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Whoever believes that the ‘scientific’ method should not be the sole approach to quality assurance and evaluation research may be attracted to fourth-generation evaluation The first three generations of evaluation have been categorized as ‘measurement-orientated,’ objective-orientated’ and ‘judgement-orientated’, whereas fourth-generation evaluation is ‘negotiation-orientated’ In the present paper the author embarks on a description of these generations and makes suggestions for the implementation of fourth-generation evaluation in the health care setting The appeal of fourth-generation evaluation is that it argues for all ‘stakeholders’ to have a right to place their claims, concerns and issues on the negotiating table The evaluator acts as a facilitator of the evaluation process ‘Stakeholders’ refers to all people in the setting who are affected by the evaluation, including managers, evaluators, medical and nursing staff Participation of patients/clients is central in the negotiation process