Efforts to implement case management and, subsequently, to develop critical paths at Birmingham Baptist Medical Center Montclair in Birmingham, AL, began in the late 1980s. Under the case management system, registered nurses using the CareMap system manage the care of 60-80% of the medical center's patients. Those patients whose care does not follow a map are managed by nurse case managers. The patients who do not meet the identified goals for care require a collaborative effort from all the healthcare professionals associated with their care. Since the inception of the case management program, Montclair has made significant strides in decreasing the cost per discharge, decreasing the variable cost per case, and, most importantly, improving quality outcomes for designated case types.