Collaborative goal setting and action planning are fundamental steps in supporting patient self-management. But setting goals doesn't automatically mean everyone will achieve those goals. Life has a way of interfering with self-management. Patients and their families confront many obstacles, physical, emotional, and financial.

For example, if you and a patient agree that trying a support group one time next month is a good plan, but the patient has no car and the bus ride is very long, the plan may be unrealistic. Sometimes identified obstacles lead to changing a plan – in this case it might mean encouraging the patient to consider a goal  that doesn’t depend on transportation. In other cases, you and your patient might want to work on overcoming the obstacles. This process is called problem-solving and learning it can improve patients’ lives and health tremendously.

One of the best ways to help patients enhance their problem-solving skills is to model the process of problem-solving in dealing with a problem that affects them.

Typically, a problem-solving process with the following steps is helpful:

1. Help the patient identify an obstacle preventing him from achieving his goal (for example, a lack of transportation). Make a list of things that might work to overcome the problem. Brainstorming with the patient, consider options.  For example:
   1. Carpooling with others going to the same meeting, Getting a ride from a relative,
   2. Taking public transportation and bringing a book so that the time it takes that seems like an obstacle becomes an opportunity to read, or Taking public transportation but with someone else going to the meeting so that you feel less fearful on the bus. Finding a closer group.
2. Encourage the patient to select one of the ideas and give it a fair try.  Assess the results.
3. If the problem is solved completely, great! If not, substitute another idea and see how that works If necessary, encourage the patient to seek help from others to expand the list of possible solutions.  
   1. Get help from family, healthcare providers, neighbors, or others. Many people have difficulty finding and asking for help. They might benefit from the “You’re Not in This Alone” section of this site.

Sometimes you will find that the problem is not solvable right now, but may be solvable later. If so, encourage the individual to consider a different goal. Early successes are just as important here as achieving a particular goal.  

In addition to reviewing the steps you have taken together with a patient, providers can also encourage patients to apply this set of steps to future problems.  Consider giving the patient  a handout with the problem-solving steps listed. You can print such a list from this page.

As patients grow in their ability and confidence around problem-solving, their confidence in making healthy choices should improve.