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Evaluation of the Wellspring Model for Improving Nursing Home Quality

Despite the passage of major reforms in 1987, serious quality-of-life problems are endemic throughout many of the nation's 17,000 nursing homes. In the report, Evaluation of the Wellspring Model for Improving Nursing Home Quality, researchers say, however, that a new approach to nursing home care based on collaboration and teamwork can improve the quality of care for residents.

Wellspring Innovative Solutions, Inc., an alliance of 11 nonprofit nursing homes in Wisconsin formed in 1994, is seeking to improve care principally by empowering staff. Facilities that belong to the alliance provide their "frontline" workers—particularly certified nursing assistants—with training in nationally recognized best practices while at the same time allowing all staff a voice in how their work should be performed. In addition, each home in the alliance participates in joint training sessions on clinical care and organizational change, and each shares the results of its quality-improvement activities. Findings from a Commonwealth Fund-supported study comparing Wellspring nursing homes with other facilities in Wisconsin have clearly been encouraging:

  • Rates of staff turnover declined or increased more slowly in Wellspring homes.
  • Wellspring facilities performed better on annual inspections conducted by the state department of health.
  • Some evidence suggests that Wellspring staff are more vigilant in assessing problems in quality and take a more proactive approach to resident care.
  • Based on observation and interviews, Wellspring residents enjoyed a better quality of life and benefited from improved interaction with the staff.
  • No additional increases in net resources were required for the model's implementation, and Wellspring facilities generally had lower costs than other nursing homes.

So far, five other groups of nursing homes have considered forming Wellspring alliances, mostly in Illinois and Wisconsin. Wider adoption of Wellspring, however, will require some adjustments to address the technical difficulties identified in the evaluation, including the development of explicit mechanisms for translating training into practice.

Facts and Figures

  • Nursing homes had significantly fewer deficiencies after implementing the Wellspring model (1.9 average deficiencies before implementation vs. 0.8 deficiencies after implementation).
  • The proportion of severe deficiencies in Wellspring homes fell from 22.2 percent prior to the model's implementation to 0.0 percent after.
  • The retention rate for Wellspring nursing staff increased over the four-year study period, from 70 to 76 percent. Among non-Wellspring homes in Wisconsin, the retention rate fell, from 74 to 68 percent.

Publication Details



Evaluation of the Wellspring Model for Improving Nursing Home Quality, Robyn I. Stone, Susan C. Reinhard, B. Bowers et al., The Commonwealth Fund, August 2002