Swedish health care organizations are experiencing pressure to make ever greater efforts to rationalize and to increase effectiveness in the way they plan and provide services. In order to gain a better understanding of the current practice of the three groups of key actors in Swedish health care--politicians, senior civil servants and operational managers--and their perception of effectiveness, a study was carried out in a Swedish county council using both qualitative and quantitative methods. While in general the concept of effectiveness is thought of as crucial, it is not clearly or uniformly defined within the organization. Each of the three groups defines the concept in a way that reflects their own function, which may lead efforts to achieve effectiveness into a blind alley.