Patterns and Problems

Why you should consider the quality of your questions and your system for finding answers.

New ways of thinking

This past week and today, I have been teaching a history-taking session with students. I actually love this section because it makes sense to me. It’s systematic, we are trying to solve a problem, and you get to investigate and ask questions – ultimately, to help someone. What’s not to love, right? (or is that just me?)

These students are nurse practitioner students, which means they are nurses who are returning for advanced training. Because they are already nurses, they have prior experience with patients and usually bring with them various types of expertise and skills, depending on where they work. But, the challenge is that this new role requires them to gain new skill sets and new ways of thinking.

The reason I found this interesting is because adding new skills, finding new ways of thinking, and solving problems is common to most people’s lives – regardless of their field.

We all get used to doing things a certain way and it’s very hard to change the way we see things or do things. Therefore, when we need to solve problems, we often guess or jump to action before thinking it through. We base our solutions or actions on only what we know, what has always been done, or assumptions that don’t necessarily have a sound basis. I know that I am certainly guilty of this.

Systems and Coincidences

Here recently, I realized that a few different things I was working on seemed to all merge at one underlying concept: having a system for solving problems. Coincidence?

Let me explain.

As part of my instructional design coursework, I had the opportunity to study performance improvement. According to my fancy textbook definition, performance improvement is “a system used to improve people, processes, performance, organizations, and ultimately society” (Van Tiem, Moseley, & Dessinger, 2012, pg. 5). But, simply put, it’s a process for solving problems or finding opportunities by asking really good questions before jumping to conclusions and taking actions.

Right now, I am reading Ray Dalio’s book Principles. In one part of this book, he recommends a 5-step process for getting what you want out of life and work (see process under resources). Interestingly, these steps look very similar to those steps within the performance improvement model we use for solving problems.

Meanwhile, jump to my current work assignment, where I am working with students to diagnose their patients. The process we use for interviewing patients, the questions we ask, the way we build the case, and the way we get to the heart of what is causing this person’s problem – it all looks very familiar.


Then, it hit me – these are all pretty much saying the same thing. They are systematic ways of digging into problems or goals. They force you to explore and discover what the truths are. They urge you to find the true sources of problems before taking actions or recommending solutions. Isn’t that interesting?


I don’t know about you, but when I start to see patterns, I pay attention. When some of our best systems are telling us to ask good questions and find real sources of problems in order to find truths – I think that means we should listen.

Resources, Questions, and Processes

Book: Dalio, R (2017). Principles. New York,NY: Simon & Schuster

Below are questions from Ray Dalio’s book, Principles, that made me scream YES!! (Page 202).

  • Are you willing to fight to find out what’s true?
  • Do you deeply believe that finding out what is true is essential to your well-being?
  • Do you have a genuine need to find out if you or others are doing something wrong that is standing in the way of achieving your goals?
  • Do you have a compulsive need to make sense of things? (OMG yes!).

Ray Dalio’s 5 step process for getting what you want out of life

  1. Have clear goals
  2. Identify and don’t tolerate the problems that stand in the way of your achieving those goals
  3. Accurately diagnose the problems to get at their root causes
  4. Design plans that will get you around them
  5. Do what’s necessary to push these designs through to results

International Society for Performance Human Performance Technology Model

History and Physical Patient Data Sheet (created by me for students)

I have had the opportunity to use this sheet with students and they have really liked the process of seeing their questions in this format. It makes it a great tool for seeing patient symptoms, potential diagnoses, history, tests, etc – and then being able to weigh these before making a final diagnosis.–IiiiaGrOMH9858cTD50–o6JgbE7mKXHgEbol7c/edit?usp=sharing

Textbook (for my nerd friends)

Van Tiem, D.M., Moseley, J.L., & Dessinger, J.D. (2012). Fundamentals of performance improvement: Optimizing results through people, process, and organizations. San Francisco, CA: Pfeiffer.

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