You Don’t Always Need to Fix It: Active Listening as a Human Factors Skill for Pre-hospital and Emergency Clinicians

Understanding the value of active listening as a human factors skill for healthcare professionals working in acute paediatric care

A skill we already have?

So-called ‘soft’ or non-technical skills are often framed as secondary to clinical expertise or even clinical practice. Yet, in any healthcare setting, and particularly in environments involving urgent or emergency care, they are frequently the most difficult to master despite being perhaps the most influential for patient safety, team performance, and overall well-being.

As an Advanced Paramedic working across prehospital care, an Emergency Department and Primary Care – as well as working in a supervisory role – I was recently on a leadership and coaching course where developing ‘active listening’ was highlighted as a key objective. I initially assumed this simply meant ‘listening properly’.

In practice, I have found it deceptively simple in theory but much more challenging to execute consistently – particularly in fast-paced, interruption-heavy, distraction-filled environments where cognitive load is high, and decisions often come thick and fast. Much of the discussion and theory behind active listening has come from the world of coaching; however, in my opinion, it is incredibly applicable and relatable to this area of clinical practice and healthcare more generally.

From a human factors perspective, active listening is not merely a communication nicety. It is a core risk-management mechanism that underpins safe decision-making, shared understanding, psychological safety and team wellbeing.

What actually is active listening?

These behaviours help create shared mental models; a shared understanding among clinicians, patients and families about what is happening and what the plan is. When shared mental models are absent, misunderstanding, duplication, and diagnostic error become more likely.

Active Listening as a Human Factors Skill

‘Human Factors are organisational, individual, environmental, and job characteristics that influence behaviour in ways that can impact safety…’

Communication failures are a well-recognised contributor to adverse events in acute care, as well as to breakdowns in collegial relationships and in supervisor-supervisee dynamics. Active listening, therefore, functions as a cognitive safety check; slowing thinking just enough to ensure we are truly understanding and recognising the problem.

How Not to Listen Well…

This slightly (very) silly example above, perhaps, may be more relatable to some than it should be.

For those who aren’t fans of The Office, the video clip shows what spectacularly bad, disengaged listening looks like. Whilst clearly exaggerated, most clinicians can recall real conversations where the listener is clearly focused on replying superficially rather than truly listening and understanding what you are trying to relay. This humorous example may indeed illustrate a serious patient safety risk.

In clinical settings, this may occur within a busy department when somebody is seeking your advice or sense-checking a decision, during telephone referrals, remote consultations, or even during handover. It may also be in conversation with colleagues or members of your team who want to discuss either a personal or professional issue.

The cost of disengaged listening, unlike in the clip above, is unfortunately the polar opposite of comedic – it can mean anything from missed safeguarding concerns, underestimating parental anxiety or subtle red flags, to overlooking a colleague in need of support.

Can’t fix it? No problem!

My own greatest personal barrier to active listening is the urge to immediately try to fix the problem, to ‘solutionise’. As clinicians, we are all trained and experienced problem-solvers; fixing is our professional identity, even more so when somebody is unhappy. However, the clip below from the Pixar film ‘Inside Out’ aptly illustrates a crucial point about active and empathetic listening: sometimes people do not need solutions; they need to feel heard.

From a human factors viewpoint, premature advice and closure of the listening stage of conversation can totally shut down effective communication and reinforce unhelpful authority gradients. This discourages further disclosure, particularly from groups such as:

• Adolescents unsure how seriously they will be taken
• Parents worried about ‘wasting your time’
• Less experienced colleagues hesitant to raise an issue in the first place
• Colleagues who are trying to overcome a personal or professional issue and are demonstrating vulnerability in disclosure

Active listening, by contrast, with its empathetic foundation, promotes psychological safety – the shared belief that concerns can be raised without embarrassment or blame and that they will be listened to meaningfully. True engagement and a sense of belonging within a team are strongly associated with improved performance and satisfaction.

Why this matters for our adolescent patients

Adolescents occupy a unique space in paediatric care: not always clinically high-risk, but emotionally and socially complex. They may present with vague symptoms, risk-taking behaviour, or mental health concerns that require nuanced assessment.

Active listening allows clinicians to:

• Explore unspoken worries or safeguarding issues, ideally through a framework such as HEADSSS (13)
• Validate emotions without immediately medicalising them
• Reduce perceived judgment, encouraging honest disclosure
• Allowing the patient to feel truly heard, which can be rare in this cohort

For this group in particular, being listened to attentively and respectfully may be as therapeutically important as any other intervention we can provide.

Barriers to Active Listening

Despite everything testifying to its importance, active listening is difficult and can be challenging to sustain in environments characterised by:

• Time pressure and performance metrics measured by expedience over quality
• Fatigue and cognitive overload. Active listening can be exhausting!
• Frequent interruptions and task switching
• Emotional burden and compassion fatigue
• A need to occasionally prioritise expedience in high acuity situations where respectful interruption may be unavoidable

These factors may well reduce attentional capacity and increase the likelihood that we default to directive, solution-focused communication.

