Eight hospital clown organizations saw the need to consolidate their knowledge and skill to create a federation and agreed upon a common set of goals. They became the founding members of the European Federation of Hospital Clown Organizations (EFHCO). EFHCO was established on March 3rd 2011. Nowadays EFHCO consists of 13 members. The federation aims to develop common standards on competence and good practice within hospital clowning. The federation will organise workshops and conferences on different themes that support hospital clowning and helps to explore and develop. By using subscription fees and raised funds we can support common activities and research that benefit all members. We also intend to raise awareness of the Federation’s existence and its aims and objectives.