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In the context of a refocusing of health care around patients, valuation processes are crucial, but they remain exploratory in healthcare facilities. The time-driven activity-based costing (TDABC) method is adequate but rarely implemented. This article aims to identify the concrete challenges of the TDABC method through its application to care pathways within an innovative medical structure, a university hospital institute linked to a university hospital center. The article explains the steps involved in implementing the method and the associated difficulties, in terms of defining pathways and collecting data for recovery. This makes it possible to point out the potential for process improvement during the introduction of the method, highlights the importance of the necessary communication skills, and shows the importance of adapting the method so as not to rigidify the processes but rather to foster innovation. The study makes it possible to emphasize that the TDABC, which appears easy to understand, presents difficulties prior to the final phase of costing.