Abstract
Health care, once resolutely customized, is now a process comprising an uncomfortable mix of custom and standard elements. Although the operations management literature often advocates the separation of custom and standard processes, health care managers must usually provide both simultaneously, attempting to combine the two types of service process within a single organization dynamically. If this is not done effectively, quality of care can suffer. Using examples drawn from health care delivery, this paper introduces three operational strategies for effectively combining custom and standard clinical processes. The choice of operating strategy depends on the nature of the patient's needs and the state of medical knowledge.