Development of a perioperative core process and structure indicator set using modified COMET methodology and participatory approaches

Background: Robust, patient-centred indicators are important to quality of care. This study aimed to develop a core indicator set for structure and process in perioperative care using a participatory, evidence-informed approach. Methods: We conducted a three-phase project based on modified COMET methodology. Indicators of process and structure in perioperative care were identified from a systematic review and mapped to a 10-domain conceptual framework developed in parallel. Stakeholders, including patients, carers, and clinicians, took part in indicator refinement and prioritisation through four rounds of surveys. Quantitative analyses assessed rank stability, attrition bias, and consensus strength, while qualitative comments were thematically analysed. A consensus workshop and consultation were used to finalise the indicator set. Results: From 657 sources in the systematic review, 615 perioperative indicators were identified (324 process, 248 structure, 43 unclear) and were mapped on to the conceptual framework. Four survey ranking rounds involving over 250 stakeholders reduced the number of indicators to 142, showing high stability (ρ = 0.89, W = 0.712) and increasing agreement. A consensus workshop with 26 participants produced a final set of 56 indicators (28 core and 28 desirable) that aimed to balance feasibility, impact, and patient-centredness. Conclusion: This participatory process produced a consensus-based, multidimensional core set of perioperative structure and process indicators reflecting both clinical relevance and lived experience. The indicator set is likely to be valuable in quality-related activities. The methodology used offers a potentially transferable model for developing indicator sets of process and structure.