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Metricsfrom page 3

Using Concept Mapping to Improve HealthCare Decision Making

Health and human service organizations,both public and private, engage inplanning for a wide range of voluntary

and mandated reasons. One of the most daunt-ing tasks facing any working group in the healthcare setting is how to come up with a commonframework that can guide their work as a group.Whether you’re doing strategic planning for ahospital, creating a new training program formedical practice staff, or attempting to improvethe performance of your workforce, you need tohave a better way to bring together the differentstakeholders in your organization and help themrapidly form a shared vision for what they will do.

How do most health care organizations dothis today? By way of seemingly endless commit-tee meetings that end up with walls covered byflip chart sheets or post-it notes. And the result?Reports and plans that are, more often than not,ignored. Concept mapping presents a differentway to value the input and knowledge of stake-holders and uses state-of-the-art technology andprocesses to create a common strategic vision.

In about four hours time participants brain-storm a large number of ideas in a facilitatedmeeting or over the Web from anywhere in theworld. Participants then sort and rate thebrainstormed ideas. A powerful software pro-gram groups the ideas into the “big picture.”This picture, or concept map, illustrates graphi-cally all the ideas in a series of idea “clusters.”These clusters or groupings of ideas can then beused to encourage better team decision-making.

Using concept mapping has enabled manydifferent kinds of health care organizations toprioritize ideas, assess consensus, determine

gaps and develop more effective action plans. Itis really a better way to put ideas in action.

Case Study, St. Mary’s Hospital inAmsterdam, New York11

Hospitals organizational planning needs areoften best met through a strategic planningexercise. The most successful strategic plan-ning activities are highly participatory and gatherdata from many sources. But this process can betime consuming and slow to develop consensus.In the case of St. Mary’s Hospital in Amsterdam,N.Y., the potential for a corporate merger andservice expansion activities further complicatedthe planning process. The situation required arapid planning process that would include highlevels of participation and generated a productto inform operational planning and serve as amarketing tool. After two planning meetingswith key administrators, a concept mappingexercise was conducted. In two meetings ofapproximately five hours total, board membersand department heads created a concept mapand related database that was used as the basisfor completing operational plans.

Case Study, York County Maine22

York County in the state of Maine needed tocoordinate its health and mental health servicesmore effectively. A broad cross-section of ser-vice providers mapped the major service issuesand needs. This initial map showed that, whilethere was considerable overlap of services insome areas, there were far too few servicesavailable for the elderly. This led them to de-velop a second map that concentrated on the

By Mary Kane andPatrick Q.McMahon, MPA

� target staff for education and training op-portunities;

� justify FTE increases or decreases; and� justify technology enabler expenses.

Good luck as you endeavor to improve yourorganizations financial performance throughbusiness process change, and don’t be hesitant

to contact neighboring facilities or practices tofind out how they are handling data gatheringchallenges. �

Jonathan Schiller, MS, is a senior consult-ant with Cap Gemini Ernst & Young’sHealth and Life Sciences Consulting Servicesnational healthcare practice. He can bereached for comment at 716/233-0326 orjonathan.d.schiller@us.cgeyc.com

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See Concept Mapping, page 7

kinds of services they might provide the elderly.This second map led them, among other things,to the realization that there was a population of“well elderly” that had considerable power andfinancial resources but were primarily con-cerned with issues of immediate significance tothemselves (e.g., socialization activities). Theyformulated a plan to engage these “well elderly”in advocacy for services for the elderly who weremore in need of services and less able to helpthemselves.

Case Study, Southern Tier HealthServices Network33

In rural areas of the country, the importanceof bringing service providers, consumers, andthe public together for improving access toservices is a high priority in today’s society.Perhaps this need is felt nowhere as keenly as inthe area of community health. Rural healthnetworks in New York State are among the bestdeveloped and resourced in the United States;however, they struggle with issues of participa-tory planning and action. The concept map-ping process was used in a half-dozen differentapplications to develop consensus and direc-tion for these groups. The stakeholders repre-sented 25-35 citizens and service providers whocame together to identify “health network pri-orities” and areas of service that address com-munity needs.

The Southern Tier Health Services Networkdeveloped a set of priorities for future action.Within two meetings they had maps and data-bases that indicated program priorities and theability to disaggregate data to determine the“political” realities of competing priorities withinthe network. These same databases were used asthe basis for program evaluation and manage-ment of program operations.

Creating A Pattern MatchBy working with concept maps, a group of

people can rapidly explore the relative impor-tance of different ideas and use this sharedvision as the basis for further action. Patternmatching allows you to compare, both visuallyand statistically, two ratings from a concept mapin order to explore consensus, track consis-tency over time or evaluate outcomes relative toexpectations.

Pattern matches are based on the informa-tion in a concept map. To create a patternmatch, you simply decide what you want tomeasure and select the groups you want to

compare. The Concept System does the rest foryou.

