Patient Experience Metrics – Ranked




Patient experience is one of the most important factors for any healthcare organization to pursue. An improved patient experience has been tied to improved care, better patient retention, and better outcomes. For your organization, it means reduced exposure to malpractice & faster organizational growth.


This post breaks down the research, the rationale, and the formulas for the top patient experience metrics. What are the strategic key performance indicators (KPIs) your executives should watch? What are the metrics that can tell operations how to improve? The top customer experience companies have focused on this top metrics corporate improvement strategy for some time. Healthcare is just starting to become aware of many of these measures of patients' experience. Get ahead with this easy to read but thorough resource.



Problems facing healthcare providers in an age of
consumerism & telehealth


At the most fundamental level, consumerism in healthcare is the trend for patients to make more of their own healthcare choices, instead of relying on their providers. It denotes a shift in what patients feel is important in their relationship with their providers. A 2015 McKinsey Survey found that consumers hold healthcare companies to the same standards as any other business. Their expectations regarding “great customer service” & “making life easier” were identical across healthcare & non-healthcare companies.


The 3 Kings of Consumerism



Easy reigns

Number2DeepBLue-1Speed reigns



Self-service convenience reigns



Loyalty isn’t what it used to be – patients increasingly go for ease, speed, and convenience. Nearly 1/2 of patients prefer to talk to any doctor who can see them quickly over their usual doctor, valuing rapid response rate and contact resolution., August 20,2020,August 20,2020

A survey that the enrollment system developer Connecture found that 71 percent of consumers would at least consider a plan that required changing providers if it meant saving money. 



Stuck on reaction metrics

 "Measure What You Value" - Robert Greenleaf


Most healthcare organizations measure what they can. This is a trap. As far as telehealth metrics go, reaction metrics are by far the most common. Reaction metrics measure statistics on patients' first outreach. They are very important for understanding the first few minutes of service. The most common ones are:



Average speed of answer

Number2DeepBLue-1Abandonment rate Number3DeepBLue-1Service level
We often find that these are the only metrics watched! Why? Because it is easy! Any telephone platform worth its salt reports on these, and has beautiful dashboards showing the history and probably forecasting the future. This is useful and good. But when it is the only thing watched, it implies that the only thing valued are the first few moments of a patient’s outreach!

So what is missing?
These metrics do not measure the overall service, speed & convenience that a patient experiences over the life of their request. The metrics that you need to forecast, understand & improve the patient experience are holistic measurements that cut across your entire organization. Reaction metrics do have their place. You will find them at #12 on this list, & you can read more about them there.

The Most Important Executive KPI’s


"If You Can Not Measure It, You Can Not Improve It" Lord Kelvin
You can measure how much your service is contributing to your growth by developing a patient experience scorecard. No matter the size of your organization, the most important metrics to measure are listed below. They give you the big-picture measurements that tell you how your service matches up to patient expectations. This, in turn helps you to improve your patient experience, increase your patient retention, and grow your company.

These top metrics are broken into leading metrics & trailing metrics.
icon_benefits_1      Leading KPI’s:
      • Net Promoter Score: “How likely are you to recommend [this organization] to a friend?”
      • Customer Effort Score: “How easy was it to get the help you wanted today?”
      • Overall Service: “How did our service compare to your ‘ideal’ service?”
icon_benefits_2-1      Trailing KPI’s:
      • Revenue Growth Rate
      • Patient Retention vs patient churn 

Leading KPI’s

Generally, leading KPI’s are measured by patient surveys. These surveys have been shown to predict future behavior, which is why they are called leading indicators. You can easily gather this information by linking to a web-based survey or using an immediate survey option at the close of each encounter or visit. It is imperative that the questions asked actually fit with the information you are looking to evaluate. Collecting data directly from patients will allow for you to track trends in service from wait times to staff interactions.




Net Promoter

Grow 2x faster than your peers

People talk. New patients are often referred by satisfied, existing patients who have spread the word. This metric will help you determine if your existing client base is likely to refer others your way. Compare your information against others & watch for trends in the data to alert you to potential issues or shortcomings.




What is it?

The Net Promoter Score (NPS) uses A single question that has been linked to 2x higher yearly growth.

