This paper reports the findings from a case study research about in-depth analysis of decoupling point as a reference model to address a particular management dilemma. Managers from a health service organisation contacted the researchers to investigate possible causes of a managerial dilemma where managers and clinical professionals were not able to agree on a satisfactory decision. Researchers designed a decoupling point reference model where decision-making was taking place to decide which particular process would be chosen for treatment. Clinical professionals were favouring a particular process because of health benefits to patients, whereas managers were more inclined to support a different process, which seemed to bring better outcomes for the organisation. The decoupling point implied applying a hybrid strategy where lean and agile paradigms coexisted so that particular operational views of these different groups of professionals could be taken into account simultaneously. The current performance management system indicated some limitations in the sense that it did not include relevant knowledge of the processes that the reference model suggested. The paper concluded that reference models have potential to offer benefits if considered as tools of process-driven analysis for service organisations. They could serve to find out about potential conflict between different professional groups, as well as indicating the limitations or weaknesses of other critical aspects of management such as measuring of performance and allocations of resources so that better integration across all facets of the service could be achieved.