Many trainers and instructional designers have experienced the frustration of designing and delivering a stellar training intervention only to find out after training that the learners are not performing on the job as expected. Supervisors also experience frustration when staff members participate in training interventions but then do not use their new knowledge and skills to improve their work. Upon completion of the training intervention, the learners had demonstrated the skills competently and passed the knowledge test — so why are they now unable to perform those same skills at their work place? There are many possible reasons.

Historically, training interventions have rarely been successful in resolving job performance problems caused by factors other than lack of knowledge and skills. In some situations, learners acquire knowledge and skills during training only to find that they are not supported in using this new information in their work environment.

Before embarking on the design of a learning intervention and making an investment of resources in training, it's imperative to make certain that you are dealing with a performance issue that can be "fixed" by training. Once you've invested in training, you must then ensure that your learners are supported on the job by their organizations, their work environment, their supervisors and their co-workers.

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 the Performance Factors table). When a performance problem is identified in terms of these factors, a solution or intervention usually becomes clear.

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.