The power of this shortened satisfaction survey was highlighted in the Harvard Business Review’s The One Number You Need to Grow (2003). A simple solution to identifying performance, this metric is centered around customer responses on their encounter with your company.


What do I ask?

Question: "How likely are you to recommend [this practice] to a friend?”

Request answers on a scale of 1 – 10. The process is simple & fast, making it more likely that customers will take a moment to answer.

Follow-up question: “What is the most important reason for this score?”

infographics Net Promoter Score


How do I interpret the results?

Infographic 1-100



The follow-up question provides you actionable insights. It’s not always clear from the first question what you need to change, & the second question fixes that. 




illustrations-facts Customer Effort Customer Satisfaction

Customer Effort

The driver of loyalty

Once again, the Harvard Business Review shook up the service industry with the article “Stop Trying to Delight Your Customers.” This article indicated that ease of service, even if that service is inferior, is what drives behavior. While research shows that this claim went too far, there is no doubt that ease often drives behavior just as much or more.




What is it?

The Customer Effort Score (CES) is also measured by a single question, and Gartner claims it is the single metric most highly correlated to loyalty in a consumer market.



96% of customers with high effort service interaction become disloyal compared to 9% who have low effort experience



What do I ask?

“How easy was it to get the service I received today?”

Alternatively, “The company made it easy for me to solve my issue.”

Answers are on a scale of 1 – 5. Just like NPS, the process is simple and fast, making it more likely that customers will take a moment to answer.



How do I interpret the results?

Customer Effort Score is a percentage of agrees that their interaction was easy to the total. You calculate this by taking the total number of patients who agree (rating of 4 or 5) divided by the total number of responses. For example, if 65 customers out of 100 gave you a rating of 4 or 5, your CES would be 65%.


Total Number of Responses




Customer Satisfaction#3 Satisfaction

The old standby

Customer satisfaction (CSAT) is the oldest and most used metric across all industries. A CSAT Score is a value that reflects how a customer feels about a specific contact. Its shortcoming stems from the fact that patients often rate each interaction very highly, but will turn around & rate the organization as a whole much lower. These shortcomings led to the development of the NPS and the CES. Combined with those two metrics, it remains a very powerful tool.



Why is it important?

How is your service measuring up to the level of service you want to provide? CSAT gives a good measure of how patients view your service. It’s a leading indicator of trends & an early warning sign of something going wrong. Look for correlations between the CSAT & quality and retention scores.


What question should you ask?

This is another simple, easy survey-based metric.
“How would you rate your overall satisfaction with the service you received?”

Given the ubiquity of Amazon & their star ratings, another version of the CSAT doesn’t even ask a question, but
just gives the patient 5 stars with which to rate their service.


How to measure?

Like the prior methods, having a survey that automatically goes to patients after each encounter is the best

Low tech options would involve a website link or an email survey via Constant Contact.

A healthcare customer relationship manager (CRM) can automatically follow up with patients after each resolution or interaction.

CSAT Infographic 3-100
The “star” method that Amazon uses simply calculates the average response across all ratings.


Trailing KPI’s

Trailing KPI’s are measured by historical trends. This information is gathered in your financial statements and in your scheduling system. Because historical data is "messy," it takes time to identify long-lasting trends. These are called "trailing" KPI's because it may take weeks or sometimes months to understand and calculate what has been happening.



illustrations-facts-4 Patient Retention

Patient Retention

The Net Promoter & Customer Ease scores are forward-looking predictors of loyalty. Patient Retention is a backward-looking metric looking at  the same behavior *after* patients have already made their decisions.






Why is it important?

Bain estimates that a 5% increase in patient retention can boost overall profitability by 25%. It is commonly reported that acquiring a new patient takes 5x – 25x more effort & cost than retaining an existing patient.


How to measure?

There are a couple ways of measuring retention, & the one that makes sense will depend on your company's specialty. The first method is to compare the number of attended sessions against the number of recommended sessions.

Patient Retention Rate, 1st formula is:

Infographic 4-1 Measure Client Session Attendance
This calculation gives you the client retention rate as a percentage of attended sessions before self-discharging or completing the treatment plan.

There is no “right” number that comes from this ratio. The key is not to reach 100%, but to improve this number over time.

The second method looks at the number of sessions of returning patients in the latest time period (a year or a quarter) vs the number of sessions of returning & new patients over the same time period in prior years.

