Skip to main content
Top
Published in: Implementation Science 1/2011

Open Access 01-12-2011 | Study protocol

SCOPE: Safer care for older persons (in residential) environments: A study protocol

Authors: Lisa A Cranley, Peter G Norton, Greta G Cummings, Debbie Barnard, Carole A Estabrooks

Published in: Implementation Science | Issue 1/2011

Login to get access

Abstract

Background

The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. High resident acuity can result in increased staff workload and decreased quality of work life.

Aims

Safer Care for Older Persons [in residential] Environments is a two year (2010 to 2012) proof-of-principle pilot study conducted in seven nursing homes in western Canada. The purpose of the study is to evaluate the feasibility of engaging front line staff to use quality improvement methods to integrate best practices into resident care. The goals of the study are to improve the quality of work life for staff, in particular healthcare aides, and to improve residents' quality of life.

Methods/design

The study has parallel research and quality improvement intervention arms. It includes an education and support intervention for direct caregivers to improve the safety and quality of their care delivery. We hypothesize that this intervention will improve not only the care provided to residents but also the quality of work life for healthcare aides. The study employs tools adapted from the Institute for Healthcare Improvement's Breakthrough Series: Collaborative Model and Canada's Safer Healthcare Now! improvement campaign. Local improvement teams in each nursing home (1 to 2 per facility) are led by healthcare aides (non-regulated caregivers) and focus on the management of specific areas of resident care. Critical elements of the program include local measurement, virtual and face-to-face learning sessions involving change management, quality improvement methods and clinical expertise, ongoing virtual and in person support, and networking.

