Table 1

Contrast Between Standardization and Customization in Health Care

Conception of health careTransactionalRelational
Conception of cliniciansClinicians will perform better with clear standards and regulations.Clinicians are the interpreters between the guideline and the individual circumstance and can be trusted to use good judgment in working for patient’s best interests.
Organizational approachThe approach is one of management: to regulate systems and direct individuals.The approach is one of leadership: to optimize systems and to guide individuals.
Change management strategyThe strategy is command/control; design and deploy.The strategy is to empower and encourage.
Management approachManagement makes top-down decisions, ideally with local input.Management encourages local engagement; promotes agency for the teams.
Resultant cultureCulture may have elements of security as clinicians don’t have to exert judgment over standard processes, yet culture also has elements of learned helplessness, along with fear or moral distress when the standard processes don’t match the needs of the patients.Culture is possibility-based; clinicians are empowered to embrace responsibility and creativity, and yet this requires additional cognitive work and accountability for outcomes beyond that of simply following a process.
At its worstOppressive; flawed standards and metrics may harm people and cause burn-out.Chaotic, unreliable, poor quality, difficult to measure.
At its bestImproves the chance that routine and required tasks will be performed, freeing clinicians for deep thinking and relationship building.Allows modification of care processes for people’s individual needs. Builds trust. Encourages innovation.
Example of care at its bestSystem-wide initiative to reduce cardiovascular events by promoting medication adherence at every opportunity (office consult, flu shot, pharmacy visit, etc).Primary care team at satellite clinic develops a workflow that includes co-location of reception staff with nurses and MAs, allowing greater sharing of care under the supervision of the local site leadership.
Contrary to hospital rules, a husband was allowed in bed with his dying wife and to bring extended family members into the ICU.10
  • ICU = intensive care unit; MA = medical assistant.