This section introduces the Learning For Performance process and explains its benefits. It also contains descriptions of three areas of work that are fundamental to the process: performance improvement, instructional design and human resources for health.
Health workers1 are among the most valuable resources of any health system. Developing a strong workforce requires training health workers to perform their jobs, updating their skills and knowledge to match evolving health needs and helping health workers advance along appropriate and satisfying career paths.
Learning interventions2 are critical components of offering good quality health care services, ensuring that health workers perform to standard and addressing the human resources for health crisis facing many countries.
Learning For Performance is an instructional design process that is targeted to fix a performance problem or gap when workers lack the essential skills and knowledge for a specific job responsibility, competency or task. The Learning For Performance process combines experience in two key areas: performance improvement and instructional design. This process can be used to develop learning interventions of any scale.
Learning for Performance uses a step-by-step process with practical tools. The steps of Learning for Performance appear in this document in the order they are typically performed. As the development team follows the process, it is often appropriate to go back to an earlier step and refine the outputs to make the education or training program focused, efficient and effective. The Learning for Performance process is flexible and, depending on the situation, it may be possible to use only portions of the process, or enter the process at steps other than the first step. Experience shows that the first few steps usually occur in tandem.
|Box 1: The steps to Learning for Performance|
|Key Companion Resources for Learning for Performance|
Learning for Performance places learning interventions in the context of performance improvement, a method of analyzing performance problems, determining the missing factors that lead to these problems and setting up systems to improve and support worker performance. Performance improvement is based on addressing the factors that need to be in place for workers to perform their jobs to standard. There is some evidence that attention to the performance factors can also improve job satisfaction and staff retention.3
|Box 2: Factors that support health worker performance|
|Performance Factors||Question to identify which factors are missing|
|Clear job expectations||Do workers know what they are supposed to do?|
|Clear and immediate performance feedback||Do workers know how well they are doing?|
|Adequate physical environment, including proper tools, supplies and workspace||What is the work environment like and what systems are in place to support it?|
|Motivation and incentives to perform as expected||Do workers have a reason to perform to standard? Does anyone notice? Do they believe the task is important or that they can perform successfully?|
|Skills and knowledge required to do the job||Do workers know how to do the job?|
When a performance gap is identified in terms of these performance factors, a solution or set of interventions can be matched to the root cause of the gap.
For example, if health workers do not know HOW to do the job, the performance gap is likely caused by a lack of skills and knowledge, and a learning intervention is an appropriate solution.Performance gaps may be identified at different levels. For example:
|Box 3: Is a learning intervention the only intervention needed?|
|When more than one performance factor is responsible for an overall performance gap, coordinating all related interventions helps ensure that, together, the interventions will result in better performance. For the above example where clinic-based health workers are not performing appropriate infection prevention practices to standard, the missing performance factors and related interventions are listed below.|
|Missing performance factors||Planned interventions|
|lack of sterilization equipment and consumable supplies for infection||provide sterilization equipment and ongoing supply of consumables to improve the physical environment in the clinic|
|health workers do not know how to perform appropriate infection prevention||provide training in skills and knowledge for infection prevention tailored to the health characteristics and infection prevention responsibilities, worksite requirements and protocols|
|lack of clear job expectations and performance feedback about infection prevention||
|Key Companion Resources for Performance Improvement|
|Stages, steps and tools: a practical guide to facilitate improved performance of health care providers worldwide. Available Here|
Instructional design is a systematic five-phase process used worldwide in health, education, business and industry to develop training and educational programs. The five phases of the instructional design process are: analyze, design, develop, implement and evaluate.
Learning for Performance applies the five phases of instructional design and strengthens the relevance and efficiency of the learning by systematically linking the curriculum content and learning methods to the job tasks, the specific learners and specific work contexts. This results in better transfer of learning to improved performance on the job. (See References and Resources for more information on instructional design.)
|Box 4: The instructional design process and Learning for Performance steps|
Many countries are taking bold steps to identify human resources for health issues and to meet the goal of getting adequate numbers of "the right health workers with the right skills in the right place doing the right things."4 Wherever human resources issues are identified, a multisectoral approach to planning, developing and supporting the health workforce is recommended. Within the framework of this multisectoral approach,5 addressing the performance of health workers is a key strategy. The Learning for Performance approach can play an important role in enhancing health worker performance.
|Box 5: Selected situations where Learning for Performance supports efforts to address human resources for health issues|
Learning for Performance enhances and increases the efficiency of education and training efforts required to support the following processes:
The Learning for Performance approach offers several key benefits within the context of human resources programming because it:
The structured process of Learning for Performance can be used to develop professional skills, behaviors and attitudes that may be lacking in the traditional education for health professionals. Examples of such skills are: management skills for nurses, supportive supervision, lifelong learning skills, sensitivity to gender issues, treating all clients or patients with respect and empathy (e.g., destigmatization and elimination of discrimination toward persons living with HIV and women seeking postabortion care).
|Key Companion Resources for Human Resources for Health|
In some settings comprehensive human resources for health (HRH) assessments are available.
However this is often not the case. An optional worksheet is included to help training developers
understand and take into account the human resources context in which the Learning for Performance process will
be applied and the specific linkages between a learning intervention and other HRH
strategies and approaches. Additional companion resources for human resources for health are listed below:
Training is often proposed as a stand-alone intervention to fix a service delivery problem. This approach often fails to bring about desired changes in health care or in worker performance, not because the training has failed, but because of a failure to support training with interventions that address other root causes of poor performance.
Every effort should be made to ensure that other potential root causes of performance gaps are identified and addressed to better ensure the success of learning interventions. For example:
Stakeholder support and involvement are critical to the development of learning interventions of any scale. Especially when the learning intervention involves multiple groups, it is essential to convene a stakeholder group or to involve stakeholders at the beginning of the development of a learning intervention and to involve them when key decisions are made. Stakeholder groups may include representatives from: