# Unstable net promoter scores

If you work in the NHS you’ll know that the “net promoter score” (aka the friends and family test- “would you recommend this service to family and friends?”) is coming to NHS services, indeed it’s hit the headlines with the coalition government promoting its use in the face of some pretty stiff opposition (e.g. here).

I have never been all that convinced by it, particularly the way the score is calculated by subtracting the percentage of detractors (those who would not recommend or unlikely to) from the percentage of promoters (those who would recommend). We’ve started using it in our survey and I have had a query because one area’s scores are jumping around a lot. I thought it was high time I looked at the actual scores. We don’t use a 10 point scale as many do, we use a 5 point scale, with the points being equal to “Extremely unlikely”, “Unlikely”, “Neither”, “Likely”, and “Very likely”. Net promoter is calculated by taking the proportion of “Very likely”s and subtracting the proportion of the bottom 3 categories summed.

I’ve looked at the methodology in two ways. Firstly, by comparing the net promoter method with just finding the average (allocating 1 to 5 points from “Extremely unlikely” to “Extremely likely”). It’s arguable how appropriate the average is given the negative skew to the responses, but it will have to do as a comparison. It should be noted that I’ve used two y-axes, one blue on the left for the net promoter methodology and pink on the right for the average methodology. One has to be very careful when using two y-axes, it’s easy to mislead the reader by moving the scales up and down, but really we’re just watching the lines go up and down together over time, so we should be safe here.

Here is the results, with each panel representing a different service (anonymised).

Actually, it looks pretty okay to me. You can see the service this query originated with, right at the top left, labelled “V”. The promoter scores jump about quite a bit more, but the inverse “V” shape is evident also in the average

Secondly, I’ve compared the question itself by comparing with our overall “How do you rate the service quality” question using the net promoter methodology. Here are the results of that.

Again, the results look okay, but you can see again poor service “V” whose family and friends test promoter scores (blue) are jumping around but, interestingly, even with the promoter methodology their Service quality scores are pretty static.

A lot of the objections to the friends and family test (e.g. here) are based on preliminary psychometric investigations rather than “live” data, so this is an interesting addition to the overall debate.

So, if anything, it’s the question that appears to be problematic, I must admit I did think it would be the other way around. I’ll follow up this analysis when we have more data.

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