Secondary outcomes—residents
pain
Examination of two of the three resident care indicators from the RAI-MDS showed no difference in change between groups over the period of observation. The finding in pain assessment is however, encouraging, suggesting that teams were successful in improving the quality of care for residents in pain, but this is a single finding in need of replication. There may be several reasons for the inability to detect a change in resident outcome measures. Firstly, the SCOPE intervention was implemented over a year and most teams took time to function effectively, to design their aim statements and conduct tests of small changes to improve quality [For all outcomes and teams, SCOPE was dependent upon leadership sufficiently able to support change. Leaders were called upon to remove obstacles, provide sufficient time for QI initiatives and to allow the care aide leaders to lead the team. This was variably achieved, with some leaders adopting and maintaining a more authoritarian approach to SCOPE implementation, providing less than sufficient resources and time for teams to meet, potentially adding to work life pressures, rather than relieving them [