Background: Amid the increasing prevalence of chronic diseases and multimorbidity globally, the quest for integrated care models has intensified. However, empirical evidence on their implementation remains limited. Understanding the intricacies of effective interprofessional collaboration is crucial for achieving seamless integration of care.

Aim: This study seeks to construct a grounded theory elucidating the dynamics of interprofessional collaboration across care providers to support integrated care for persons with complex needs.

Design: A constructivist grounded theory approach guided the research.

Methods: Observational and interview data were collected and analyzed using constant comparative methods to reach theoretical saturation. The sample consisted of 86 participants from diverse professional backgrounds within health and social care sectors, including hospital, ambulance services, primary care, and community care settings.

Results: The theory titled “Negotiating Care in Organizational Borderlands” conceptualizes interprofessional collaboration as a complex and layered process. The process encompasses three distinct levels, influenced by how effectively organizational and professional boundaries are navigated. At the fragmentation level, care is disjointed, leading to a lack of cohesion among providers. The dependence level sees professionals relying on each other yet struggling with boundary issues. Ultimately, integration is possible when care providers collaboratively transcend organizational divides, leveraging their collective expertise while maintaining clearly defined accountability lines.

Conclusion: Establishing clear pathways for robust collaboration is pivotal for care integration. However, care integration from the patient's perspective does not prevent healthcare professionals from encountering fragmented roles. This underscores the importance of clearly defined accountability lines to support shared responsibility and to bridge gaps across professional and organizational boundaries.

Relevance to Clinical Practice: This research emphasizes the need for adaptive collaboration to support integrated care for persons with complex needs. It underscores the importance of clear accountability and communication pathways in organizational borderlands to provide person-centered care and meet individual patient needs.