Intervention
one-and-a-half, pain
The SCOPE intervention is based on a modified Institute for Healthcare Improvement (IHI) Breakthrough Collaborative Series model designed around successful collaborative learning approaches for quality improvement [A “Getting Started Kit”: Teams and Sponsors (unit and facility managers) received baseline performance data on their selected clinical area, one of three—reducing pain, maintaining mobility, reducing responsive behaviours, selected by care aides as the most pressing problem within their LTC home in a Delphi process [Four face-to-face “Learning Congresses” (LCs) brought together team members and sponsors from each region for one to one-and-a-half days every three months for networking and short plenary sessions and activities on the improvement model, measurement in PDSA cycles, team dynamics and function, engagement of colleagues in implementing ideas, and overcoming barriers to spread. The final congress was a celebration meeting, allowing teams to showcase their achievements and share experiences. Learning congresses were delivered primarily by the regional Quality Advisors and the Quality Coordinator.Three “action periods” (improvement activity with ongoing coaching from Quality Advisors and the Quality Coordinator between LCs) when teams made small tests of change using Plan-Do-Study-Act (PDSA) cycles to improve care delivery in their selected clinical area and conducted small-scale measurement to gauge improvement. Teams used the IHI model for improvement comprising elements of successful process improvement: specific and measurable improvement aims, measures of improvement tracked over time, changes resulting in the desired improvement, and a series of testing “cycles” during which unit teams learned how to apply their ideas across their care unit. Teams implemented their change ideas with increasing numbers of residents on the unit during this time. PDSA cycles continued to adapt, adopt, or abandon change ideas throughout these action periods.Participation in several facilitation activities to support QI during the action periods. Teams participated in a minimum of monthly teleconferences and a site visit facilitated by the regional Quality Advisors. Teams were supported in adoption and use of best practices, idea generation, measurement tools, analysis of results, and implementation challenges, with the degree of support tailored to the needs of each team.A program of in-person learning sessions and online discussions on leadership, focused on “supporting and enabling change” for sponsors, delivered by the Quality Co-ordinator.The SCOPE intervention