Research Paper Keeping one step ahead: A qualitative study among Norwegian health-care providers in hospitals involved in care coordination for patients with complex needs Audhild Høyem 1 , Deede Gammon 1,2 , Gro Berntsen 1,3 and Aslak Steinsbekk 4 Abstract Introduction: Various efforts aim to enhance continuity of care for patients with long-term health-care needs. Since 2012, Norwegian hospitals are mandated to appoint individual care coordinators for patients with complex needs to ensure continuity in the care pathway. New roles must meld with current practice. Implementation has been slow. This study investigates current care coordination across hospital contexts, from the perspective of health-care providers, a scarcely researched area. Methods: A qualitative study using semi-structured individual, duo, and group interviews with 16 purposefully selected Norwegian health-care providers from different hospitals, departments, professions and with various roles. A thematic cross-case analysis using systematic text condensation was performed. Results: Common for the interviewees’ care coordination experiences was to “keep one step ahead.” The scope of their coordination activities varied from diagnostics and treatment to orchestrating long-term, cross-sectional multi- disciplinary care. This work was often performed without designated resources. The interviewees applied experience, knowledge, and sensitivity when defining the patients’ needs and searching for resources to orchestrate coordination work. They strived to balance the needs of patients with the resources available and adjusted the continuity ambitions on behalf of their patients to what they considered doable in the relevant contexts. However, many told of negotiating special solutions for selected patients with particularly complex needs. Discussion: Care coordination for patients with complex needs emerged as diverse and context-sensitive. Acknowledgement of coordination activities that go beyond established workflow routines and clinical pathways, togeth- er with flexible leadership support and accessible infrastructural resources are needed. Keywords Qualitative research, health personnel, hospital departments, delivery of health care, long-term care, continuity of patient care Background Fragmented care is a great challenge for people living with complex, long-term needs of health care. 1,2 A growing number of patients are in need of health services from multiple providers and units over time 3,4 and they request improved care coordination. 5,6 Feeling secure when crossing care boundaries, having the opportunity and the means to be involved in care on their own premises, and having access to a contact 1 University Hospital of North Norway, Norway 2 Oslo University Hospital, Norway 3 UiT The Arctic University of Norway, Norway 4 Norwegian University of Science and Technology, Norway Corresponding author: Audhild Høyem, Department of Integrated Care, University Hospital of North Norway, P.B. 35, 9038 Tromso, Norway. Email: Audhild.hoyem@unn.no International Journal of Care Coordination 2018, Vol. 21(1–2) 15–25 ! The Author(s) 2018 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2053434518764643 journals.sagepub.com/home/icp