Safer Care for Older Persons (in residential) Environments

What is SCOPE?

Safer Care for Older People (in residential) Environments (SCOPE) is a randomized controlled trial which examines the effect of a quality improvement (QI) intervention which empowers Care Aides to take the lead on improvement strategies within their nursing home.

SCOPE also provides additional training/coaching for facility management on how to support the frontline teams to succeed with their improvement strategies.

By empowering frontline staff such as Care Aides, SCOPE aims to increase the use of best practices among frontline staff thereby leading to improved quality of care for residents.

SCOPE also aims to improve quality of work life for staff (e.g., measures of work engagement, staff empowerment and job satisfaction). The intervention places special emphasis on developing the leadership skills of Care Aides and senior leadership for successful operation.

What is involved?

Teams of five staff members on one unit within a participating nursing home initiate and test the effect of quality improvement activities in their daily delivery of care using tools that assess whether a change has occurred. Each team is focused on one of three areas to improve: pain, mobility or behaviour.

Throughout the year the teams receive regular coaching from the SCOPE Quality Advisor, participate in monthly teleconferences, and attend four Learning Congresses. The first two Learning Congress are 1.5-day events that bring together all teams to share their challenges with one another and to participate in educational sessions. The third and fourth Learning Congresses are 1-day events, with the final congress being a Celebration Congress where the teams can celebrate their achievements and share their successes.

Additionally, senior sponsors and team sponsors come together on a monthly basis to receive coaching on how to support the teams (SCOPE Leadership).

What are the benefits?

  • An opportunity to improve care in a selected area
  • Staff learning and development in the area of quality
  • Increased staff engagement and mobilization of their experiential (tacit) knowledge
  • Acquisition of a method that can be used to tackle other quality areas in the future
  • Participation in learning congresses
  • Sessions on leadership for senior facility staff

How will we measure success?

SCOPE SPC ChartOne of the key ways that we will measure success in SCOPE is with control charts. Control charts (run charts) allow us to map resident outcomes (e.g., a quality indicator or a scale) over time and determine if observed improvements are “real” or part of the normal variation seen in clinical settings. The graph shows a run chart from two of the SCOPE pilot sites that worked on improving skin care. The initial increase was attributed to the project prompting more accurate recording. As the project progressed, the proportion of residents with pressure ulcers significantly decreased.

Why is it important?

With increasing rates of dementia there will be an increased demand for residential care for older persons with complex needs. Quality of care and quality of life will remain a major challenge in this vulnerable population. Our SCOPE pilot showed that with support, care aides can successfully lead local quality improvement initiatives resulting in improved resident outcomes and increased work engagement. Our full scale evaluation of the SCOPE model will assess its success across a wider range of settings building on finding from the pilot about how to implement the model. Following the evaluation, we will work with our partners to plan for sustainability and scale-up.



Alberta and British Columbia

Type of study

Randomized control trial (RCT)

Facilities involved

16 facilities in each province

Target audience

Care aides
LTC Facility management

Length of project

12 months, launching in Jan 2018