Standards have played an important, but often unrecognized role in the development of modern organizations. This role is accentuated by today\u27s growth of large business and government infrastructures, in the turbulent processes of globalization. In this article we investigate the relationships - and tensions – between standardization strategies and service innovation in the health care sector. Our empirical material is nine longitudinal case studies in the Norwegian healthcare sector, collected and analyzed over a period of 20 years. We identify three generic standardization strategies; anticipated standardization, integrated solutions and flexible generification. We argue that the two first strategies do not support service innovation, while the strategy of flexible generification allows for local experimentation, and is also scalable