Having a Standard is Different Than Standardization 

Let’s get one thing straight: doctors don’t like the word standardization. 

Say it in a room full of physicians and watch the energy shift. The word implies rigidity––a loss of autonomy. A box too small to hold the nuance and clinical judgment we trained our whole lives to bring to patient care. And when it comes to clinical practice—and the art of medicine—I agree. Standardization has its limits. But this isn’t about patient care at the bedside. It’s about the business side of medicine… and in that world, we’ve got to think differently. 

Here’s the truth: standardization is a tool. But having a standard—that’s a principle.  

Let me explain. 

The Unicorn Exception 

Recently, I sat down with a client who told me, “We can’t standardize anything, we’ve got too many unicorns.” They were talking about their physician compensation model, and I get it. Not every physician fits neatly into a box. Some have national reputations, research funding, niche specialties, or roles that go beyond patient visits. 

But here’s the trap: using variability as an excuse for chaos. 

When you throw out standardization altogether, you’re not empowering people. You’re just avoiding hard conversations. What I told them was simple: you do need a standard approach, even if some people fall outside it. That doesn’t mean ignoring the unicorns. It means having a clear, consistent process for how you handle exceptions. 

For example, maybe your standard compensation model applies to 90% of your physicians. But when someone truly unique comes along, the approach is still the same: bring the case to the compensation committee, have an open discussion, document the rationale, and vote. That’s orderly. That’s transparent. And that’s a standard. 

Order vs. Chaos 

Years ago, I worked with a cardiothoracic leader who never liked the term “standardization.” But he used a word that stuck with me: orderly. 

He didn’t want cookie-cutter rules. He wanted an orderly way to handle complexity. In my mind, that’s exactly what having a standard is all about. 

Healthcare is chaotic. Complex. Full of nuance. But as leaders, our job isn’t to throw up our hands and say, “that’s just how it is.” It’s to bring clarity to chaos. To simplify the complex. To create structures that allow our teams to operate with efficiency, accountability, and fairness—even when things aren’t black and white. 

Context Is Everything 

This isn’t a one-size-fits-all philosophy. The level of standardization you need depends on the context. Are we talking about operational workflows? Recruitment? Compensation? 

When it comes to operations—things like patient flow, scheduling, supply management—you need tight, repeatable processes. Standardization isn’t the enemy; it’s the only way to scale, manage resources, and deliver care reliably. 

When it comes to decisions that require human judgment— like determining the best treatment plan for a patient. —you may not be able to standardize the outcome. What you can do is create a standard approach to decision-making. That’s the difference. 

You Can’t Scale Chaos  

Here’s what it comes down to: you can’t build a sustainable healthcare organization on exception-making and ad-hoc decisions. You have to have a standard—even for things that aren’t standardized. 

Not because it’s easy. Not because it solves everything. But because if you don’t create order, the chaos will win. 

Instead of letting variability become an excuse to avoid structure, let’s acknowledge that thoughtful standards can coexist with nuance. It’s time to reframe how we think about standardization—and define it in a way that works for healthcare organizations and their teams.  

In medicine, there will always be room for nuance. For judgment. For the art.  

But if we want to keep the lights on—and build organizations that are fair, scalable, and built to last—we have to start with this mindset: 

Even where we can’t standardize, we can still have a standard.