The Wellspring Program

In the early 2000s, Augsburg Lutheran Home in Baltimore, Maryland, had already embarked on a mission to improve its quality of care through a variety of measures: staff development and training, empowerment of frontline staff, and culture change. In an effort to deepen those interventions, Augsburg elected in 2003 to become a part of the Wellspring Program, an initiative of the LifeSpan Network, that provides nursing homes with the education and guidance they need to revitalize their cultures and create a higher quality of life for their residents and workers alike.

The Wellspring Program was originally structured around a mutual support model, in which participants were members of local “alliances.” Thus, for seven years, Augsburg was one of 13 nursing facilities participating in a Maryland Wellspring Alliance. Within close geographic proximity, members of the alliance met on a monthly basis to share educational resources and training, as well as lessons learned and best practices. Members also shared a Geriatric Nurse Practitioner who advised members as they sought to improve clinical and staffing outcomes.

The Wellspring Program, in 2010, began to shift away from the alliance structure, but it is continuing to support nursing homes in empowering staff, improving skills, and implementing person-centered practices that improve clinical outcomes. The practices that Augsburg institutionalized through participation in the Wellspring Alliance will continue, though it will not be part of a formal Wellspring Alliance in 2011. Instead, Augsburg will continue with the Wellspring program under an individual contract.

Empowering Staff

After participating in the Wellspring Program, Augsburg’s leadership say that empowerment of their frontline staff has made the biggest impact on their facility. According to Durga Kolli, Augsburg’s Wellspring coordinator, three core components of the Wellspring model have been especially critical to empowering staff:

• Clinical training modules for staff at all levels;
• Consistent assignment; and
• Care Resource Teams (CRTs), which involve staff at all levels in improving quality of care.

Kolli’s role as Wellspring coordinator is part-time (she is a nurse, and is also in charge of staff development and quality assurance at Augsburg) and consists of two primary components, in her assessment—communication and coordination. As coordinator, Kolli facilitates communication between all of the departments in the building with respect to the activities of the Care Resource Teams– multidisciplinary committees that take on specific clinical issues in order to improve quality of care (see details below).

Kolli notes that her role is to provide information, make sure meetings take place, and to hold people accountable. Once these tasks are done, Kolli says that she doesn’t even need to be in the building when the meetings take place, and in most cases, frontline staff run the CRTs.

Program Components

Clinical training modules. According to Kolli, Wellspring offers education and training modules to staff on a regular basis. Under the Alliance model, member organizations sent approximately 10 staff members from different levels and departments to these trainings. The trainings offered an opportunity to learn about specific clinical practices, usually through a morning seminar for all participants, followed by time for small group work, by job title, in the afternoon. In the future, Augsburg and other Wellspring participants will be able to contract individually for educational trainings.

Consistent Assignment. Another key aspect of staff empowerment at Augsburg Lutheran, implemented as part of the Wellspring program, is consistent assignment. Geriatric Nursing Assistants (GNAs), the Maryland term for nursing assistants, used to rotate resident care to “make it even,” according to Kolli. Now nurses and GNAs have permanent, or consistent, assignments, making it easier for the GNAs to decide what kind of care is most suitable for the resident, and allowing the GNAs to have a deeper relationship with the family members of their residents.

At Augsburg, residents have the same caregiver five-to-six days per week; they have a different caregiver only when their primary caregiver has the day off. The GNA works with the resident and/or their family to determine the schedule that best suits the resident’s needs. This system of consistent assignment affords the GNAs a high level of autonomy, which is a critical part of staff empowerment.

As a result of the education and organizational changes associated with Wellspring, GNAs feel they can make suggestions regarding the care of their residents to the nursing staff, which is important to achieving quality outcomes.

Care Resource Teams. The final aspect of front-line staff empowerment at Wellspring homes is the Care Resource Teams (CRTs). The CRTs are composed of 10 to 15 people from different levels and departments in the home and focus on a single (usually clinical) issue facing the residents, such as falls, elimination, psycho/social issues, nutrition, or skin care. Wellspring homes have found these CRTs to be useful for both prevention and healing.

All CRT meetings at Augsburg are “stand up” meetings, meaning everyone gathers together on the unit for a face-to-face meeting of usually not more than 15 minutes. According to Kolli, “conference rooms are not used for these meetings,” and this has helped GNAs to feel more comfortable, and on an equal footing with their colleagues. Kolli observed that in several of the CRTs, GNAs are now the most talkative members, with more senior staff taking the opportunity to listen to their observations, particularly around falls and psycho/social issues.

Some of the CRTs are led by GNAs. GNAs that are team leaders are encouraged to focus on that one CRT, and to try not to wear too many other hats while leading a CRT, since it is a big responsibility. Allowing the GNAs to lead the CRTs has been another critical element of front-line staff empowerment. According to Kolli, “At Augsburg, we work to make leaders out of the GNAs, by making them accountable and giving them support.”

Phyllis Young, who has worked at Augsburg since 2000, first in housekeeping, and now as a GNA, is the team leader of the “falls” CRT. Twice a month, Young runs the meetings focused on falls prevention. Kolli provides Young with recent facility data on falls to share at the meeting, but Young comes with her own ideas on how to work with her colleagues to reduce falls among residents.

According to Young, “I am an outgoing person. I wanted to take on something new.” When asked if her colleagues have been accepting of her in her leadership role, she responded that they have been very supportive. At her meetings, CRT members form a learning circle to brainstorm ways to prevent falls, and when they agree on good ideas, they implement them. Young says she is now “adamant about preventing falls” and that she loves being a team leader because it is exciting and allows her to learn new things. She has been the falls team leader for five years.