Document Type: Commentary
Health Services Management Centre, University of Birmingham, Birmingham, UK
This article builds on Mannion and Exworthy’s account of the tensions between standardization and customization within health services to explore why these tensions exist. It highlights the limitations of explanations which root them in an expression of managerialism versus professionalism and suggests that each logic is embedded in a set of ontological, epistemological and moral commitments which are held in tension. At the front line of care delivery, people cannot resolve these tensions but must navigate and negotiate them. The legitimacy of a health system depends on its ability to deliver the ‘best of both worlds’ to citizens, offering the reassurance of sameness and the dignity of difference.