Patient Retention Rate, 2nd formula:

Inforgraphic 4-2 Measure Patient Attendance

Just as with the first method of calculation, you are not looking for a “right” number, but you are looking for improvement of this ratio over time. 




Revenue Growth Tracking IllustrationRevenue Growth

The bottom line is perhaps not surprisingly the most important historical patient satisfaction metric. Compare these historic trends with your patient experience responses above. Reviewing the numbers as they become available & analyzing patterns will help you determine where the policies, procedures, or your staff need some additional help.

5. Growth Rate Infographic-100


The Most Important Operations KPIs

The executive metrics are the best indicators of overall patient experience. But they are not the best tools for
identifying where to improve or to spend your organization's efforts. A significant amount of research has been conducted on what operations can do to improve the patient experience. To make a significant impact, put the following metrics on your scorecard.

To understand operations KPI’s, we need to break down patient requests into more detail:


A healthcare encounter is one or more interactions intended to provide services the patient needs or to assess what services are needed.



An interaction is a conversation with a patient over a single channel, such as phone, text chat, SMS, video chat, etc.



Resolution is when the services the patient sought were delivered.



When a patient initiates a request, they are seeking to start an encounter. The patient’s reason for the encounter determines what resolutions may be appropriate or possible. For example, the patient may be initiating a encounter for a prescription, advice on new symptoms, follow-up post surgery, etc.

Each of these has possible resolutions appropriate to that reason. In order to complete the service, the patient may have a number of interactions with staff, nurses, providers & pharmacists before the service is complete. Lowering the number of interactions and improving patient-centered communication often improves the patient experience and retention.



illustrations-facts-6 Time Resolve

Time to resolve

As society has evolved, patience is no longer a virtue! Waiting for an issue to be resolved only increases the patient’s level of frustration and decreases the likelihood of him or her leaving that call feeling satisfied.





What is it?

This should come as no surprise, as wait times are some of the most researched problems in healthcare. Waiting has patient health implications as well as revenue implications. Among other things, greater time to resolution has been linked to:




Lower Satisfaction

Number2DeepBLue-1Increased no-shows Number3DeepBLue-1Increased emergency room use - "The impact of unacceptable wait time on health care patients' attitudes and actions" "Impact of waiting times on Healthcare - by the example of outpatient clinics and general practitioners."

Contact Resolution time is strongly linked to customer satisfaction and correlated to First Call Resolution, so working on these two metrics simultaneously is a two-for-one opportunity for you.


Customer Satisfaction MTTR Graph Illustration

Metric of the Month: Mean Time to Resolve (InsightSquared)

Also see:


How to measure?

In order to track this metric, you need a mechanism to clearly capture every reason for patient contact AND then have the ability to track when that reason has been fulfilled. This typically requires a Healthcare CRM that is fully integrated into your phone system, your organization's website & your practice-management-scheduling system.


Make it happen:

icon_MakeItHappen_1Low tech options are cumbersome but doable. They include staff coordinating over HIPAA compliant cloud storage. The simplest is probably keeping an Excel sheet of calls in a spreadsheet online. Staff who take each call record the patient name and encounter start time. The staff who resolve each call open the spreadsheet to record the contact resolution time.




Healthcare CRM solutions are needed to provide automated measurements for resolution time.




illustrations-facts-7 First Contact ResolutionFirst contact resolution

Thinking back to your best customer service experiences, how many people did you talk to before your situation was resolved? How many times did you have to explain your story, or at the very least, clarify for a new representative? Generally, people don’t mind waiting if their issue is handled by the first person they speak with instead of having a number of interactions with with more than one representative. Use the information obtained to guide training for your frontline staff so they can handle more of those first interactions themselves & improve call times.


What is it?

How many times do you want to call in to have an issue handled? Are your patients finding resolution before they hang up the phone? If they aren’t, this is a good way of identifying problem areas & potential training opportunities.


Why is it important?

This metric is related to resolution time. If you can fully resolve your patients’ needs the first time they contact you, then the time to resolution will clearly decrease.

But there is more going on here. Patients are also frustrated with having to repeat themselves. Do your patients have to repeat their name, phone, and demographic information every time they call? When they call Amazon, American Airlines, or even Roto Rooter, they don’t. If your patients are forwarded to a nurse, do they have to give this information again? Do they have to repeat their reason for calling every time they talk to someone new?

