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Strengthening primary health care: when soft skills are hard « Back to Blogs

Soft skills in healthcare are those of communication, team-working, and collaboration. These skills are essential if we are to transfer academic knowledge of medicine to clinical practice that will impact patient care. Soft skills always get a mention in healthcare professional education, but it is often only a cursory mention. In an educational meeting, they might get a 20-minute slot at the end of the day. In a paper, they might merit a short final paragraph stating that you have read about the evidence, but of course you should share the final decisions with your patient. In a workshop, there might be an optional session on real world barriers to the implementation of evidence-based medicine and how to overcome them.


But these real-world barriers are significant, and perfunctory efforts to overcome them will not succeed. For that reason, the paper by Valaitis et al is especially welcome – the entire paper focuses on the influence of intrapersonal and interpersonal factors in strengthening primary health care through primary care and public health collaboration. (1)


They found that the following factors were influential: “trusting and inclusive relationships; shared values, beliefs and attitudes; role clarity; effective communication; and decision processes”. So how can we work on these factors and develop such relationships? The answer is that a lot of different strategies are required. Time is an essential enabler in all of this – relationships cannot be built overnight and many people who the authors interviewed spoke about developing relationships over many years. The capacity to meet colleagues in face-to-face environments is also critical – but this takes time as well. Role clarity was an important albeit complex factor. Role clarity starts with understanding – different members of a team need to understand the role that they and others play in delivering healthcare. That is a baseline – but the ideal is when different members of the team understand roles and yet at the same time are willing to be flexible to achieve the healthcare outcomes that all are aiming at. Better communication can be a catch-all phrase – and one that nobody would disagree with. However, in this paper, the authors helpfully delve into what is meant by better communication. They found that better communication involved exchange of information” andfacilitated engaged dialogue”, and that both were required to help communication. This demonstrates how the factors can relate to each other and sometimes overlap – as an engaged dialogue will only happen amongst people have time and also the capacity to meet face-to-face.


BMJ Learning has published a range of learning modules on communication and team working skills. The feedback from users suggests that they find them an effective way to learn about basic and advanced communication skills. They are likely to be a low cost and accessible way of learning communications skills – that are relevant to a range of different type of professionals. (2). They can certainly enable primary care practitioners to build the foundations of strong communication skills – but it is how learning is put into action that will strengthen primary care health systems. And to do this, practitioners will need time and support to put their new-found skills into practice.  




  1. Valaitis RKO’Mara LWong STMacDonald MMurray NMartin-Misener RMeagher-Stewart D. Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors. Prim Health Care Res Dev.2018 Jul;19(4):378-391.  


  1. Walsh K, Reeves S, Maloney S. Exploring issues of cost and value in professional and interprofessional education. J Interprof Care. 2014 Nov;28(6):493-4.

Competing interests


KW works for BMJ Learning which produces educational resources on a range of subjects – including communication skills.




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