Purpose: This study explores the dynamics of patient transfers within the Polish healthcare system during the COVID-19 pandemic, focusing on the roles of negotiation, boundary work and systemic flexibility. Despite extensive literature on patient transfers, gaps remain in understanding the general mechanisms that complicate these processes, especially under crisis conditions. Design/methodology/approach: By interviewing 18 specialists across various medical fields, our research provides empirical evidence from Poland, highlighting the experiences of medical practitioners who navigated the complex landscape of patient transfers during the pandemic. Findings: By integrating negotiation and boundary work theories, we reveal how healthcare professionals manage patient flows and the challenges they face. Our findings show that during the unique situation caused by the uncertainties and lack of preparedness for the pandemic, while standardization and rationalization tools have limited effectiveness, proactive involvement and strategic negotiation are crucial for successful patient management. Research limitations/implications: The study's primary limitation is its focus solely on the Polish healthcare system during the COVID-19 pandemic, which may not fully represent other contexts or healthcare systems. Originality/value: The study underscores the importance of communication and interpersonal skills in facilitating patient transfers. We also argue that the previous experiences with negotiating orders, dealing with limited resources and making constant compromises had, in a way, built resilience in Polish medical experts and prepared them for the uncertainties encountered while treating COVID-19 patients. These insights contribute to academic theories and offer practical recommendations for enhancing healthcare system resilience and adaptability in future crises. Ultimately, the study emphasizes that flexibility and strategic negotiation are key to managing patient transfers in a fragmented and complex healthcare environment. © 2024, Emerald Publishing Limited.