Discussion

There are two sustainability challenges in this study: ongoing staff and leadership engagement, and organizational infrastructure. Addressing these challenges will require strategic planning with input from key stakeholders for sustaining quality improvement initiatives in the long-term care sector.
Appendix
Available only for authorised users
Literature
1.
go back to reference Mitchell SL, Teno JM, Miller SC, Mor V: A national study of the location of death for older persons with dementia. JAGS. 2005, 53: 299-305. 10.1111/j.1532-5415.2005.53118.x.CrossRef Mitchell SL, Teno JM, Miller SC, Mor V: A national study of the location of death for older persons with dementia. JAGS. 2005, 53: 299-305. 10.1111/j.1532-5415.2005.53118.x.CrossRef
2.
go back to reference Statistics Canada: Census. Statistics Canada. 2001 Statistics Canada: Census. Statistics Canada. 2001
3.
go back to reference Ramage-Morin PL: Successful aging in health care institutions. Supplement to Health Reports. 2005, 16: 47-56. Ramage-Morin PL: Successful aging in health care institutions. Supplement to Health Reports. 2005, 16: 47-56.
4.
go back to reference Alzheimer Society: Rising tide: The impact of dementia on Canadian society. 2009 Alzheimer Society: Rising tide: The impact of dementia on Canadian society. 2009
5.
go back to reference Bostick JE: Relationship of nursing personnel and nursing home care quality. J Nurs Care Qual. 2004, 19: 130-136. 10.1097/00001786-200404000-00010.CrossRefPubMed Bostick JE: Relationship of nursing personnel and nursing home care quality. J Nurs Care Qual. 2004, 19: 130-136. 10.1097/00001786-200404000-00010.CrossRefPubMed
6.
go back to reference The Organization for Economic Co-operation and Development (OECD) Health Project: Long-term care for older people. 2005, Paris, France: OECD Publishing The Organization for Economic Co-operation and Development (OECD) Health Project: Long-term care for older people. 2005, Paris, France: OECD Publishing
7.
go back to reference National Advisory Council on Aging: NACA demands improvement to Canada's long term care institutions. 2005, Ottawa. Press Release National Advisory Council on Aging: NACA demands improvement to Canada's long term care institutions. 2005, Ottawa. Press Release
8.
go back to reference Dunn F: Report of the auditor general on seniors care and programs. 2005, Edmonton, Alberta: Auditor General Dunn F: Report of the auditor general on seniors care and programs. 2005, Edmonton, Alberta: Auditor General
9.
go back to reference Committee on Nursing Home Regulation: Improving the quality of care in nursing homes. 1986, National Academy of Sciences Committee on Nursing Home Regulation: Improving the quality of care in nursing homes. 1986, National Academy of Sciences
11.
go back to reference Institute of Medicine: To Err is Human: Building a Safer Health System for the 21st Century. 1999, Washington DC. National Academy Press Institute of Medicine: To Err is Human: Building a Safer Health System for the 21st Century. 1999, Washington DC. National Academy Press
12.
go back to reference Institute of Medicine: Crossing the quality chasm: A new health system for the 21st century. 2001, Washington DC. National Academy Press Institute of Medicine: Crossing the quality chasm: A new health system for the 21st century. 2001, Washington DC. National Academy Press
14.
go back to reference Knapp M, Missiakoulis S: Predicting turnover rates among the staff of English and Welsh old people's homes. Soc Sc Med. 1983, 17: 29-36. 10.1016/0277-9536(83)90076-X.CrossRef Knapp M, Missiakoulis S: Predicting turnover rates among the staff of English and Welsh old people's homes. Soc Sc Med. 1983, 17: 29-36. 10.1016/0277-9536(83)90076-X.CrossRef
15.
go back to reference Staw B: The consequences of turnover. J Occup Behav. 1980, 1: 253-273. Staw B: The consequences of turnover. J Occup Behav. 1980, 1: 253-273.
16.
go back to reference Morgan DG, Semchuk KM, Stewart NJ, D'Arcy C: Job strain among staff of rural nursing homes: A comparison of nurses, aides, and activity workers. J Nurs Admin. 2002, 32: 152-161. 10.1097/00005110-200203000-00008.CrossRef Morgan DG, Semchuk KM, Stewart NJ, D'Arcy C: Job strain among staff of rural nursing homes: A comparison of nurses, aides, and activity workers. J Nurs Admin. 2002, 32: 152-161. 10.1097/00005110-200203000-00008.CrossRef
17.
go back to reference McGilton KS, McGillis Hall L, Wodchis WP, Petroz U: Supervisory support, job stress, and job satisfaction among long-term care nursing staff. J Nurs Admin. 2007, 37: 366-372. 10.1097/01.NNA.0000285115.60689.4b.CrossRef McGilton KS, McGillis Hall L, Wodchis WP, Petroz U: Supervisory support, job stress, and job satisfaction among long-term care nursing staff. J Nurs Admin. 2007, 37: 366-372. 10.1097/01.NNA.0000285115.60689.4b.CrossRef
18.
go back to reference Bostick JE, Rantz MJ, Flesner MK, Riggs CJ: Systematic review of studies of staffing and quality in nursing homes. J Am Med Dir Assoc. 2006, 7: 366-376. 10.1016/j.jamda.2006.01.024.CrossRefPubMed Bostick JE, Rantz MJ, Flesner MK, Riggs CJ: Systematic review of studies of staffing and quality in nursing homes. J Am Med Dir Assoc. 2006, 7: 366-376. 10.1016/j.jamda.2006.01.024.CrossRefPubMed
