<p>In the context of intensified global efforts for carbon neutrality, carbon emission efficiency has emerged as a pivotal aspect in emission reduction strategies. As a result, policymakers require finer-grained insights into the driving forces behind and pathways of carbon emission efficiency improvement. This study developed a methodology to quantify carbon emission efficiency, analyze dynamic changes, clarify the configuration of driving forces, and propose pathway improvements based on 189 cities in China. The results reveal that: (1) carbon emission efficiency exhibited fluctuating growth in China’s cities, improving overall by 20.70% from 2010 to 2019. (2) The pattern of improvement changed in 2017, with urban development starting to benefit carbon emission efficiency instead of hindering it. This change was attributed to the shift from a negative to a positive relationship between urbanization and the carbon emission efficiency (CEE value): the higher the per capita GDP, the larger the population, and the higher the CEE value. (3) Dynamic analysis unveiled a southeastward shift in the spatial distribution of CEE values, with East China (value of 0.78) and South China (value of 0.74) being the two regions with the greatest CEE values. (4) Using the fsQCA approach, this study identified the complex mechanisms driving carbon emission efficiency improvement. It found that by combining urbanization, technological innovation, and industrial reorganization, carbon emission efficiency was practically and effectively enhanced. In conclusion, three efficiency improvement pathways were proposed. This study tells a positive story about carbon emission efficiency. The configuration analysis of trends and driving forces will help scientists and policy-makers balance urban development and carbon reduction so their cities can achieve carbon neutrality.</p>