An exploration of the organizational performance of a care pathway applied to ambulatory surgery: a systems approach

BACKGROUND: Ambulatory surgery is experiencing significant growth in France and OECD countries, accompanied by a profound transformation of care pathways. Existing performance evaluation approaches remain fragmented, limited to a single dimension, an isolated segment of the pathway, or the perspective of a single category of stakeholders. A systemic and multidimensional approach, grounded in real-world practices, is lacking. OBJECTIVE: As part of research aimed at developing a framework for evaluating the organizational performance of care pathways in ambulatory surgery, the primary objective of this study was to identify the dimensions and sub-dimensions of this performance, and then to explore their interactions within a systemic approach. METHOD: A qualitative study using non-participant observation was conducted in nine French healthcare facilities (public and private, with varied organizational models), covering the entire in-hospital pathway. The observations utilized three analytical perspectives: the facility, patients and their pathways, and professional practices. The data were analyzed using an inductive approach inspired by grounded theory (descriptive, axial, and matrix coding), with double coding and thematic saturation achieved at the seventh facility. RESULTS: The analysis identified 103 codes, grouped into 24 sub-dimensions and then synthesized into five dimensions of organizational performance: flow management, working conditions, professional-patient communication, clinical outcomes, and patient experience/satisfaction. No sub-dimension contributes to only a single dimension; the sub-dimensions are part of an interdependent system. Some emerge as priority cross-cutting levers, notably the quality of the professional-patient relationship (N = 544), the organization of the in-hospital pathway (N = 365), and the information provided to the patient (N = 457). CONCLUSIONS: This research provides an empirical basis for the development of a multidimensional evaluation framework that can be applied to other healthcare systems and used to develop performance evaluation tools at both the institutional level and the macro level by regulators.