Hospitals have become more and more complex organizations that require increasing degrees of vertical, lateral and longitudinal coordination among their staff. As organizations, hospitals positively organize the coordination between the activities of its different agents, as well as the associated communication between them. The overall goal is to construct a “common ground” between the agents about the work process. In order to achieve this, a series of management tools are called upon. However these coordination mechanisms may fail. In the case analyzed, the agents seem to organize their behavior through direct and local individual interactions with their work environment, rather than through a global representation of the work. The case study demonstrates that intentionally organized coordination mechanisms interact with, and may be superseded by, the “emergence-through use” of coordination mechanisms in real time. These two mechanisms are clearly embedded at work, and can both be beneficial in promoting coordination in large scale systems.