Standardisation vs. Customisation in healthcare. Can we achieve a balance, or is it a myth?

Healthcare systems face an inherent tension between the standardisation and customisation of care delivery processes. There exists a delicate balance to be achieved; too much customisation can lead to chaos, consume considerable time, and yield suboptimal outcomes, whereas excessive or inappropriate standardisation can suppress, disenfranchise, and limit clinicians, preventing them from adapting to the specific needs of their patients and their own unique circumstances, thereby also risking adverse outcomes. The challenge lies in identifying the optimal point on the continuum between these two approaches for any given process, a task that demands meticulous consideration and ought to be a primary objective for organisational leadership, standard setters, and regulators.

Recent trends encompass the consolidation of smaller practices into larger health systems, an industrial approach to care processes such as "standard work", and the rapid development and implementation of health information technology. This shift brings with it heightened mandates for measuring and monitoring, including audits of record activity by role type, meaningful use measures necessitating specific team workflows, and requirements for universal documentation of patients' pain levels and learning styles. Although many of these trends are not inherently harmful and some level of resultant standardisation can be beneficial, the way these processes and policies are developed and disseminated is crucial. Large hierarchical organisations often employ top-down strategies for the development, implementation, and enforcement of standards, which can leave providers feeling like mere "cogs in machines" and contribute to increased burnout.

An empowering leadership style that seeks input from frontline workers and decentralises authority might take more time initially, but it is shown to be more effective in the long term. Moreover, shifting authority for clinical oversight of staff functions to a local level can reduce inefficiencies.

It is important to recognise that not all variation is detrimental. Some variations will uncover opportunities for improvement.

At one end of the spectrum, personalisation is often equated with higher quality but at a greater cost, while standardisation is seen as cost-effective, offering fewer features and limited scope for customisation. Yet, in an era where meaningful, real-time analytics are increasingly accessible, healthcare providers can gather outcomes data from local, regional, national, and global sources to create personalised care plans that consider a variety of factors. Standardising care and measuring outcomes allows for the development of customised treatment plans that cater to individual patient needs.

With data as the common denominator, the healthcare sector can achieve a synthesis where standardised care and personalisation intersect, offering the best of both worlds.