Concept Mapping as a Method to Engage Patients in Clinical Quality Improvement

Marianna LaNoue; Geoffrey Mills; Amy Cunningham; Adam Sharbaugh

doi:10.1370/afm.1929

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Table 1

Concept Mapping Steps and Lessons Learned

Step	Description	Lessons Learned
Preparation	Identifying and recruiting stakeholders; creating and testing the focus prompt	Build support for project with leadership; include administrative stakeholders in process Use a third-person prompt Extensively pilot-test focus prompt Recruit many participants; allow for attrition between steps
Generation of statements (brainstorming)	Group, individual, or online brainstorming can be conducted simultaneously or sequentially	Allow brainstorming group process to reach saturation; use a mix of written and group brainstorming to encourage responsiveness by all members Carefully screen output for redundancies and clear wording before using it for the sorting task Solicit responses from a wide range of stakeholders, even if they may not be involved in further tasks Brainstorming output can be used for other visual displays such as word clouds
Structuring of statements (sorting and rating)	Individual sorting of statements into categories online or in person Rating statements in 1–2 domains (impact, importance, feasibility, etc)	Allow ample time and consider remuneration for sorting task For practice-based implementation, provide a large table and quiet space for sorting Consider wrapping process in a practice “engagement day”
Representation (maps and other visual displays)	Creating a point map and cluster maps using multidimensional scaling and cluster analysis Visual depiction of rated statements in clusters “go/no-go” and pattern matching graphical displays	Not all projects will require all visual output types: choose output that satisfies task purpose Point map as an intermediate step is not generally useful: cluster maps are more intuitive displays Some projects may find cluster maps not useful and can move to the other visual displays Pattern matching is especially useful for identifying differences in ratings between patients and clinicians/clinical staff
Interpretation	Sharing output with participants for interpretation as a group with facilitation	Can generate maps with interpretative guidance from some stakeholders but not necessarily all For our practice improvement purposes, interpretation step not emphasized
Use	Brainstormed solutions, visual conception of “problem space,” graphical displays of concordance between groups in ideas can drive practice change	Consider presentation at staff meetings and faculty meetings, and across multiple stakeholders, including those not involved in the other steps

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Table 2

Results of Statement Cluster Analysis With Examples of Idea Statements

Cluster	Examples of Idea Statements
Access and navigation (12 statements)	Assist patients with navigating interactions with other departments Identify patient transportation needs and concerns Give more time for self-management support to the medical assistants Access texting program to help remind patients about appointments, studies, medications, and referrals^a
Empowering patient proactivity and self-care (14 statements)	Patients could participate in creating an action plan for improving their health care^a Encourage patients to bring their medications to their visits Examination rooms could have computers with health-related or disease-specific education modules for patients to view while they wait Patients should have high expectations of our health care system, but they must also be patient: modern health care is complicated and frustrating for everyone at times
Formalize patient involvement in the practice (14 statements)	(Patients could) work on developing standards of care in the practice Provide more opportunities for patient feedback, committees, questionnaires, rating evaluations^a Patients could participate in a “run-through” of practice redesign ideas Patients could draft materials like brochures for procedures
Patient-provider communication (23 statements)	Allow patients to give feedback to their providers Patients could write down questions before their appointment^a Provide a way for patients to give feedback to providers about how they are doing Train the doctors to ask sensitive questions, for example, about sex or addiction
Community resources (20 statements)	(Patients could) assist the practice in identifying community resources that can support health (The practice could) provide help for patient caregivers Offer more interactive health education opportunities^a Provide opportunities in the waiting room for things that patients could participate in
Technology (18 statements)	Have a laptop or iPad at check in for patient health surveys and entering patient information Increase opportunities to communicate with health professionals using portal or website Have a method to help patients track their progress in managing their chronic diseases^a Help patients with computers in the waiting room

↵a An idea that appeared in our go-zone diagram as having both high feasibility and high impact.

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The Article in Brief

Concept Mapping as a Method to Engage Patients in Clinical Quality Improvement

Marianna Lanoue , and colleagues

Background Patient engagement is a priority in primary care research and practice, but there is little guidance on how best to engage patients in practice improvement or how to measure the impact of their involvement. Group concept mapping, a process where concepts in a particular subject area and their interrelationships are visually represented in a map, may be a means to engage patients in primary care practice improvement.

What This Study Found Group concept mapping is a promising method with several potential applications in primary care including practice improvement, research, and evaluation. A quality improvement project with patients and staff found that concept mapping offers a feasible patient engagement technique that can also illustrate and quantify the convergence and divergence of ideas from patients and other stakeholders, highlight the perspective that patients bring to practice improvement, and provide a basis for patient-centered practice improvements. Concept mapping may also be a powerful method for stakeholder engagement in other types of clinical research because it demonstrates and quantifies the effect of patient involvement in the process.

Implications

Group concept mapping appears to be a viable method of engaging stakeholders. The authors call for research to measure engagement as an outcome of group concept mapping.