Abstract: The Dutch Institute for Healthcare Improvement CBO started in 1982 with the development of clinical guidelines in cooperation with medical specialists. In the beginning, our guideline development procedure followed a consensus-based methodology. In the late nineties a new approach was adopted promoting guideline development based on evidence and comprising a number of steps. These include(after selection of the topic and formulation of the clinical questions) a systematic literature search, critical appraisal and grading of evidence in the literature, drawing conclusions and formulation of recommendations. To make these steps transparent for the end-user of the guideline a special guideline structure visualizing each step taken has been developed. The first part, "the scientific justification", consists of a summary of existing evidence. In this part the most important studies are summarized and critically appraised. In the second part, a conclusion is drawn. The conclusion based on literature review is being delineated and presented in a visually attractive way accompanied with a list of key references used. The grading of the evidence of these references is also visualized here. Digressing from the procedure used previously, where the recommendations followed directly the literature summary, the new structure envisages a separate third part outlining the rationale for the final recommendation. We clearly separate here the evidence from other considerations of the experts that influence the content of the final recommendation like patient satisfaction, harm, compliance, costs, availability in the national health care system and organizational and implementation aspects. In contrast to the increasing amount of literature available on effectiveness of an intervention, limited evidence can be found regarding other consideration listing above. Therefore expert opinions are being used, and are presented in a separate third section. The fourth part contains a synthesis of the evidence based conclusion (second part) and other considerations (third part) underlined by attractive editorial lay-out. This, forth part, represents final recommendations of the guideline, applicable in daily practice. The new structure is being developed in order to increase the transparency and clarity of the translation process from evidence presented in literature to recommendation applicable in daily practice. An added value might be the possibility of comparison on the national and international level, with scientific justification and conclusion being objectively defined. The other considerations are more subjective and should be responsible for the variation in guidelines.