Evidence for a front line approach to improving quality
What happens if you give front line care providers the tools to make change? What happens when the people who provide more than 80% of the direct care in nursing homes lead changes?
Safer Care for Older Persons in Residential Environments (SCOPE)
Safer Care for Older Persons in Residential Environments (SCOPE) examines the effects of empowering care aides to take the lead on quality improvement strategies within their units—a bottom-up model for change. SCOPE was motivated by patterns identified in TREC’s first phase TMS data. Care aides reported high levels of emotional exhaustion and cynicism, but also reported high levels of a sense of meaning and purpose in their work. This triggered the idea that empowering care aides to participate in change and quality initiatives, and in fact lead them, might access significant untapped care aide potential. In 2010, TREC launched a feasibility study in seven nursing homes in BC’s Interior region and in two larger Alberta homes. That study brought measurable improvements in resident pain, behaviours and skin health, and improvements in care aide quality of work life. In February 2017 a full SCOPE pilot study (phase 1 of a larger trial) wrapped up in Manitoba. Teams of care aides from seven different nursing homes focused on quality improvement in pain, mobility or responsive behaviours of dementia.
For example, the team from the Salvation Army-Golden West Centennial Lodge “set out to get residents moving and keep them moving.” They worked with 29 residents at varying stages of mobility. Among the team’s strategies: charts and picture reminders outside each resident’s room to communicate the mobility program to staff on other shifts, and a Sunday evening mobility program for residents.
"The biggest impact is probably the growth that I’ve seen in the care aides. Their overall engagement and commitment to the goals they are working to accomplish to benefit residents is incredible." HANA FORBES EXECUTIVE DIRECTOR OF LONG-TERM CARE WINNIPEG HEALTH REGION
Residents who needed staff to push their wheelchairs are now self-propelling. One resident needed help to walk but now ventures on her own with her walker to visit the facility’s pet birds every day. “We saw such improvement firsthand with the residents— they moved better, slept better and their moods were better,” says Rosanette Mintac, a care aide for 17 years and part of the Golden West SCOPE team. “We felt such a sense of accomplishment. Our efforts were recognized by the facility and by families, and our opinions were valued and listened to by the management team.” Mintac now feels confident voicing her opinion, a new confidence despite her years of experience.
“The biggest thing we gained from SCOPE was the voice it gave to care aides,” affirms Kyla Gilmour, director of resident services at Concordia Place, another participating facility. “It was so amazing to see the growth in team members and their passion for quality improvement, and for them to see what a vital role they play in that quality improvement.”
The greatest early improvements from SCOPE are in indicators of staff health and work life, particularly when managers are engaged at participating sites. Improvements in resident outcomes follow. SCOPE is an affordable approach to improving quality, making use of nursing homes’ existing staff and resources. TREC launches the full pragmatic randomized trial of SCOPE in Alberta and British Columbia later in 2017.
"The long-term care sector for decades was forgotten as far as robust research into quality of care. TREC put the quality agenda on the map for researchers and clinical staff. Many quality improvement initiatives developed within the TREC framework can apply more broadly in health care than just in the residential care sector." HEATHER COOK EXECUTIVE DIRECTOR HOSPITALS AND COMMUNITIES, INTERIOR HEALTH (BC)