Healthcare organizations face significant challenges in coordinating cohesive responses to large-scale unexpected disruptions. Previous studies have emphasized the need for protocols and planning in response to crises. However, for crises that are extended, novel, and ambiguous, the coordination of responses to the unfolding crisis becomes more important. In order to understand how coordination unfolded over time, we conducted a two-year qualitative field study in a frontline hospital during the 2020–2022 COVID-19 pandemic. Our findings reveal that such wide-spread crises unfold as multiple concurrent episodes, disrupting work across units and requiring flexible and evolving coordination practices. These practices enable the hospital to manage novel interdependencies, establish shared frameworks to navigate disruptions, and strategically foreground and background relevant expertise across the organization. Our study highlights how hospitals can leverage localized knowledge and resources to produce cohesive, organization-wide responses. This approach enhances efficiency, fosters innovation, and ensures coherence in addressing both routine and extraordinary challenges.
