Mission attachment, satisfaction, employee retention

“Nonprofit organizations rely on the mission to attract resources and guide decision making. Increasingly, mission statements are recognized as a strong management tool that can motivate employees and keep them focused on the organization’s purpose. This research investigated employee attitudes toward the mission in a youth and recreation service organization. In general, the employees expressed positive attitudes toward the organization’s mission, and those attitudes were related to employee satisfaction and intentions to remain with the organization. However, dissatisfaction with pay tended to override employee’s mission attachment as explanation of why they may leave the organization. The implication is that mission might be salient in attracting employees but less effective in retaining them.
Mission attachment appears to be a valid consideration for younger, part-time employees, but the intrinsic motivations run thin as full-time employees earn salaries that appear noncompetitive to other organizations
Among part-time employees, older employees were more likely to indicate intentions to stay”
….
Personally, at both personal and organizational levels, I’ve looked for the sweet spot between commitment to org mission, challenging responsibilities and satisfactory remuneration.
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Benefits and costs of open source EMR

McMaster operates a web site at https://know2act.org for sharing clinical and EMR related knowledge. As expected on the EMR side, it offers user-supplied OSCAR solutions.  This is an example of some of the costs/benefits of open source.

Benefits:

  • Their accessibility and openness invites users to raise and share questions and solution.
  • The solutions are readily ‘plugged-in’ and implemented.
  • The larger the network, the greater the likelihood that a successful solution emerges.
  • Sharing mechanisms are readily available.
  • Modifications and enhancements implemented by CHC consensus

Costs:

  • Solutions require technical skills which may not be available across all member locations
  • Solution quality depends on checks at network or at individual user level with feedback for improvement.
  • Requires participation within available sharing mechanisms.

Best practice for system selection is to first establish the core requirements, then to look at TCO – total cost of ownership, not simply the vendor fees.

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Poor system design risking patient privacy?

When a health provider works for multiple organizations, laboratory data systems sometimes send the results to the incorrect location. That location will usually report the error back to the lab and destroy any sent documents.

Apparently lab systems can only associate a provider with one location. They lack the ability to distinquish sending source location or to accept instruction regarding delivery destination for a specific request.

It is difficult to understand how this problem can exist in these advanced days of electronic data exchange.

In my view, from a governance perspective, OntarioMD should be involved in approving these systems. The situation of a doctor/provider working at many locations and each location using many doctors/providers has been around since the start of locums and part timers. EMR systems have been around for 20 years. No testing location should be able to set up, move or close shop without:

1 – passing approval from a centralized registry which would ensure legitimacy, accuracy and EMR interface compliance
2 – demonstrating that their systems can receive, process and send requisitions and results electronically without possibility of repudiation by either sender or receiver
3 – demonstrating that their systems can update results without alteration of existing results
4 – protecting the data from request receipt to provider acceptance

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OSCAR – DB reference and resources

