Purpose - Responding to demand fluctuations is a difficult problem in the marketing of services. This problem is particularly difficult in the delivery of health care, as it requires a complex network of facilities, equipment and trained personnel. This paper aims to examine how health care organizations are deploying volume flexible strategies in response to these changing demand patterns. Design/methodology/approach - This research used interviews with hospital administrators and a survey of administrators at academic medical centers in the USA to identify the use of internal and external volume flexible strategies, their impact on the creation of volume flexible capability, and their impact on performance outcomes. Findings - The results show that there is a positive relationship between the use of internal volume flexible strategies, volume flexible capability, patient satisfaction, and organizational performance. Research limitations/implications - Although the measures used in this study were adequate for this exploratory research study, they require further development to improve their reliability as well as to capture additional dimensions of the constructs examined. Practical implications - The results validate the impact of these strategies and indicate that internal volume flexible strategies are positively related to patient satisfaction and organizational performance. Originality/value - Although health care organizations have implemented these strategies, little is known about their use or the impact that they have on satisfaction and performance - this work addresses this gap.