Understanding the coordinating process of services providing care to multimorbid patients: An exploratory case study in Norway

Healthcare systems face increasing demand from limited supply capacity. This is particularly difficult in multimorbid health care. Multimorbid patient pathways frequently involve a larger number of interrelated medical specialties, and to fit into silo-organized settings, the flow of patients involves both transfers within several departments in the same organization as well as inter-organizational handovers. Multimorbid settings experience a high degree of complexity in their day-to-day operations. Coordination has been extensively applied as an organizational response to complexity in contexts with some degree of interdependence. The operationalization of coordination mechanisms - to manage complexity to improve operations and performance in health care has been discussed. Yet, comprehensively determining and regulating different sources of complexity in multimorbid health care must be stated explicitly and developed further. Hence, this study addresses the question of how the complexity in multimorbid health care affects the operationalization of coordination mechanisms.