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The financial challenge facing the UK's health services over the next four years, combined with the relentless rise in the demand for services, means that it is imperative that the NHS delivers more for less. The authors of this report studied UK and international literature on hospital efficiency, and surveyed senior managers and clinicians in six hospital trusts that had been 'turned around' following financial difficulties. They found much research evidence on what measures are associated with higher productivity in hospitals. They gleaned practical lessons from the managers about what successful steps had been taken to improve efficiency in their financially challenged hospitals. An accompanying research summary highlights the report's key findings within the context of the current Government health reforms. The publications and other resources, together with more information on our work in this area, can be accessed at www.nuffieldtrust.org.uk/efficiency