Improving communication: the role of the healthcare environment

Categories: Care.

Good communication between a patient and healthcare professional can make a huge difference to the person’s experience of their illness and treatment.

Whenever we talk about improving communication with patients, we tend to focus on interventions to improve healthcare professionals’ knowledge and skills around communication.

In this article, I would like to widen the discussion and look at how we can create an environment that supports healthcare professionals and encourages good communication with patients.

Before we zoom out to the environment, let’s first look at the impact of good communication.

Does good communication really make a difference?

Earlier this year, I attended a public lecture organised by Marie Curie on the importance of communication between patients and healthcare professionals, particularly for people with long-term and life-threatening health conditions.

At this lecture (Let’s Talk about Cancer), Andrew MacDonald creatively enacted the impact of different types of communication on his experience of being diagnosed and treated for prostate cancer. A report (1) was also launched at this event which provides further detail about the impact of poor communication and what needs to be done to improve communication practices.

Good communication with patients can promote more effective treatment decisions, support patients with their treatment plans, provide emotional support, and improve patients’ overall experience and outcomes.

Research in end of life care has shown that good communication improves patients’ satisfaction with the quality of their care and can have an influence on treatment decisions, with patients opting for less aggressive treatments.

The Marie Curie report also discusses how improving communication with patients saves costs for the NHS by reducing NHS litigation and improving adherence to medications.

Communication practice is improving, but slowly

There is wide recognition of the importance of good communication and significant progress has been made to improve communication practice.

Communication is a core part of the medical education curriculum and additional communication skills training programmes have been developed for working healthcare professionals. The “hello my name is” campaign started by Dr Kate Granger was initiated to remind healthcare staff of the importance of introducing themselves to patients when caring for them.

However, instances of poor communication with patients still exist. So why haven’t we solved this problem yet? We need to widen our discussions to include the impact of the healthcare environment on communication.

An environment that supports good communication

Behaviour change theories (eg social cognitive theory) talk about the need to consider the dynamic interplay between the person, their behaviour and the environment when attempting to modify behaviour.

To improve communication between patients and healthcare professionals, we also need to focus on modifying certain aspects of the physical and social environment of healthcare services.

With the physical environment, this involves structuring clinic schedules so that there is adequate time to discuss important issues with each patient. It also means having easy, ongoing access to communication skills training programmes for healthcare professionals.

Research by Dr Eduardo Bruera has shown that simple modifications to the physical environment such as the physician sitting down, increasing privacy in the physical layout of the clinic, providing patients with prompt sheets or audio cassettes of the consultation, can increase patients’ satisfaction with the consultation. (2,3,4,5)

Modifying the social environment is even more important. We need to embed good communication practice into the culture of healthcare services.

Do services encourage healthcare staff to attend communication skills training programmes? Are communication skills viewed as ‘soft skills’ within the organisation? Are staff regularly asked about their training needs with respect to communication skills?

Both the physical and social environment need to reinforce and support healthcare professionals in order to improve communication.

Changing the environment is a big and difficult ask, especially when healthcare resources are constrained. However, interventions will only be successful if we consider this bigger picture and foster good communication practice in the structure and culture of healthcare services. 

Cathryn Pinto is a researcher in palliative care at King’s College London. You can find Cathryn on Twitter at @CathrynPinto


  1. McDonald A. A long and winding road: Improving communication with patients in the NHS. Marie Curie; 2016. Available at:
  2. Strasser F, Palmer JL, Willey J, Shen L, Shin K, Sivesind D, Beale E, Bruera E. Impact of physician sitting versus standing during inpatient oncology consultations: patients’ preference and perception of compassion and duration. A randomized controlled trial. Journal of pain and symptom management. 2005 May 31;29(5):489-97.
  3. Bruera E, Sweeney C, Willey J, Palmer JL, Tolley S, Rosales M, Ripamonti C. Breast cancer patient perception of the helpfulness of a prompt sheet versus a general information sheet during outpatient consultation: a randomized, controlled trial. Journal of pain and symptom management. 2003 May 31;25(5):412-9.
  4. Bruera E, Pituskin E, Calder K, Neumann CM, Hanson J. The addition of an audiocassette recording of a consultation to written recommendations for patients with advanced cancer. Cancer. 1999 Dec 1;86(11):2420-5 
  5. Nayak S, Pradhan JP, Reddy S, Palmer JL, Zhang T, Bruera E. Cancer patients’ perception of the quality of communication before and after the implementation of a communication strategy in a regional cancer center in India. Journal of clinical oncology. 2005 Jul 20;23(21):4771-5.

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