19.
go back to reference Banaszak-Holl J, Hines MA: Factors associated with nursing home staff turnover. The Gerontologist. 1996, 36: 512-517. 10.1093/geront/36.4.512.CrossRefPubMed Banaszak-Holl J, Hines MA: Factors associated with nursing home staff turnover. The Gerontologist. 1996, 36: 512-517. 10.1093/geront/36.4.512.CrossRefPubMed
20.
go back to reference Brabant LH, Lavoie-Tremblay M, Viens C, Lefrançois L: Engaging health care workers in improving their work environment. J Nurs Manag. 2007, 15: 313-320. 10.1111/j.1365-2834.2007.00678.x.CrossRef Brabant LH, Lavoie-Tremblay M, Viens C, Lefrançois L: Engaging health care workers in improving their work environment. J Nurs Manag. 2007, 15: 313-320. 10.1111/j.1365-2834.2007.00678.x.CrossRef
21.
go back to reference Gibbons J: Employee engagement: A review of current research and its implications. 2006, Conference Board of Canada Gibbons J: Employee engagement: A review of current research and its implications. 2006, Conference Board of Canada
22.
go back to reference Castle NG, Engberg J: The influence of staffing characteristics on quality of care in nursing homes. Health Serv Res. 2007, 42: 1822-1847. 10.1111/j.1475-6773.2007.00704.x.CrossRefPubMedPubMedCentral Castle NG, Engberg J: The influence of staffing characteristics on quality of care in nursing homes. Health Serv Res. 2007, 42: 1822-1847. 10.1111/j.1475-6773.2007.00704.x.CrossRefPubMedPubMedCentral
23.
go back to reference Kalisch BJ, Curley M, Stefanov S: An intervention to enhance nursing staff teamwork and engagement. J Nurs Admin. 2007, 37: 77-84. 10.1097/00005110-200702000-00010.CrossRef Kalisch BJ, Curley M, Stefanov S: An intervention to enhance nursing staff teamwork and engagement. J Nurs Admin. 2007, 37: 77-84. 10.1097/00005110-200702000-00010.CrossRef
24.
go back to reference Temkin-Greener H, Cai S, Katz P, Zhao H, Mukamel DB: Daily practice teams in nursing homes: Evidence from New York State. The Gerontologist. 2009, 49: 68-80. 10.1093/geront/gnp011.CrossRefPubMedPubMedCentral Temkin-Greener H, Cai S, Katz P, Zhao H, Mukamel DB: Daily practice teams in nursing homes: Evidence from New York State. The Gerontologist. 2009, 49: 68-80. 10.1093/geront/gnp011.CrossRefPubMedPubMedCentral
25.
go back to reference Mukamel DB, Temkin-Greener H, Delavan R, Peterson DR, Gross D, Kunitz S, Williams TF: Team performance and risk-adjusted health outcomes in the program of all-inclusive care for the elderly (PACE). The Gerontologist. 2006, 46: 227-237. 10.1093/geront/46.2.227.CrossRefPubMed Mukamel DB, Temkin-Greener H, Delavan R, Peterson DR, Gross D, Kunitz S, Williams TF: Team performance and risk-adjusted health outcomes in the program of all-inclusive care for the elderly (PACE). The Gerontologist. 2006, 46: 227-237. 10.1093/geront/46.2.227.CrossRefPubMed
26.
go back to reference Yeatts DE, Cready CM: Consequences of empowered CAN teams in nursing home settings: A longitudinal assessment. The Gerontologist. 2007, 47: 323-339. 10.1093/geront/47.3.323.CrossRefPubMed Yeatts DE, Cready CM: Consequences of empowered CAN teams in nursing home settings: A longitudinal assessment. The Gerontologist. 2007, 47: 323-339. 10.1093/geront/47.3.323.CrossRefPubMed
27.
go back to reference Temkin-Greener H, Gross D, Kunitz SJ, Mukamel D: Measuring interdisciplinary team performance in a long-term care setting. Med Care. 2004, 42: 472-481.CrossRefPubMed Temkin-Greener H, Gross D, Kunitz SJ, Mukamel D: Measuring interdisciplinary team performance in a long-term care setting. Med Care. 2004, 42: 472-481.CrossRefPubMed
28.
go back to reference Scott-Cawiezell J, Schenkman M, Moore L, Vojir C, Connolly RP, Pratt M, Palmer L: Exploring nursing home staff's perceptions of communication and leadership to facilitate quality improvement. J Nurs Care Qual. 2004, 19: 242-252. 10.1097/00001786-200407000-00011.CrossRefPubMed Scott-Cawiezell J, Schenkman M, Moore L, Vojir C, Connolly RP, Pratt M, Palmer L: Exploring nursing home staff's perceptions of communication and leadership to facilitate quality improvement. J Nurs Care Qual. 2004, 19: 242-252. 10.1097/00001786-200407000-00011.CrossRefPubMed
29.
go back to reference Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu S, Mendel P, Cretin S, Rosen M: The role of perceived team effectiveness in improving chronic illness care. Med Care. 2004, 42: 1040-1048. 10.1097/00005650-200411000-00002.CrossRefPubMed Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu S, Mendel P, Cretin S, Rosen M: The role of perceived team effectiveness in improving chronic illness care. Med Care. 2004, 42: 1040-1048. 10.1097/00005650-200411000-00002.CrossRefPubMed
30.
go back to reference Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP: The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 1996, Danvers, MA: Jossey-Bass Inc Langley GJ, Nolan KM, Nolan TW, Norman CL, Provost LP: The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 1996, Danvers, MA: Jossey-Bass Inc
31.
go back to reference Deming WE: The New Economics for Industry, Government, and Education. 2000, Cambridge, MA: The MIT Press Deming WE: The New Economics for Industry, Government, and Education. 2000, Cambridge, MA: The MIT Press
35.
