Urgent care is all about access and convenience: getting patients to a provider quickly, treating their medical issues and sending them home.

That is why American Family Care systematically collects and analyzes patients’ feedback about their visit to one of the urgent care chain’s more than 180 centers in 26 states. The effort is part of a larger initiative to manage the end-to-end patient experience at American Family’s urgent care centers and, thus, build repeat business.

Since late 2016, American Family, based in Birmingham, Ala., has been tracking its Net Promoter Score, which measures how loyal a customer or patient is to a product or service. Fred Reichheld, a fellow at Bain & Company, introduced the Net Promoter Score, which is based on the concept that organizations with strong customer relationships grow faster than those with weak customer relationships.

To measure its Net Promoter Score, American Family sends a two-question survey to patients via a text message. First, it asks patients to rate their clinic visit on a scale from 1-to-10. If they give a score of six or less, American Family then asks patients to explain the reasons behind the score.

In the first quarter of 2017, American Family garnered a 40 percent response rate from 56,000 patients. “People are attached to their phone most of their waking hours, so when we send a text message, it is super simple to respond,” said William Koleszar, chief marketing officer at American Family Care.

Based on their response to the first question, American Family divides patients into three categories: “Promoters,” or most loyal patients, with ratings of 9 or 10; “passives,” with ratings of 7 or 8, and “detractors,” with ratings of 0 to 6.

Net Promoter Scores range from +100, the highest score for an organization with all promoters, to -100, the lowest score for an organization with all detractors. American Family’s overall score hovers around +80.

American Family purchased a SaaS text-based patient feedback tool from Calibrater Health in New York to send the surveys to patients’ mobile phones. The tool is integrated with American Family’s electronic health record from DocuTAP in Sioux Falls, SD, primarily through HL7 messaging, according to Anthony Williams, CIO of American Family Care. Patients’ feedback is tied to their individual electronic health record using a unique patient ID—not just their mobile phone number.

When a provider closes a clinical note in American Family’s EHR, the action triggers a message to the feedback tool, which sends the survey to the patient’s phone.

Patients’ responses are stored in Calibrater Health’s SQL database. Using a combination of algorithms and machine learning, the software assigns the text messages to categories, such as complaints, suggestions, requests and compliments, according Williams.

The software also assigns survey responses with scores of six or less to a queue for patient advocates. They follow up with patients personally to resolve any outstanding issues.

American Family tracks its Net Promoter Score by region, facility and provider. “That is the beauty of the tool—you can get super granular,” Koleszar says.

The urgent care chain uses the NPS score and patients’ comments to coach providers and other employees about how to improve the way they deliver medical care and interact with patients. Since using this approach, underperforming clinics have increased their Net Promoter Scores dramatically, Koleszar says.

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