Assessing the impact of training on patient experience


Increased customer satisfaction is associated with reduced complaints, a positive business reputation and often financial return. Within the clinical setting it has more importantly been shown to have a direct correlation with improved clinical outcomes. The therapeutic relationship is one area that can impact on a patients overall experience and their engagement in treatment. This relationship can be improved by making sure that the patients expectations and perceptions are not only acknowledged but clearly understood.

A number of physiotherapists identify that they struggle with changing mind-sets of their patients or find that they are unprepared for having those difficult conversations. Supporting physiotherapists to have effective communication skills, the ability to listen and engage and have awareness of the impact of verbal and non verbal cues is essential in improving the patient experience. Training was required to address the gap in skill and knowledge.

10% average increase in customer satisfaction
after physiotherapists attended the Clinical Conversations course.


The clinical conversations course was designed to help improve the physiotherapy therapeutic alliance within the business. It is a one day workshop that utilises a variety of teaching and learning tools that are based around the different aspects of communication.

The learning objectives of the course are listed below.

• Understand the different ways in which we communicate and the impact that this can have on the therapeutic relationship.
• Be able to modify communication styles to maintain agreement and achieve a desired outcome.
• Learn how to manage difficult conversations and patient expectations within the therapeutic environment.
• Understand and put into context the power of non-verbal communication and how this can be used to facilitate conversations with patients.
• To understand how to recognise when patient expectations aren´t being met and therefore promote positive experiences.
• Understand the implications to everybody involved when things do not go to plan.

To assess the impact of the training the average patient reported overall satisfaction scores and the net promotor scores were compared for the 3 months before and the 3 months after the physiotherapists had attended training. These patient feedback forms are completely anonymous and therefore deemed to be an accurate account of their experience. The delegates self selected to go on the training and were a mix of a variety of physiotherapy job roles and levels of experience from across the organisation.


  • 77 physiotherapists attended the training
  • There was an average increase in customer reported overall satisfaction of 10%
  • There was an average increase in Net promotor scores of 16%
  • Feedback from the delegates was all positive, with requests for the training to be made mandatory, and reports of immediate positive impact on clinical practice.

Cost and savings

Physiotherapists who attended the Clinical Conversations course on average had improved customer satisfaction scores and improved net promotor scores after completing the training.

The project was run as part of an on-going training programme and as such the creation and set up were absorbed into every day running costs. Attendance on the course was free for the physiotherapists and they were able to use their allocated CPD allowance towards travel expenses to attend.


Some physiotherapists feel unprepared or do not have the appropriate skill or training to develop a positive therapeutic relationship, this should be taken into consideration when providing training to prepare individuals for clinical practice. Further work to assess the impact these changes in skill level has on clinical outcomes is required.

Further training should be provided for physiotherapists regardless of their level of experience to help them identify both positive and negative communication styles and techniques and help them to understand how these can be used to improve the therapeutic alliance. Improved therapeutic alliance can lead to better sharing of information, improved clinical reasoning and a patient centred decision-making process.

Top three learning points

  1. The clinical conversations course has been shown to improve Net promotor scores and customer satisfaction.
  2. The importance of communication styles and how they can have both positive and negative impact on the patients journey and potentially clinical outcome as well.
  3. Physiotherapists are willing to change their practice and are very receptive to training on communication skills and can acknowledge that this can improve the experience for both the therapist and the patient.

Funding acknowledgements

This work was funded by Nuffield Health.

Additional notes

Presented at Physiotherapy UK 2018.