What is SCOPE?

Safer Care for Older Persons (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 aims to improve quality of work life for staff, demonstrated by measures of work engagement, staff empowerment and job satisfaction.

SCOPE places special emphasis on developing the leadership skills of Care Aides and senior leadership for successful operation. This is achieved by providing 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.

Quick Facts

Alberta and British Columbia

Logomakr_6fb18l.pngType of study
Randomized control trial (RCT)

Logomakr_1NbR52.pngFacilities involved
16 facilities in each province

Logomakr_172HmD.pngTarget audience
Care aides
LTC facility management

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. The teams are made up of 3 Care Aides (one of whom leads the team) and 2 other members of staff, with support from a Team Sponsor and a Senior Sponsor. Each team chooses to focus on one of three areas: recognizing and treating pain, optimizing resident mobility or accommodating dementia-related responsive behaviour.

Throughout the year that the intervention takes place, teams receive regular coaching from the SCOPE Quality Advisor and participate in monthly teleconferences. They also attend four Learning Congresses - events that bring together all teams to participate in educational sessions, and share their challenges. The first two Learning Congress are 1.5-days while 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, via the SCOPE Leadership Stream, senior sponsors and team sponsors come together on a monthly basis and at each Congress, to receive coaching on how to support the teams.

Quality Improvement Team


What are the benefits?

  • An opportunity to improve care in an area selected by the team
  • 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
  • Potential for the spread of improvement methodology throughout the facility
  • Participation in Learning Congresses
  • Sessions on leadership for senior facility staff

How will we measure success?

Baseline data for each facility involved in SCOPE are collected via the TREC Measurement System (TMS). This data collection is repeated 4-6 months after the last Learning Congress to look for any changes. During the intervention, one of the key ways success in SCOPE is measured is with control charts. Control charts (run charts) enable the mapping of 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. Teams are taught how to record data and construct these charts by the Quality Advisors, so that they can see what is changing in ‘real time.’

Why is it important?

Nursing home residents are among the most vulnerable population in Canada. The demand for residential care for older persons with complex needs will only continue to increase. Quality of care and quality of life will remain a major challenge. Our SCOPE pilot (Manitoba, 2010 – 2012) 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 findings from the pilot about how to implement the model. Following the evaluation, we will continue to work with our partners to plan for sustainability and scale-up.


Cranley LA, Hoben M, Yeung J, Estabrooks CA, Norton PG, Wagg AS. (2018). SCOPEOUT: Sustainability and spread of quality improvement activities in long-term care: A mixed methods approach. BMC Health Services Research, 18:171.

Norton PG, Cranley LA, Cummings GG, Estabrooks CA. (2013). Report of a pilot study of quality improvement in nursing homes led by healthcare aides. European Journal for Person Centered Healthcare, 1(1), 255-264.

Cranley LA, Norton PG, Cummings GG, Barnard D, Estabrooks CA. (2011). SCOPE: Safer Care for Older Persons (in residential) Environments – A study protocol. Implementation Science, 6:71.

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