Table 1

Concept Mapping Steps and Lessons Learned

StepDescriptionLessons Learned
PreparationIdentifying and recruiting stakeholders; creating and testing the focus promptBuild 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 sequentiallyAllow 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
InterpretationSharing output with participants for interpretation as a group with facilitationCan generate maps with interpretative guidance from some stakeholders but not necessarily all
For our practice improvement purposes, interpretation step not emphasized
UseBrainstormed solutions, visual conception of “problem space,” graphical displays of concordance between groups in ideas can drive practice changeConsider presentation at staff meetings and faculty meetings, and across multiple stakeholders, including those not involved in the other steps