go back to reference Linstone HA, Turoff M: The Delphi Method: Techniques and Applications. 1975, Reading, MA: Addison-Wesley Linstone HA, Turoff M: The Delphi Method: Techniques and Applications. 1975, Reading, MA: Addison-Wesley
36.
go back to reference Canadian Institute for Health Information: Continuing Care Reporting System, RAI-MDS 2.0 Output Specifications 2010-2011 Supplement: Quality Indicators. 2010 Canadian Institute for Health Information: Continuing Care Reporting System, RAI-MDS 2.0 Output Specifications 2010-2011 Supplement: Quality Indicators. 2010
37.
go back to reference Estabrooks CA, Squires JE, Cummings GG, Teare GT, Norton PG: Study protocol for the translating research in elder care (TREC): building context-an organizational monitoring program in long-term care project (project one). Implement Sci. 2009, 4: 52-10.1186/1748-5908-4-52.CrossRefPubMedPubMedCentral Estabrooks CA, Squires JE, Cummings GG, Teare GT, Norton PG: Study protocol for the translating research in elder care (TREC): building context-an organizational monitoring program in long-term care project (project one). Implement Sci. 2009, 4: 52-10.1186/1748-5908-4-52.CrossRefPubMedPubMedCentral
38.
go back to reference Estabrooks CA, Squires JE, Cummings GG, Birdsell JM, Norton PG: Development and assessment of the Alberta Context Tool. BMC Health Serv Res. 2009, 9: 234-10.1186/1472-6963-9-234.CrossRefPubMedPubMedCentral Estabrooks CA, Squires JE, Cummings GG, Birdsell JM, Norton PG: Development and assessment of the Alberta Context Tool. BMC Health Serv Res. 2009, 9: 234-10.1186/1472-6963-9-234.CrossRefPubMedPubMedCentral
40.
go back to reference Riordan CM, Weatherly EW: Defining and measuring employees' identification with their work groups. Educ Psychol Meas. 1999, 59: 310-324. 10.1177/00131649921969866.CrossRef Riordan CM, Weatherly EW: Defining and measuring employees' identification with their work groups. Educ Psychol Meas. 1999, 59: 310-324. 10.1177/00131649921969866.CrossRef
42.
go back to reference Kang S: Simulation results about sample size on aggregation statistics. 2010, Report. Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta Kang S: Simulation results about sample size on aggregation statistics. 2010, Report. Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta
44.
go back to reference Van de Ven AH: Central problems in the management of innovation. Manage Sci. 1986, 32: 590-607. 10.1287/mnsc.32.5.590.CrossRef Van de Ven AH: Central problems in the management of innovation. Manage Sci. 1986, 32: 590-607. 10.1287/mnsc.32.5.590.CrossRef
45.
go back to reference Nowotny H, Scott P, Gibbons M: 'Mode 2' revisited: The new production of knowledge. Minerva. 2003, 41: 179-194. 10.1023/A:1025505528250.CrossRef Nowotny H, Scott P, Gibbons M: 'Mode 2' revisited: The new production of knowledge. Minerva. 2003, 41: 179-194. 10.1023/A:1025505528250.CrossRef
46.
go back to reference Estabrooks CA, Norton P, Birdsell JM, Newton MS, Adewale AJ, Thornley R: Knowledge translation and research careers: Mode I and Mode II activity among health researchers. Res Policy. 2008, 37: 1066-1078. 10.1016/j.respol.2008.04.006.CrossRef Estabrooks CA, Norton P, Birdsell JM, Newton MS, Adewale AJ, Thornley R: Knowledge translation and research careers: Mode I and Mode II activity among health researchers. Res Policy. 2008, 37: 1066-1078. 10.1016/j.respol.2008.04.006.CrossRef
47.
go back to reference Straus S, Tetroe J, Graham ID: Sustaining knowledge use. Knowledge Translation in Health Care: Moving from Evidence to Practice. 2009, Oxford: Blackwell Publishing Ltd, 165-173.CrossRef Straus S, Tetroe J, Graham ID: Sustaining knowledge use. Knowledge Translation in Health Care: Moving from Evidence to Practice. 2009, Oxford: Blackwell Publishing Ltd, 165-173.CrossRef
48.
go back to reference Buchanan DA, Fitzgerald L, Ketley D: The Sustainability and Spread of Organizational Change. 2007, New York: Routledge Buchanan DA, Fitzgerald L, Ketley D: The Sustainability and Spread of Organizational Change. 2007, New York: Routledge
49.
50.
go back to reference Tolson D, Rolland Y, Andrieu S, Aquino JP, Beard J, Benetos A, Berrut G, Coll-Planas L, Dong B, Forette F, Franco A, Franzoni S, Salvà A, Swagerty D, Trabucchi M, Vellas B, Volicer L, Morley JE: International Association of Gerontology and Geriatrics: A global agenda for clinical research and quality of care in nursing homes. J Am Med Dir Assoc. 2011, 12: 184-189. 10.1016/j.jamda.2010.12.013.CrossRefPubMed Tolson D, Rolland Y, Andrieu S, Aquino JP, Beard J, Benetos A, Berrut G, Coll-Planas L, Dong B, Forette F, Franco A, Franzoni S, Salvà A, Swagerty D, Trabucchi M, Vellas B, Volicer L, Morley JE: International Association of Gerontology and Geriatrics: A global agenda for clinical research and quality of care in nursing homes. J Am Med Dir Assoc. 2011, 12: 184-189. 10.1016/j.jamda.2010.12.013.CrossRefPubMed
Metadata
Title
SCOPE: Safer care for older persons (in residential) environments: A study protocol
Authors
Lisa A Cranley
Peter G Norton
Greta G Cummings
Debbie Barnard
Carole A Estabrooks
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2011
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-6-71

Other articles of this Issue 1/2011

Implementation Science 1/2011 Go to the issue