It should be no surprise that First Call Resolution is highly correlated to customer satisfaction.


infographics_5 Customer Satisfaction Percentage Info Graph

Metric of the Month: First Contact Resolution (MetricNet)


How to Measure?

First contact resolution is easier to measure than time to resolution. While that metric requires integration across multiple systems and staff, this is measurable entirely by your telehealth staff who answer the phones, chats, and website requests.

7. FCR First Contact Resolution-100

There is no ideal number, as clearly this will never be 100% in healthcare within our lifetimes. How high you can get depends on a number of factors, including your specialty. The higher this statistic, the better.


icon_howToMesure_1No tech? You’ve still got that notepad & pen, right? Document the reason for contact & whether that reason was answered during that contact session or on first response.




Healthcare CRM’s measure this the best, as encounter tracking is a central function. The only way of measuring this from your phone system is to ask agents or callers if their issue was fully resolved. The problem with asking agents is the quality of the data, and the problem with asking callers is the low response rate.



illustrations-facts-8 Number of Interactions Illustration

Number of Interactions

This is the more complicated version of first contact resolution, & it is harder to measure. The idea, however, is the same.





What is it?

How many interactions does it take to resolve an encounter?
Here is an example that takes 10 interactions to get the visit that results in a referral:


infographics_top_13_patient 10 Interactions


Here is the same example where automation helps the organization complete those same results in 4 interactions.




Given the complexity of healthcare, you could be tremendously improving your service, but the single stat of “first contact resolution” may never reflect these improvements.

While it is usually impossible to fully deliver the service immediately when the service is first requested, it is important to realize this is the idealized goal that you measure against. Otherwise, your operational measurements may indicate fantastic service while patients are still frustrated.


How to Measure?

Determining the right measurement is critical for patient experience. Measure the number of interactions based on the customer's goal, not your service. For example:


icon-nurseThe Nurses may say
"We triaged the patient in one contact resolution."



The Schedulers may say:
"We scheduled the patient in one contact resolution."



icon_providerThe Providers may say:
"We completed the visit in one contact resolution."



But from the customer's perspective, triage & scheduling are just waypoints along the journey. They don’t deliver the “resolution” that the patient needs. In an idealized world, everything including the visit would happen at the time they first reach out.

Tracking the number of interactions requires a system that captures patient reason for contact and tracks all interactions across the organization until that reason is fulfilled. This requires a Healthcare CRM that is used across departments and is integrated into everything from the phone, to the website, the EHR and the PM systems.



illustrations-facts-9 Employee Satisfaction Index Illustration 9

Employee Satisfaction Index

This is the more complicated version of first contact resolution, & it is harder to measure. The idea, however, is the same.





What is it?

Employee satisfaction is just what it sounds – how satisfied employees are with the work they are doing, their relationship with their coworkers, & with their superiors.


Why is it important?

A lot of employee satisfaction and employee engagement surveys trend to very long. Understandably, employers want to get extensive information on employee satisfaction regarding rewards, autonomy, leadership, the work itself, and so on. The problem is that longer surveys greatly reduce the answer rate and the accuracy of surveys. If they gave you much deeper insights, this would be worth it, but the right short survey gets you 90% of the way there. The employee satisfaction index is one of these. Employees answer only 3 questions for the quantitative score, & one open-ended question for qualitative feedback:


1-mini-blue-icon How satisfied are you with your workplace? (rated 1 – 10)

2-mini-blue-icon How well does your organization meet your expectations? (rated 1-10)

3-mini-blue-icon How close is your job to your ideal job? (rated 1-10)

4-mini-blue-icon Please explain: (text box)

Employee Satisfaction Index

9. Employee Satisfaction-100


The result is a number from 0 - 100.


Number of Open Issues Task List Illustration

Number of open issues

The total number here will give you an idea of the unresolved volume. Look for trends in active issues.





What is it?

How many unresolved patient requests are currently open? Typically this number isn’t measured on its own, but is used to create a number of very helpful ratios:


1-mini-blue-iconOpen issues per patient


3-mini-blue-iconOpen issues / resolved issues (per time period)

2-mini-blue-iconOpen issues per day


4-mini-blue-icon Open issues / dollar of expense


Why is it important?