This is OK – recognising these pressures as often system issues, not individual failings, is itself a key human factors insight. Additionally, if you felt you weren’t able to give a conversation the attention it deserves, address it later, try again when some of the barriers above can be removed or mitigated.

Practical Strategies

Active listening does not always require more time – only more intentional consultations or conversations. Remember that increased time intensity in an initial conversation may pay dividends in the longer term. Small adjustments to listening strategies may make a significant difference:

• Pause before responding: Allow a brief cognitive reset and time for reflection.
• Use one reflective statement: ‘It sounds like you might be most worried about…’
• Check your understanding: ‘Have I got it right?’
• Name emotions when responding, particularly with distressed caregivers or adolescents.
• Resist the solutionising! Consider whether you are being asked for direct advice or just to listen?

These small but effective strategies can enhance rapport, trust, and engagement, as well as potentially improve diagnostic accuracy and support safer team communication.

Take-home messages

Active listening is a patient safety skill, and key strategy to supporting our colleagues; not merely a preferred communication style.

It may reduce cognitive error by supporting shared mental models.

Empathetic listening promotes psychological safety for patients, families and colleagues.

Adolescents and supervisees may particularly benefit from feeling heard rather than immediately ‘fixed’.

Small, deliberate listening behaviours can be embedded even in high-pressure, high-demand clinical settings.

Conclusion

Non-technical skills are often the hardest to master. They rely on sustained self-awareness, emotional regulation, and deliberate practice.

In pre-hospital and emergency care, uncertainty, time pressure, and complexity are constant. Active listening should not be seen as optional. Instead, it should be a core component of safe, compassionate, and effective clinical practice—supporting us to be better colleagues and leaders.

References

Dolev N, Naamati-Schneider L & Meirovich, A. (2022). Chapter 6: Making Soft Skills a Part of the Curriculum of Healthcare Studies. Medical Education for the 21^st Century. IntechOpen: 2^nd Ed. Available at: https://www.intechopen.com/books/11004.

Whitmore, J & Gaskell, T. (2024). Coaching for Performance: The Principles and practice of Coaching and Leadership. (6^th ed.). John Murray Business.

Friston K, Sajid N, Quiroga-Martinez D, Parr T, Price C & Holmes, E. (2021). Active listening. Hearing Research. 399 (4).

Tennant K, Long A, Toney-Butler, T. (2025). Chapter 4: Active Listening. StatPearls Human Factors Study Guide. (2^nd ed.). StatPearls. Available at: https://pubmed.ncbi.nlm.nih.gov/28723044/.

Mathieu J, Tonia H, Gerald G, Salas E and Cannon-Bowers, J. (2000). The influence of shared mental models on team process and performance. Journal of Applied Psychology. 85 (2), p273-283.  

Clinical Human Factors Working Group. (2024). What are clinical human factors? [Webpage]. Available at: https://chfg.org/what-are-clinical-human-factors/. Last accessed: 18^th February 2026.

McKenna L, Brown T, Oliaro L, Williams B and Williams, A. (2020). Chapter 25: Listening in Health Care. The Handbook of Listening. Editors: Worthington D & Bodie, G. Wiley: London.

Denham C, Dingman J, Foley M, Ford D, Martins B, O’Regan P & Salamendra, A. (2008). Are you listening… are you really listening? Journal of Patient Safety. 4 (3), p148-161.

The US Office: Dwight & Active Listening (2013). Available:  https://www.youtube.com/watch?v=Qg8PIK74KO4. Last accessed 18^th February 2026.

Jahromi V, Tabatabaee S, Abdar Z & Rajabi, M. (2016). Active listening: the key of successful communication in hospital managers. Electronic Physician. 8 (3), p2123-2128.

Inside Out (Pixar) (2015).  An Example of Empathetic Listening. Available: https://www.youtube.com/watch?v=t685WM5R6aM. Last accessed 18^th February 2026.

Harris, P. (2020). Active Listening and Patient Experience. [Doctoral thesis: Grand Canyon University]. ProQuest Dissertations and Theses Global. Available at: https://www.proquest.com/openview/ac3a266e87b431ac48731c7256bc4d8f/1?cbl=51922&diss=y&pq-origsite=gscholar. Last accessed: 15^th February 2026.  

Tagg, A. (2025). The HEADSSS Screen: A framework for adolescent assessment. Available at: https://dontforgetthebubbles.com/mental-health-screening/. Last accessed: 18^th February 2026.

Weinstein N, Huo A, Itzchakov, G. (2021). Parental listening when adolescents self-disclose: A preregistered experimental study. Journal of Experimental Child Psychology. 209 (1).

Weger H, Bell G, Minei E & Robinson, M. (2014). The relative effectiveness of active listening in initial interactions. International Journal of Listening. 1 (2), p13-31.

King, G. (2022). Central yet overlooked: engaged and person-centred listening in rehabilitation and healthcare conversations. Disability and Rehabilitation. 44 (24), p7664-7676.