Pattern matching can be used to:� assess consensus by comparing the views of

different stakeholder groups, e.g., managersvs. line staff or one department versus an-other;

� relate the importance of various programelements to the financial support given tothem;

� match expectations for a project with thework accomplished to date;

� tack the consistency of performance overtime; and

1Project planners develop the focusof the project, such as the

components of a new training programor the strategic performance objectivesfor their organization;

2Project planners identifyparticipants from staff and

stakeholders;

3Group generates ideas over theweb using internet software or in a

facilitated group session using theConcept System Core Program;

4Participants organize the ideas bysorting them into groups of related

ones and rating them according to a

one or more 1-5 scale (i.e.,importance or feasibility);

5Using state-of-the-art software andanalytic methods map the ideas for

the entire group, and provides a singlegraphic that acts as a roadmap orblueprint for subsequent work;

6Project planners and/or participantsinterpret the maps, discuss how

the ideas are organized and identify thecritical high priority areas;

7Organization utilizes the maps toorganize for action, examine

consensus and evaluate subsequentactions.

It takes only a few simple steps to create a concept map:

Figure 1: The Concept Mapping Process

Creating a Concept Map

Steps in Concept Mapping

7. Utilize Maps

6. Interpret Maps

5. Compute Maps• Multidimensional scaling• Cluster analysis

3. Generate IdeasBrainstorm ingroups or on line

2. Identify participants

1. Develop a focus

4. Structure Ideas• Sort• Rate

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Figure 5: In this case, the layers in the clusters show the relativeimportance of that topic. (To compare subgroup ratings, use patternmatching.) Here, Efficiency and Employee Issues are considered by theraters to be the most important while Community Relations is judgedleast important.

Figure 2: Ideas are brainstormed and then sorted and rated by eachparticipant

Figure 3: The Concept System software automatically takes thesorted ideas, clusters them into concepts or groups of ideas andplaces them on the map. This example shows the brainstormedideas that were grouped into a cluster called Employee Issues.

Reading A Concept MapConcept maps pack an enormous amount of information into a concise, readable graphic. This example shows a strategic planning project.

Figure 4: Clusters that are closer together are more similar in meaningthan ones that are farther apart. For example, the Employee Issuescluster is closer to (more similar to) Employee Relations/Communications than it is to the Databases cluster. Participantsinteract directly with the map to examine different arrangements ofideas.

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Concept Mappingfrom page 5

� assess how well outcomes or results meet thegroup’s expectations.The pattern match in the box at right shows

the level of consensus between managers andstaff working on a strategic planning project.

At this point in the process the final conceptmap might be used to enhance either a plan-ning or evaluation project. The uses of the mapare limited only by the creativity and motivationof the group. The planning group might use itfor dividing up into subgroups or task forces,each of which is assigned a specific cluster orregion. Each task group could then examineissues like: the organizational budget allocationfor each cluster, how organizational personnelare distributed within each cluster, how impor-tant each cluster is relative to the others, howconsensus be improved, what resources mightbe brought to bear in addressing each cluster,what level of competition exists from otherorganizations providing services in each clus-ter, and so on.

Concept mapping can bring order to a taskthat is often extremely difficult for groups ororganizations. First, it encourages the partici-pant groups to stay on task and layout a frame-work or focus for a project relatively quickly.Second, it expresses the conceptual frame-work in language participants and stakehold-ers can understand. Third, it results in a graphicrepresentation that at a glance shows all of themajor ideas and their interrelationships.Fourth, this graphic images are understand-able to all of the participants and can be pre-sented to other audiences relatively easily. Fi-nally, observations over many concept-map-ping projects clearly show that groups are morecohesive, morale is enhanced and decision-making is improved. �

References1. This project was performed in conjunction with

Don Tobias, PhD and William Trochim, PhDDepartment of Policy Analysis and Managementat Cornell University.

2. This project performed in conjunction withWilliam Trochim, PhD., Department of PolicyAnalysis and Management at Cornell Univer-sity.

3. This project performed in conjunction withKen Oakley and the Southern Tier Health CareSystem, Inc.

To learn more aboutconcept mapping, e-mailMcMahon at mcmahon@conceptsystems.com orlook at the Web site atwww.conceptsystems.com.

Mary Kane is the president of Concept SystemsIncorporated, Ithaca, N.Y. She has morethan 25 years’ experience with nonprofit andacademic organizations. She has for morethan eight years helped many governmentagencies, national associations, nonprofitorganizations, and private businesses develophundreds of concept mapping projects.

Patrick Q. McMahon is the director ofcommunications for Concept SystemsIncorporated, Ithaca, N.Y. He has more than20 years experience working for healthinsurance companies, hospitals, medicalpractices and consulting companies.

Figure 6: This pattern match shows the level of consensus between managers andstaff working on a strategic planning project.

1The labels on each side are the samelabels that were used for the clusters

in the concept map. The order of thecluster labels from top to bottomshows the order of importance for eachgroup.

2Color-coded line for each clusterlinks the average importance ratings

of the managers and staff. Sharply angledlines suggest a “disconnect” betweengroups; horizontal lines suggestagreement. Here, there is a cleardisconnect between managers and staffon the importance of Databases and

Employee Issues while the two groupsagree that Community Relations islowest in importance.

3Each pattern match generates acorrelation, a number that indicates

the overall degree of agreementbetween the groups. Correlations rangefrom +1.0 (perfect agreement) to -1.0(opposite views). Here the lowcorrection of -.17 indicates there islittle overall consensus between staffand management (even though they mayagree well on certain topics likeCommunity Relations).

Pattern Matching