This simple metric does a lot of legwork. It is important for forecasting demand. It is Important for understanding your costs, & keeping them under control. Open tickets are your measurement of a backlog, and the rate of open requests vs the rate of resolved issues is key for identifying changes. Open issues vs expenses are useful for identifying opportunities to improve service costs.


How to Measure?

To measure this, you need to have a way of tracking requests across the organization, identifying the reason for the request, & whether or not the request has been satisfied.




Quality Metrics Illustration 11

Quality Metrics

Part of efficiency entails collecting & providing the appropriate information to your patients. Do your agents know where to find the information they need in a timely manner? Are they provided with all of the tools necessary to serve the patients? This metric may be trickier to decode but vital to the bottom line




What is it?

Quality metrics are a collection of metrics that determine how much the service provided matched what the patient actually needed. These can be broken into two categories – generic quality metric & service specific quality metrics. Generic quality metrics use the same measurement not matter the service being performed. Examples of these would be patient complaints & provider complaints.

Most metrics will be specific to services performed. Quality metrics for scheduling, for example, will be different from quality metrics for nurse triage, which will be different than metrics for prescription orders.


Why is it important?

Patient and Provider Complaints

Amazing as it sounds, your most loyal customers are not the ones who’ve always received great service. Your most loyal customer base is most likely comprised of patients who have had a problem with your service at some point in time. Research shows that the most loyal customers are those who were reasonably angered by an encounter only to have it corrected in an exceptional manner by an agent. It helps to predict when these opportunities could arise. Patient complaint metrics give you the opportunity to nip things in the bud and improve your operations to preempt the dissatisfaction.

Tracking your complaints allows for better, more efficient training. Complaints aren’t always bad if you use them to improve your customer service and overall operations. In some ways, complaints give you another opportunity to satisfy a customer. A TARP study found that customers whose complaints were satisfactorily resolved were 30% more loyal than those who never complained and 50% more loyal than those whose complaints were unsatisfactorily handled. The complaint handling can be as important as the initial interaction!

Service Specific Quality

Every one of your services should have a quality assurance process that includes training, measures of quality, & performance review. Typical quality items are:

Quality Assurance Process Graphic


How to Measure?

Measure Complaints

Give patients an opportunity to reach you via email on the website and/or measure their utilization of Healthdesk. This can increase patient engagement and improve patient communication.

Measure Quality
1. Sit with your agents & observe the calls. These results can be skewed by anxiety at having somebody over their shoulder.


2. Listen to recorded calls & then score the call via an evaluation.


3. Use live call monitoring software. 


Industry Measures of Quality

Most industry measures of quality include some factors for measuring the patient experience. Many of these have been developed over a long time period and are well established:

Hospital Metrics:

CAHPS - a standardized survey for measuring patient perspectives on quality. It is well researched but a bit long and cumbersome from the customer standpoint, resulting in a low response rate compared to surveys recommended in this article. That said, even low response rate data has its place and can yield valuable insights.

AHRQ - Agency for Healthcare Research and Quality

ORYX - a set of performance metrics required by the joint commission


Provider Metrics:

PCMH - Patient Centered Medical Home, by NCQA, a set of standards and guidelines for physicians.

CHIP - CMS has a program called "Children's Health Insurance Program" that has a significant quality component.


Contact Reaction Metric IllustrationContact Reaction Metrics

Obviously, with so many number-crunching options, there are hundreds of metrics available to monitor just about any aspect of your process. Not all of them are useful to everybody, but there’s something for everybody. The metrics discussed above have very definitive uses, but that doesn’t mean there aren’t more opportunities to analyze your efficiency. The following measurements may not be as important but should not be overlooked as they all contribute to the big picture.


Why do we run into these next five metrics so much? Because they are easy! Every phone, chat, or SMS system for the last 30 years will report on these metrics. They are ubiquitous. Also, they are operational metrics that are easy to interpret. When speed of answer grows, its pretty easy to figure out what your options are.


1-mini-blue-icon  Average speed of answer

2-mini-blue-icon  Abandonment rate (rated 1-10)

3-mini-blue-icon  Service level (% answered within X seconds)

4-mini-blue-icon  Concurrent interactions (asynchronous - chat, SMS, etc.)

