Health care quality in current terms started towards the end of the 19th Century.

Its origin goes back to analysis on the variability observed in mortality rates of hospitalized patients, being developed from Codmans studies on efficacy of surgical interventions in the early 20th Century. From then, its development has been vertiginous, both in its focus and its method and scope, covering all health care professional. The aim of quality management systems is to decrease variability in clinical practice, both when establishing an indication (either medical or surgical) and when getting it into practice and all the subsequent process.4 Therefore, it is more and more necessary to have tools that allow comparing results of activities of different centers and countries between each otherHaemodialysis (HD) makes survival possible for more than a million people with end-stage renal disease (ESRD) throughout the world. Still, it is a continuing notion everywhere that the survival rate for prevalent dialysis patients is low and without significant improvement in later years. At the same time, the healthcare spending for ESRD patients on dialysis is immense and the growing population of ESRD patients represents a significant economic burden to countries worldwide.1 Dialysis providers are facing increasing pressure to become more cost efficient; reducing costs for dialysis delivery, while at the same time improving or at

least maintaining quality of care. Within quality management, benchmarking is another methodological tool expected to yield the best results. Benchmarking is an operating process of permanent learning and adaptation aimed at optimisation of results; it consists of apprehending, adapting, and implementing already tested methods that have given positive results in other organisations. This requires knowing how that process was developed and what practice made it possible to achieve a high performance level. The purpose is to obtain an indepth knowledge of the factors that allowed for such improvement, which is stimulating for both the entity taken as reference and for the one that wants to implement such improvement in its organisation. Benchmarking acts as a mechanism for cooperation and collaboration between similar organisations in order to share information to improve their processes. It involves helping another department to face similar situations or problems based on a proven practical experience and sharing information. All this will serve to establish standardised alternatives for future development because, among its results, benchmarking provides a measure of excellence that may be used as a comparative standard