Total Quality Management techniques have recently been introduced into clinical practice. We describe the application of process management to hemodialysis therapy in a Spanish public hospital. The "ownership" of the hemodialysis process and its limits have been defined. We present a flowchart with all the activities involved in the process and the task description. Monitoring indicators have been selected according to the recommendations of the US Committee on the National Report on Health Care Delivery. Data sources for indicators have also been described.