Some of the most useful insights come from making connections across apparently unrelated disciplines. I first heard Jeff Patton mention medical SOAP notes many years ago, and he reminded me of them again in a recent conversation. What strikes me the most is how much they have in common with Strategy Deployment and the TASTE X-Matrix.
What Is A SOAP Note?
SOAP is a structured format that clinicians use to document patient care. Developed in the 1960s, it remains a widely used clinical note-taking framework. The acronym stands for:
- Subjective – the patient’s complaint and context in their own words
- Objective – the clinician’s observations, examinations, and measurable data
- Assessment – the diagnosis that connects the subjective and objective evidence
- Plan – the immediate next steps for treatment
The purpose of SOAP Notes is to create a cognitive framework for clinical reasoning that links the treatment plan back to the reason for seeking care. Anyone reading the notes should be able to understand the rationale and relevance of the care provided.
The Structural Parallel With TASTE
What interests me is how the elements of SOAP Notes map onto the elements of TASTE and the X-Matrix.
- Subjective and Objective are Evidence. In a SOAP note, the Subjective section captures qualitative data – the patient’s own experience, their description of symptoms, and their history. The Objective section captures quantitative data – vital signs, test results, clinical findings. Together, they represent two complementary kinds of evidence. In the TASTE X-Matrix, Evidence is the outcomes that indicate progress. The SOAP format reminds us that good evidence has both a subjective and an objective dimension. We need the qualitative narrative of how things are experienced as well as the quantitative measures of what is observed.
- Assessment is Diagnosis. The SOAP Assessment is where the clinician connects the dots between the evidence to arrive at a diagnosis. This maps directly to Rumelt’s diagnosis – the understanding of the critical challenge being faced. In Strategy Deployment, I have generally considered diagnosis as a step between Aspirations and Strategy, and more recently have been exploring how the Crux sits at the heart of the X-Matrix. In both SOAP and Strategy Deployment, the assessment or diagnosis is the creative, analytical work of making sense of what the evidence is telling us.
- Plan is Strategies and Tactics. The SOAP Plan describes the immediate next steps for treatment. In TASTE, Strategies are the guiding policies that enable choice, and Tactics are the coherent actions we will take. Together, these describe the approach and the work, which is exactly what a treatment plan does.
The Direction Of Flow
The mapping is interesting, but there is something more insightful going on. In SOAP Notes, the direction of flow is from evidence to action. The clinician begins by gathering evidence – listening to the patient (Subjective) and making observations (Objective) – and this evidence then drives the Assessment and the Plan. A clinician who starts with a Plan and then looks for evidence to support it would be practising dangerously.
This resonates with something I have already been exploring in the Order of the X-Matrix. When populating an X-Matrix in practice, I work through Evidence before Tactics. The reason is to avoid confirmation bias. The risk of discussing Tactics before Evidence is that the Evidence identified becomes biased towards confirming that those Tactics are working. By identifying Evidence first, the conversation becomes about exploring what Tactics might generate the Evidence, rather than what Evidence might validate the Tactics.
The SOAP format reinforces and extends this principle. In SOAP Notes, not only does evidence come before the plan, but the evidence also drives the diagnosis. The Subjective and Objective sections exist to ensure that the clinician has thoroughly understood the situation before jumping to an Assessment or Plan.
This is consistent with the idea that strategy is based on challenge rather than goals. Rumelt is clear that before we decide on goals and actions, we need to understand the situation. The SOAP format embodies this. We should be starting with what we are observing and experiencing – both the qualitative (what people are telling us) and the quantitative (what the data shows) – and allowing that evidence to drive the diagnosis, the strategy, and the tactics.
Implications For Practice
There are three practical takeaways from this comparison.
First, it provides independent validation that the Order of the X-Matrix – working through Evidence before Tactics – is the right instinct. SOAP Notes have been doing this for many years, putting evidence before action. The SOAP distinction between Subjective and Objective is additionally helpful here. Are we listening to what people are telling us (the organisational equivalent of the patient’s own words) as well as looking at the data?
Second, it highlights the importance of the diagnostic step. In SOAP Notes, the Assessment is the critical bridge between evidence and action. In Strategy Deployment, the diagnosis or Crux serves the same function. Skipping this step – going straight from evidence to action, or worse, from aspiration to action – is the equivalent of a clinician prescribing treatment without a diagnosis.
Third, the enduring popularity of SOAP suggests there is something powerful about a simple, structured format that creates coherence. The correlations on the X-Matrix serve a similar purpose, ensuring that every element can be traced back to its rationale. Both SOAP and the X-Matrix are designed so that anyone picking them up can quickly understand what is going on and why.
It is reassuring to find that practitioners in a completely different field have independently arrived at a similar structure. And it is a useful confirmation that the direction of flow matters – starting with the evidence, not the plan.