Beyond “Challenging”: Using 8 Steps for Clinical Problem Solving

“Challenges” has become a popular phrase, even in lactation circles. It seems everyone talks about encountering “challenges.” I don’t. A professional deals with real, multifaceted, complex, persistent, thorny problems—and strives to solve them. Nearly every day, clinicians tell me about the many “challenges” they have encountered, for which they have found no effective solution. A part of the problem must be that few are using a process for problem solving, such as this classic 8-step problem-solving process. 

Step 1: Define the problem

As Charles Kettering, the famed inventor and head of research for GM said, “A problem well-defined is a problem half-solved.” Here’s an example: Often, I hear professionals claim that a client “doesn’t have enough milk.” Actually, she has plenty of milk, but her baby is not getting it. Ooops.  

Step 2: Gather data

Professionals have an obligation to gather all of the relevant data. This step involves both finding facts and exploring feelings. Most people immediately recognize the facts related to the problem; far fewer recognize the clients’ feelings — positive or negative. Yet, feelings have a huge impact on whether the problem will be solved.    

Let’s say the mother’s baby has trouble latching. We think a shield would help, but are fearful that the baby will become “addicted” to the shield. Instead, we offer a nursing supplementer. We don’t realize that the mother really hates using it. Ooops. Ignoring the mother’s feelings are likely to have serious implications for how long the mother continues to breastfeed. (For more about using gadgets to support the breastfeeding mother, read here.)

Step 3: Analyze the data

Look at all of the data you’ve gathered. Try to identify the root causes of the existing problem, and determine how the information “adds up.”  Whereas Step 2 is more about developing a list or a description, this step is more about breaking down the information you’ve obtained in a way that helps the pieces to fit together.  

Step 4: Generate possible solutions

This means brainstorming to come up with a long list of possible solutions. (Brainstorming is a specific technique; it is not aimless “discussion”.) The temptation here is to jump to the most commonly-used solution.

Jumping to conclusions often happens. For example, I pose a question to an IBCLC only to be told the solution is to “tell the mother to pump.” When I ask, “What are some other options?” the IBCLC is stumped. Pumping may have merit, of course! But seldom is it the only solution, or the first solution.  

 In any case, your aim is to generate at least three possible solutions–preferably many more–in the process of problem-solving.  

Step 5: Select a solution

This is about weighing the risks and the benefits. Most of us are immediately drawn to the benefits of an action; it’s often hard to take a step back to see the risks. But tactics to fix a short-term problem can impede a long-term strategy. Be sure to take note of the whole picture–both the benefits and the risks. 

Step 6: Plan and implement

Think about what preparation and resources you need in order to “do” your chosen selection. Then do it! This step is about both planning and acting.  

Step 7: Re-visit the problem

Did your action solve the problem?  

 As a young nurse, I often noticed that people were in pain, and nurses gave pain pills. But few nurses checked back to see if the pain pill really helped the client. In the breastfeeding world, the “pills” we give are typically actions or recommendations, but we need to make sure that we check back in to see whether they have helped to relieve the “pain.”  

Step 8: Continue to improve

In addition to the clinical problems we face with clients, we’ve all had real, thorny issues in our own lives. If you’ve ever had trouble losing weight, getting out of debt, housebreaking a puppy, growing a plant, or passing an exam, you know what I mean!  

With that in mind, you should realize that when you’ve helped the client to solve a problem, you must also find ways to prevent or minimize the problem in the future.  

How do you apply any of these steps in your life, or with mothers and babies in your care?