Critical path analysis in head and neck cancer: a management technique for surgical oncology.

This paper describes a study of critical path analysis (CPA) as applied to the process of care for patients with head and neck cancer. CPA is a management technique, which has been developed in both the Armed Forces and a wide range of industries. It identifies the parts of a process where improvements are most likely to make an impact on the overall time for that process. There is evidence that reducing the overall times for an oncology care process has a major impact on outcome for patients. This paper describes an appraisal of a formal application of CPA in the setting of oncology. The technique was applied to a single head and neck unit. The results were compared with published standards for times in the care process and with the comparable times for the whole of the South and West of England. The critical path (the combination of processes that limits the total time taken for the whole process) at this unit ran through the combined oncology clinic, leading to a decision to increase the frequency of these clinics, which lead to a reduction in overall process time for patients. A randomised controlled trial in five centres in the South and West region will follow which includes patient quality of life outcomes and collaborative practice to assess the impact of CPA on the patient care process.