Although the management literature often treats custom and standard processes as separate, service managers must often provide both within the same operating system, dynamically combining the two types of service process. The challenge this poses is particularly evident in health care, once resolutely customized and now an uncomfortable mix of custom and standard. Using examples drawn from healthcare delivery, this paper proposes four operational strategies for combining custom and standard processes. Sorting strategies group customers into those whose needs can be met with pure a custom or standard process and combining strategies mix the two process types. The choice of operating strategy depends on the characteristics of both the customer's needs and the service processes. Mismatch between these characteristics and the operating strategy chosen is discussed.