Monday, March 2, 2009

Mapping a conversation

Whether the disease is diabetes, heart failure, asthma or obesity, there is a lot of information that we think is necessary to share with our patients. Unfortunately, none of us have truly perfected the art of sharing that information in a way that universally makes sense to our patients. Maeve Binchy, in her latest book Heart and Soul, eloquently highlights the stories heart disease patients might tell themselves when faced with the doom and gloom of their disease diagnosis. The wise healthcare provider will hear these stories before engaging in any dialog about diets, medications and other disease-based to dos.

Fortunately, disease management organizations are looking for ways to improve the dialog between healthcare provider and patient. Many are embracing the health coaching model and enhancing their use of motivational interviewing or change talk. Lately I've seen reference to conversation mapping in the education arsenal. Medication manufacturer, Merck, has funded work on conversation mapping. Building on this work and in partnership with the American Diabetes Association, Healthy Interactions has developed the U.S. Diabetes Conversation Map Tool (R). This tool has most recently been incorporated into Kaiser Permanente Mid-Atlantic region's diabetes education curriculum. The tool (a 3 x 5 foot table-top visual display) acts as a conversation enhancer allowing a trained facilitator to use the patients' perspectives to guide the discussion and help lead participants to make sustainable lifestyle change to better manage their disease.

Conversation mapping has been around for awhile and is used frequently in organization, research and social media fields. It is a modeling process used to explore complex and ill-defined issues. It can help frame key perceptions that prevent consensus and action-oriented work in a certain area. Conversation mapping can explore the inherent tensions and problems related to changes. Better yet it can frame the various elements of the ‘root definition' of a problem.

Just imagine having the perspectives of policy makers, scientists, physicians, medication and/or surgical device manufacturers, psychologists, dietitians, nurses, town planners, food manufacturers and patients all around the table discussing the future action to take to stem the obesity epidemic? Imagine a conversation mapping tool helping these folks, with many different and divergent perspectives, navigate the complexity of the obesity epidemic to come to a unifying approach for action? What would that conversation LOOK like?

As it turns out, visualizing a conversation isn't that hard anymore. Wordle makes it very easy to "see" a conversation by creating word clouds - the larger a word is in a word cloud the more often it has been repeated. People have been using it to map email threads and Twitter feeds. Possibly we should be using this tool more often. Perhaps evaluating the effectiveness of our conversations or uncovering the focus of our beliefs. Is what we are saying aligning with what we think we are saying? And if we were to "word cloud" the text of our portion of a conversation with that of our patient's portion of the conversation - would it look divergent or similar?

Please note that the word cloud above is from this blog post and was made at

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