Differentiating Between Healthcare Performance and Education Issues

April 1, 2021
April 1, 2021

By: Gen Guanci, MEd, RN-BC, CCRN, Consultant at Creative Healthcare Management

As a young nursing professional development specialist I learned a very valuable lesson: It’s extremely important to understand exactly what the desired outcome of an educational program is. 

Early in my career as a nurse educator, I received a call from a nurse manager asking me to do “customer service” education with her staff.  Off I went. I created an outstanding program.  People came to the workshop.  They laughed. They participated. They gave it rave reviews. So imagine my surprise when several weeks later the nurse manager said to me, “I don’t know what you taught in the class of yours but their attitudes still stink!” Attitude!? I thought, “Education can’t fix a poor attitude!” I spent valuable time and energy creating a course that was 100% ineffective in addressing that leader’s desired outcome. 

The lessons I learned the hard way were: 

1) to find out the requester’s desired outcome

2) to help the requester differentiate between what truly is an education or knowledge issue and what is a performance or behavior issue  

Leadership owns performance issues that are unrelated to knowledge deficits.  Education owns knowledge issues.  There are times when the two issues merge; however, most of the time it really is an either/or deal—it’s either a performance issue or knowledge issue. 

Education vs. Performance Deficits

If an employee isn’t doing what’s required, the question is whether they can’t do the skill or they won’t do it. If they can’t do it, it’s an education issue. If they won’t do it, it’s a performance issue. While there are algorithmic approaches to assist in differentiating if an individual employee has a performance issue or an education issue, the quickest and easiest way I have found is to ask one simple question: “If the employee’s life depended upon it, could they do it?” If the answer is yes, then the leader has a performance/behavior issue to deal with.  Our role as NPD specialists is to ask the right questions to help the leader see this difference.    

I’d like to start a conversation about this to see if we can generate some best practices on how you’ve successfully helped leadership to distinguish between performance and education issues. How are you dealing with requests for education that are clearly not related to education issues? 


As a consultant at Creative Health Care Management, Gen is focused on advancing nursing as a profession and nursing professional development. Whether it’s educating on Relationship-Based Care, helping education departments with structure and competency metrics, or guiding organizations as they establish a culture of excellence, including the journey to Magnet®designation, Gen sees the possibilities in all of her clients.