The processes described in this article, which first appeared in the fall 1992 issue of Quality Management in Health Care, while long-established in industry, were new to the field of health care quality assessment at that time. As the authors state, "It [critical path analysis] can be thought of as a visualization of the patient care process."1 A critical path, now often referred to as a clinical path, provides a sort of moving picture of the patient's progress from admission through investigation to diagnosis to treatment and finally to discharge or referral. The analogy to an assembly line or a manufacturing process, while possibly offensive to some, is unavoidable.

Two characteristics addressed in critical/clinical path analysis are the efficient sequencing of the procedures carried out and the multidisciplinary nature of the patient care team. In this connection, efficiency in sequencing is defined as that progression that will yield the highest return in terms of providing timely effective care to the patient. Critical path analysis also emphasizes the fact that the members of the clinical team must be able to rely on one another, interacting and communicating across professional discipline boundaries.

During the 12 years since this article was published, a good deal of progress has been made in introducing control charting together with the principles of evidence-based medicine in hospital quality improvement programs. Critical path analysis is the logical process to follow-up on control chart findings in the effort to analyze and improve the quality of the care of the patient. While this pattern seems obvious in 2004, it was not so widely understood in the health care industry in 1992. That is why this article was ahead of its time, and continues to be of practical value.

Jean Gayton Caroll, PhD

Editor

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