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When crew dynamics disrupt patient care

5 insidious partner issues to avoid so that patients feel safe in our care


The quickest way for us to unsettle a patient’s sense of security is to disrupt our team dynamic and leave them wondering what’s going on.

Photo/Ed Murray via MCT

The most vulnerable person involved in any EMS interaction is usually the patient. Suffering from pain, fear, embarrassment, out of their comfort zone and in the hands of strangers, the people that we have signed up to help need to feel safe.

We only have to put ourselves in their shoes for a moment to understand how important it is that those entrusted with their care have their best interests at heart – that they are the focus of our attention – that they are being attended to by a cohesive unit.

The quickest way for us to unsettle a patient’s sense of security is to disrupt our team dynamic and leave them wondering what’s going on. In our defense, it isn’t always smooth sailing with crewmates. We generally don’t get to pick our partners and, even when we do, there will always be stormy seas of disagreement or dissatisfaction to navigate, just like every other human-centered relationship in life.

So, what do patients notice as insidious issues dividing crews on scene and disrupting their desire to feel wrapped in our care? Here are 5 ways your partnership dynamics can impact the patient.

1. Misguided humor

The little jokes that medics make about each other are a double-edged sword. If managed well, in the right tone, subtle in nature and flowing well between parties, they can put everyone at ease. Patients get to feel part of the team and enjoy the gentle teasing. But it’s all about balance. If those jokes undermine a colleague’s decisions or suggest a lack of skill, experience or knowledge, everyone loses.

Trust breaks down between the crew, frustration fires up, solidarity splinters and the patient feels it – unsure who to laugh at or when, not knowing who to trust or how, wondering why they have to participate in what appears to be a rocky relationship when all they want is to receive care.

Shared humor is a great way to present a united front and enhance the patient experience, as long as crew unity remains front and center. As soon as that starts to split and create confusion, it’s time to tone it down.

2. Inattention, poor communication

Turning up as a team is the image we portray when travelling together in identical uniforms. That we function as a team, therefore, is a reasonable expectation for any patient. If one of us demonstrates disinterest, which may happen if it’s our turn to drive, then the team dynamic dies. When the attending shares details, drug doses, updated vitals and decisions for their partner to hear, any lackluster response will be obvious.

Even worse, if it’s followed up with a dismissive comment, patients may lose their sense of safety, security and satisfaction. We don’t have to get so involved that we risk taking over care, but attentive listening pays high dividends. Minimal effort for maximal reward – crewmates feel supported, mistakes are less likely to be missed, patient safety increases and satisfaction surges all round.

3. Arguing clinical decisions

Taking two or more autonomous clinicians and confining them to close quarters for long periods will always create some disagreement. We each have different ways of working, and we all have different experiences, knowledge and education to draw upon. Most of the time, we resolve partner conflicts quickly and discreetly. Those peaceful protests are not under discussion here. Instead, it’s the blatant conflict on scene, those matters of such importance that they cannot be dropped. Playing these out in front of a patient cannot fail to cause discomfort.

Already fearful and confused by their medical situation, the last thing we want to do is increase patients’ fear or create more confusion. Witnessing conflicting opinions may make them worry that if one is wrong and the other is right, which will make or break their outcome? It is possible to disagree amicably and seek a solution together, but when it gets to that point, the patient doesn’t need to know. Simply stepping away, with the excuse of retrieving something from the vehicle will set the scene for appropriate discussion before returning to the patient, blissfully unaware that any obstacle arose.

4. Incivility

Treating each other with respect and compassion is just as crucial in work-based partnerships as it is in our delivery of prehospital care. When patients comment on how well a team works together, it’s clear that they observe crew dynamics closely. Ideally, we get to work with a friend and solidarity is seamless, or, it may be our first ever shift with a new partner. Perhaps we wouldn’t choose to hang out together in our personal lives, or we may even dislike each other intensely. Whatever the case, it should never make a difference to patient care. If it does, then we need it to stop.

Incivility takes many forms, but all of them are insufferable. Any eye-rolling, exasperated sighing, shaking of the head, facial expressions of disapproval, raising the eyebrows in judgment or similar body language cues will indicate incivility to everyone around. Even worse, a one-worded comment such as “whatever” or “OK,” dripping with contempt, will confirm any suspicion that insidious incivility is taking precedence over patient care. This stage in any work or personal relationship is complicated, and there are plenty of resources available online, in books and quite possibly in the workplace. For the purpose of this article, the only way to deal with the dilemma is to make it stop.

5. Losing focus

Tapping into a truly rewarding team-based dynamic, when it happens, feels great. It makes work more satisfying, and the shifts fly by. But we can have too much of a good thing if we’re not careful. Remembering the reason for us being there is to care for the patient is vital in not going too far. A partnership may be peppered with inside humor and shared opinions, perhaps best left in the vehicle each time we enter the patient’s domain. Any hint of feeling left out of the joke, or unsure of the reason behind laughter will increase patients’ vulnerability and erode their sense of safety and trust.

Should a patient feel like a source of entertainment or amusement, we become guilty of causing further harm, something that none of us signed up to do. The benefit of a perfect partnership, used wisely, with conscientious care at the heart of every patient-centered interaction, is that it creates warmth. Sharing that with others increases its value and in return, the satisfaction that it brings.

A united front

Ultimately, just as we learn to create the illusion that everything will be OK to patients clinically, logistically and emotionally, an illusion of cohesion is vital. Partnership problems that arise are not the patient’s problems. No matter the personal and professional dynamics of our team, presenting a united front that envelops every person we care for can only enhance their experience of EMS.

Read next: 4 things to explain to patients to increase their comfort and compliance

Tammie Bullard is a paramedic, educator and author of “The Good, The Bad & The Ugly Paramedic,” a reflective practice text for prehospital care providers. She is passionate about best patient care and paramedic professionalism. Connect with her through LinkedIn or by visiting