How organizations coordinate a unified response under system-wide disruption impacting multiple units in different ways is a crucial question for healthcare organizations today. To address this question, we report on a qualitative field study of a frontline hospital over the course of the 2020-2022 COVID-19 pandemic. Our findings reveal that such crises require multiple extended coordinated response processes where central coordinators assign new work, prioritize resources, and modulate the autonomy and improvisational ability of multiple organizational sub-units to mount organization-wide responses. We contribute to healthcare management and coordination research by offering a process model for coordinating responses to broad-scale disruption that leverages local knowledge and resourcefulness of experienced hospital personnel under conditions of disruption, and allows for standardization and refinement as disruptions are resolved or normalized.