5-mini-blue-icon  Number of elevations / channel switches



speed-iconAverage Speed of Answer
ASA is the average amount of time an encounter (call, chat, email, SMS, etc.), sits in a queue waiting for a response. Watching your number of callers being served versus those waiting to be connected is a real-time metric that alerts you to call volume and when it may be necessary to pick up the pace of calls – but not at the expense of call quality!

ASA = total time requests were in queue waiting / total number of requests



Abandonment rate
Patients lose their patience and drop the call. It happens, but is it happening too often? Track the level of call abandonment to make sure you are truly serving your patients and providing the best communication between visits.


Abandonment rate = (number of interactions initiated – interactions handled)/ number of interactions initiated


service-level-iconService Level
Service level is a customer service term for how many requests are answered or responded to within a set threshold. It is often stipulated as a form of guarantee. For example, a telephone service level could be that 90% of calls are answered within 20 seconds. A chat service level could be that 85% of all chat initiation is responded to within 45 seconds. An SMS service level could be that 90% of all SMS requests are answered within 2 minutes, and so on. If the service level is missed, then some sort of credit or discount often applies.


concurrent-interactionsConcurrent interactions
This metric measures simultaneous contacts over asynchronous channels, like chat, SMS, etc. 


Concurrent Interactions-100



contact-transfer-iconContact transfer rate
Patients hate waiting again once someone answers them. They’d often rather just wait longer the first time and have whoever answers address everything. A transfer feels like going backwards. Patients also dislike repeating information to someone new. Contact transfer rate measures the number of contacts that get transferred to a new person, department, or queue.


Contact Transfer-100


Cost Efficiency Metrics Illustration 13

Cost Efficiency Metrics

In any context, the primary cost of contact centers are the cost of the employees in the contact center. Traditionally, contact centers have been cost centers, so cost metrics were almost always within the top 3 metrics measured. However, as telehealth and patient access grows, the contact center is increasingly seen as a revenue center. The revenue the contact center can help generate usually far exceeds the cost optimizations available. That said, cost is always an important issue, and for that you should be monitoring the following metrics:




Cost per request
This metric provides an overall view into operational effectiveness across all types of requests. It is used to drive resource allocation, and is also a key metric in determining return on investment (ROI) for automation.

Cost per request = total cost of all services / number of service requests Cost Per Request



average-iconAverage Handle Time
Patients lose their patience and drop the call. It happens, but is it happening too often? Track the level of call abandonment to make sure you are truly serving your patients.


Abandonment rate = (number of interactions initiated – interactions handled)/ number of interactions initiated

icon_schenduler-1Staff schedule
How effective is an employee if he or she is not actively handling calls during a shift? Tracking employee schedules & time available on the phones is crucial to productivity and effectiveness of your team.


Adherence Rate


agent-iconAgent utilization
With the agent utilization rate, call centers can assess the productivity of their labor force.


Agent Utilization Rate infographicUtilization is a good metric to use for staff who are not handling remote requests 100% of the time, but might be split with other tasks.




Occupancy is like utilization, but specifically used in contact center contexts where the staff is handling remote patient requests full time. This rate is a way to measure agent productivity across all their call-related duties. It’s the measure of how much time your agents are on live calls and/or finishing up work related to those calls. You can use it to tell if you are overstaffed or understaffed.


If you have a phone system with detailed metrics, this would be (talk time + hold time + wrap-up time) / (talk time + hold time + wrap-up time + available time)


final-thought-iconFinal Thoughts

As the healthcare industry evolves, companies are being forced to adapt to meet patient expectations. These changes to policies and procedures result in better patient experiences, outcomes, and satisfaction. They also are required to retain patients & grow. Using these metrics to analyze the efficiency of existing processes & determine opportunities for improvement can mean the difference between losing patients & growing your client base.


Happy patients tell 3 friends. Unhappy patients tell Google!



Posted by Stephen Dean


Stephen-V2-small-optStephen first built his career in information technology. He left his philosophy major to work as a developer for Hewlett-Packard & then moved on to 3 consecutive startups, one of which grew to 150 employees before acquisition. Stephen received his MBA from the Duke University School of Business before co-founding Keona Health. At Keona Health, he directed all facets of finance, marketing & operations.