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