This organization listens to and values the role of staff members at all levels to improve quality of care and all-around satisfaction.

As part of Lutheran Homes of South Carolina, a nonprofit organization that provides continuing care retirement living, home care, and hospice services, White Rock, SC-based Lowman Rehabilitation and HealthCare Center provides services beyond assisted and independent living. “We have been in this faith-based ministry and retirement community since 1911, and we believe our history and experience separates us from our competitors,” said Derald Edwards, administrator.

At the end of 2004, Lowman Rehabilitation and HealthCare adopted the Wellspring cultural model of quality improvement, developed by a confederation of 11 freestanding, not-for-profit nursing homes in eastern Wisconsin called The Wellspring Alliance. The Wellspring model is based on listening to and valuing the role of all levels of staff members—from housekeepers to nursing assistants to directors of nursing—to improve quality.

Key elements of the Wellspring method include The Wellspring Alliance, an alliance of nursing homes with top management committed to quality of care; shared services of a geriatric nurse practitioner, who teaches recognized clinical guidelines; care resource teams (CRTs), interdisciplinary teams that receive training in specific areas; involvement and sharing of all departments within the facility; empowerment of all nursing home staff to make decisions that affect the quality of residents; and continuous reviews by CEOs and all staff of performance data on resident outcomes.

Innovative teams
According to Edwards, there are no other competitors in the area that are involved in the Wellspring cultural change model. Before implementing seven of its own CRTs, Lowman Rehab educated a number of staff members on the Wellspring model during two-day workshops.

Lowman Rehab’s teams consist of a nutrition CRT, an elimination CRT, a fall and restraint CRT, a pain/palliative CRT, a psychosocial CRT, a wound and skin CRT, a socialization CRT, and an implementation CRT. Realizing the value that all employees can bring to all areas of the organization, the Wellspring model’s CRTs are made up of individuals of every department. The pain/palliative team works to make certain all staff members, not just CRT members, recognize pain when they see it, even though some residents aren’t cognitive enough to tell staff members about the pain.

“Our environmental services and housekeeping individuals are great participants in the pain palliative area,” said Gail Stuard, Wellspring coordinator at Lowman Home.

“Everyone on our teams have equal say and bring concerns to their team—and we work on everyone’s concerns. It’s not top down; it comes from the bottom up.”

Through the Wellspring model, Lowman Rehab has been trying to veer away from being a typical institution and offer a more home-like atmosphere for residents. “We’ve made a concerted effort to provide consistent staffing so we have the same people taking care of residents. We don’t want our caregivers to be pulled from unit to unit,” said Dee Longno, director of nursing. “This way, they get to know the residents and know what each individual wants.”

The Wellspring model has produced significant results throughout the organization. The licensed staff stability rate in April 2006 was at 56% compared to 73% in April of this year. The certified nursing assistant turnover rate from January 2005 to December 2005 was 52%; the following year, that decreased to 45.21%. Resident satisfaction rates have soared, going from 93% from in the calendar year of 2005 to 100% in calendar year 2006. From March 2005 to June 2007, pressure ulcers and restraints have been reduced by 75% and 79%, respectively.

Sharing responsibility
Lowman Rehab has developed an innovative way for its residents to dine by creating a more socialized atmosphere “There are two seating times in its dining area,” said Wendy Reeves, director of therapy. “One is for the independent individuals who can feed themselves in the dining room, and the other is for the individuals who need more personalized assistance with eating their meals.”

Staff members from all areas of the organization—housekeeping, administration, therapy, nursing, etc.—are assigned to assist and help feed residents in the dining room. According to Stuard, under the new model, housekeeping staff is predominately on hand as they can’t be working on the unit cleaning while residents are trying to eat.

Each resident that comes to the dining room usually has the same person working with him or her each day so a relationship can be established. Sometimes a resident might need to be fed, and other times a resident just needs some coaching to continue to eat.

“We started a walk-to-dine program for residents who are healthy enough to walk into the main dining room. We want to make the environment feel more like home,” said Reeves. “The dining experience should be a very social occasion, and that’s one of the biggest reasons why we started this program.”

According to Longno, there are many other areas in the facility where employees crossover responsibilities to increase efficiencies. The concept at Lowman is that it is everyone’s responsibility to assist residents or to ensure that residents get the assistance they need.

“What we do here is a crossover between all departments. If a chair alarm or bed alarm goes off, it’s the responsibility of the employee walking down the hall to check on that resident, no matter what their position in the organization is. It makes everyone feel like they are part of a team, and that’s our ultimate goal—to be united, not divided,” Longno concluded.