Physician-Directed Diagnostic and Therapeutic Plans: a quality cure for America's health-care crisis.

The most effective way to improve quality is to reduce variation in the processes of providing a service. Physician-Directed Diagnostic and Therapeutic (PDDT) Plans are a proven methodology for reducing variation in clinical processes and improving the quality of care. A major part of the PDDT Plan process is the development of a critical pathway. Critical pathways are an application of Total Quality Management (TQM) principles to clinical care which have provided clear, tangible results in those hospitals committed to this process. These pathways define the processes, timelines and responsibilities associated with the patient's clinical needs from preadmission to post discharge. Representatives of the various health-care professions involved in treating the specified patient populations work together, led by a physician, to define the processes of care. When completed, everyone involved in treating the patient understands what is to be done, by whom, and when. The pathways allow clinicians to plan ahead and let the patient and family know what to expect. Through establishing standards of care, these critical pathways also reduce the uncertainty of treatment decisions and free physicians from having to practice defensive medicine, and thus reduce cost. While the most visible outcome of this process is the actual PDDT Plan, it is not necessarily the most important. The very process of designing the pathway improves intra- and interdisciplinary communication, and fosters teamwork.