Introduction (continued)

The literature on performance improvement describes several primary factors, often interrelated or complementary in their impact, that support good performance in the work place (see table below). When a performance problem is identified in terms of these factors, a solution or intervention usually becomes clear.

The Performance Factors	Possible Interventions
1. Job expectations Do providers know what they are supposed to do?	Provide adequate performance standards and detailed job descriptions Create the necessary channels to communicate job roles and responsibilities effectively
2. Performance feedback Do providers know how well they are doing?	Offer timely, constructive, and comprehensive information about how well performance is meeting expectations
3. Physical environment and tools What is the work environment like, and what systems are in place to support it?	Develop logistical and maintenance systems to provide a satisfactory physical environment and maintain adequate supplies and equipment Design work space to suit activities
4. Motivation Do people have a reason to perform as they are asked to perform? Does anyone notice?	Seek provider input to identify incentives for good performance Provide positive consequences for good performance and neutral or negative consequences for below standard performance Encourage co-workers to support new skills
5. Skills and knowledge required to do the job Do providers know how to do the job?	Ensure job candidates have prerequisite skills Provide access to trainers and information resources Offer appropriate learning opportunities

Health care providers can only perform as well as the systems that support them. Leaders and supervisors are responsible for building and sustaining organizational structures that enable providers to work at expected performance levels. The five performance factors are tools that can be used to analyze performance and provide exemplary support.

The final factor on the list, required knowledge and skills, is addressed primarily through training and learning interventions. Interventions directly targeting the other four factors are not described in detail in this guide. However, supervisors and other stakeholders often need to address these factors to help ensure that the knowledge and skills acquired by learners result in improved performance on the job. As you read the strategies proposed in the matrix for transferring learning, you’ll see many references to these performance factors and the organizational structures that support performance.