific feedback.

Often, companies go one step further, and ask an additional question- “What would we have to do to change your answer to ‘10’?”  This question really gets to the heart of the matter, and gives you the inside scoop.  This takes the guess work out of quality improvement because it gives you the secret recipe to having loyal and engaged clients, which are much more valuable than clients who are satisfied with a ‘commodity’ they have purchased.


How do we get a measure from these responses?

As physiotherapists, we love to collect, measure and analyze outcomes, so the NPS is a perfect fit.  It is a simple way to get a numerical rating for your customer satisfaction- that you can compare year over year.  Here is how it works…

In any business, there are three types of clients:

  • Those who love your service and tell a few others
  • Those who are satisfied, and tell no-one
  • Those who are dissatisfied, and tell everyone they meet

The NPS uses these three categories of clients to provide a score.  Those who give you a score of 9 or 10 are called Promotors.  Those giving you are score of 6 or less are Detractors.  Those giving you a score of 7-8 are neutral.  To calculate your clinic’s NPS, you simply subtract the percentage of detractors from the percentage of promotors.

Figure 1 How to Calculate the Net Promoter Score: The Easy Way to Create Customer Loyalty


What does your score tell you?

Your NPS score can range from -100 to +100.  Of course, the higher the positive number you get the better.  Many Fortune 500 companies have NPS scores in the negative numbers, but work tirelessly to try and improve them.  A quick rule of thumb is that a positive NPS is good, and a score of +50  is excellent.

The actual score is important, because it lets you make year over year comparisons, or compare the scores of all of your clinic locations.

Even more important than the number, however, is the other information provided by the NPS.  What exactly is preventing clients from recommending your clinic to someone else?  Or what do you do that gets people raving about your business.  Leaving room for clients to write what they like or don’t like can allow you to focus on the things that matter to your clients.

Asking the follow-up question- “what could we do to make your answer a 10?” allows your clients to think outside the box, and come up with some solutions that you may never have thought of.  Things that you may never dream of may be really important to your clients, and may be surprisingly easy to do.

A couple of examples come to mind.  One is something most of us have in our kitchens today.  General Electric was conducting a focus group on one of their new electric ovens, and asked a simple question; “What could we do to make this better?”  One of the group members replied- “you could make it clean itself.”  The other participants agreed that making a ‘self-cleaning’ oven would be a great idea.  This was never anything GE had considered, but, if that’s what their customers wanted, they would give it a try.  In 1963, the first self-cleaning oven was introduced on the market.

A more recent example involved Enterprise car rental.  They used the NPS to measure their customer satisfaction.  When customers replied that the worst part about renting a car was finding a way to pick it up and drop it off, company executives had an idea.  What if someone from the Enterprise office was able to pick up their clients, bring them to the office, complete the paperwork, and send the client on their way?  They implemented the “We’ll pick you up” campaign, and suddenly their business took off.  They suddenly were making huge gains in what was, and still is, a zero-growth industry.


How else can we use the NPS?

Improving client satisfaction and quality of care is very important in your clinic, but there other areas where the NPS can be useful in physiotherapy.  Closely related is staff satisfaction.  By changing the question slightly, you can ask staff “how likely would you be to recommend this workplace to a fellow professional?” and the follow-up “why or why not?”  Again, this can provide valuable feedback for you, and can help to make your staff happier and more engaged.  And happy staff generally lead to happy patients.

If your physiotherapy clinic is part of a large, multi-disciplinary setting (this works well in a public setting) you can ask the other team members the Ultimate Question- would they recommend your services to a patient?

If you are hosting an education event you can use the Ultimate Question to determine satisfaction with the course, which gives you valuable information for planning other events.  If you have staff going to other courses, ask them the Ultimate Question when they return.  This will give you an idea if you want to send other staff on the same course.

Collective wisdom tells us that when people are truly thrilled with their service, they will recommend it to between 2-10 of their friends and relatives.  Those who are merely satisfied with your service will tell no one, although there was absolutely nothing wrong with the service they received.  However, those dissatisfied will tell everyone they know. In this era of social media- a few negative clients could severely harm the reputation of your clinic.  If you do have a customer who is not satisfied, make sure you are asking them why they were unsatisfied, and what you could use to make things better.  You will definitely be glad you did.

By using a tool like NPS, you will have the opportunity to find out what you are doing well, and what can be improved.  By addressing the answers, you can turn your passives and detractors into promoters, improving satisfaction and quality along the way.


Written by: Melissa Anderson, PT


Great article Melissa!

Your messaging is supported and endorsed by the Private Practice Division (PPD). You have identified a tool that measures patient/client "loyalty," a key component of the Patient Experience, which is vital for a successful  health business. Case studies have demonstrated high NPS scores are correlated with higher client outcomes and revenues. A key focus of PPD is to help clinic owners and therapists integrate the NPS into their clinic workflow (operations) and at knowing what time periods to administer and re-administer the tool for maximial effectiveness.

We believe that ... Patient Loyalty + Patient Engagement = Health Business Success.

Thank you for highlighting the importance of this tool to our membership.


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