This paper discusses ways forward in terms of making efficiency measurement in the area of health care more useful. Options are discussed in terms of the potential introduction of guidelines for the undertaking of studies in this area, in order to make them more useful to policy makers and those involved in service delivery. The process of introducing such guidelines is discussed using the example of the development of guidelines in economic evaluation of health technologies. This presents two alternative ways forward - revolution , the establishment of a panel to establish initial guidelines, or evolution - the more gradual development of such guidelines over time. The third alternative of status quo , representing the current state of play, is seen as the base case scenario. It is concluded that although we are quite a way on in terms of techniques and publications, perhaps revolution, followed by evolution is the way forward.