Refining the clinical care process to produce high-quality patient outcomes is becoming increasingly important as healthcare administrators strive for success in a mature managed care environment. This study examines the effect of structuring interventions and the evaluation of patient response, inherent in the critical pathway process, on clinical, length-of-hospital-stay and financial patient outcomes. This study differs from previous critical pathway trials in that an objective measure of quality was used and the critical pathways were not introduced concurrently with a case management delivery model. The results show that critical pathways may be a significant determinant of improved quality in a managed care environment. The findings also suggest ways to improve nursing practice, nursing education, and nursing informatics.