The purpose is to describe the essential components and output of the tactical planning process and to explore context-related variations in the applicability of the planning process for hospital departments. The paper is based on a multiple-case study of three hospital departments’ planning processes at a tactical level, wherein the department manager’s support of the planning process was found to be essential. This study illustrates how an active tactical planning process can provide for numerous potential measures to adjust capacity and how they may vary in different contexts. An active tactical planning process provides the ability to move from current short-term, costly fire-fighting measures to more proactive capacity adjustments within hospital departments, which allow the department to stay under budget while keeping waiting times and queues within limits.