Introduction: Dialysis is probably one of the areas of medicine with more guidelines than any other. Issues such as dialysis dose are dealt with in those guidelines, and minimum values to be reached are defined. A target has to be set and reached by using a data-driven continuous quality improvement (CQI) approach. Data collection must be programmed and structured from the beginning. Methods: Fresenius started its activities as a dialysis provider in 1996, following the merger of its dialysis business with the leading service provider in the US, National Medical Care. Currently Fresenius Medical Care’s European activities involve more than 320 dialysis centers located in 15 countries and treating more than 24,000 patients. Management is based on a bi-dimensional organization where line managers can rely on international functional departments. Under this framework, the CQI techniques are applied in conjunction with benchmarking in a system driven by quality targets. In order to combine clinical governance with management targets, the Balanced ScoreCard system was selected. The Balanced ScoreCard monitors the efficiency of each dialysis center compared to an ideal model, targeting maximum possible efficiency whilst having a unique target for patient outcomes. Conclusion: A clear definition of targets is fundamental and activities need to be monitored and continuously improved; scientific collection of clinical data is the key.