High quality open source applications have academic articles published about their development, features, and usage. The following excerpt is from one discussing database reverse engineering using OSCAR as the case. A very technical analysis, it shows a level of transparency that is almost never found in COTS (commercial off the shelf) software. The following summarizes the history, technical architecture and DB Schema of OSCAR. The rest of the paper goes into details about their reverse engineering of OSCARs evolution.
from https://pure.fundp.ac.be/ws/files/11937238/CRC.pdf – Science of Computer Programming 97 (2015) 113–121
Understanding database schema evolution: A case study Anthony Cleve et all – University of Namur, Belgium, University of Victoria, Canada
2. Context: The OSCAR system OSCAR (Open Source Clinical Application Resource) is full-featured Electronic Medical Record (EMR) software system for primary care clinics. It has been under development since 2001 and is widely used in hundreds of clinics across Canada. As an open source project, OSCAR has a broad and active community of users and developers. The Department of Family Practice at McMaster University, which has managed OSCAR development efforts from inception to 2012, has recently transferred oversight of ongoing development to a newly formed not-for-profit company called OSCAR-EMR. This move was motivated by a new regulatory requirement to undergo ISO certification (ISO 13485 Medical devices – Quality management systems).
OSCAR architecture. OSCAR has a Web application architecture following the classical 3-tier paradigm. It employs a Javabased technology stack, making use of Java Server Pages (JSP), Enterprise Java Beans (J2EE) and several frameworks such as Spring, Struts and Hibernate. The source code comprises approximately two million lines of code with a rough distribution of 600 kLOC for the application logic, 1200 kLOC for the presentation layer and 100 kLOC for the persistence layer. OSCAR uses MySQL as the relational database engine and a combination of different ways to access it, including Hibernate object relational middleware, Java Persistence Architecture (JPA) and dynamic SQL (via JDBC). The reason for this combination of technologies is the constant and ongoing evolution history of the product, which originated from JDBC, via Hibernate to JPA.
Oscar database. The OSCAR database schema has over 440 tables and many thousands of attributes. At the time of conducting our study, the database schema of the OSCAR distribution did not contain any information on relationships between tables (foreign keys) and no documentation was available about the schema. We later learned that the missing relationships were due to the evolution history of OSCAR, which has been using the older MyISAM database engine provided by MySQL that does not support foreign keys. A port to the newer InnoDB engine is underway, which will eventually allow foreign keys to be defined explicitly.
OSCAR software repositories. The OSCAR community utilizes a range of software repositories and tools, including a feature request and bug tracking system (provided by Sourceforge), a source code submission and review system (Gerrit Code Review), a git-based configuration management system, a community Wiki (based on Plone) and three active mailing lists (one for developers and two for users of different levels of technical expertise).
The need to understand the database schema. The OSCAR database has grown organically over many years and knowledge about its internal structure is distributed among pockets of developers who have been contributing to specific functions of the system (e.g., prescription writer, representation of lab results etc.). Our need to understand the OSCAR database schema originated from our involvement in a project with the goal to develop software for a primary care research network (PCRN). The purpose of the PCRN is to integrate health information kept in primary care EMR software in order to make them accessible to medical research and data mining. An important step in developing the PCRN software is to create “export conduits” for transferring health data from the EMR into a research database for subsequent query processing. Due to its popularity (second largest market share in British Columbia) and openness, OSCAR has been chosen as one of the first EMR products to interface with the emerging PCRN.
While designing early versions of the PCRN data migration adapter for OSCAR, we found that we were running into questions pertaining to the database schema. Of course, as could be expected for any heavily evolved, real-world system, some of them had to do with the fact that the database schema lacked documentation. Moreover, the schema did not contain any declared relationships (foreign keys). Other questions were of a more semantic and puzzling nature. For example, when attempting to design the function to export data on patient immunization records, we found two seemingly unrelated schema structures covering the same semantic issue. One schema structure revolved around tables entitled “immunizations” and “configimmunization” while the other schema structure revolved around tables entitled “preventions” and “preventionsext”. During our project we found that taking into consideration the evolution history of the database schema was helpful in answering questions like these. (We found out that the “prevention” structured superseded the “immunization” structure but has still been retained in order to deal with legacy data.) This motivated us to investigate more formally OSCAR’s evolution history and develop methods and tools to help with this investigation.
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OSCAR home – http://oscar-emr.com/
OSCAR user group – http://oscarcanada.org/
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Christmas newsletter 2016

Been years since the last annual Christmas newsletter. Just over a year ago, we moved from our Toronto condo back into a Housing Co-operative in Ottawa. Leaving Toronto was a difficult choice. For years we travelled regularly to Ottawa in order to see daughter Lisa and her family. Now we travel in the other direction to visit son Simon and family and friends left behind. Changing relationships built over 41 years is difficult.

We do enjoy spending time with Charlie, 10, Rowan, 7 this January, and Olivia 4. Jaxx a golden doodle is also part of our extended family. Sunday night dinners at Nana and Dziadziu’s are weekly highlights. When one of the wnuczki gets sick they often stay with Sue for the day. One of the kids named these  a ‘Nana day’. Don’t know if its a good thing, but they now look forward to a day with Nana and argue about whose turn it is for the next one. Everyone needs a Nana day; most of all Nana!

The best trip back to Toronto celebrated Owen’s First Holy Communion. Simon and Beth arranged a great get together of family and friends. In addition to getting a ‘peace-maker’ award at school, Owen is developing a skill and passion for running. He recently competed in the City finals. Brother Cole is also athlete and comic. He continues to advance through organized hockey in East York. And he makes us laugh.

After retiring briefly, Simon’s back at work part time supporting clinical management systems at the Sandy Hill Community Health Centre. During our delicious three day weekends we can be found hiking one of the many trails of nearby Gatineau Park. We also enjoy walking along the bike trails of the Rideau River just 100 m from our home. Good thing because after retiring from The Bay, Sue has taken to baking and cooking. The results are fabulous. Simon’s gained too many pounds despite quite active living and exercise. Rounding out our new life is Simon’s election this past summer to the Board of Conservation Co-operative Homes. Our Co-op is in the midst of renewing decor and infrastructure in this 20 year old community.

Montreal is only 2 hours away. Over the past year we’ve taken several day and overnight trips. This year Montreal celebrates its 375th. We still remember the party for the 350th. Canada celebrates its 150th this year and Ottawa, the capital,  is a centre for festivities. We invite all to visit.

Christmas blessings and best wishes to all for 2017

 

 

 

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Thoughts on AOHC – EMR validation process

Let me start by saying the PS Suite validation process improved significantly with the distribution of the requirements questions document.

This is the first time I’ve been involved with one using time-limited, real-time polling. The fastest review and comment turnaround time I’d previously experienced was a 1 week cycle.  It worked as follows: Thurs – client receives prototype for specifications agreement or app for demonstrating actual implementation for a specified set of requirements; Monday Noon client deadline for response; end of day agreement that feedback is accepted or will be subject to change management process. That was a development environment with far fewer stakeholders than the one we are all engaged in.

While sometimes irritating, the real time nature does, I believe, collect solid initial assessment in a very efficient way. As we’ve seen, many of the questions and responses ask for contextual and expanded information beyond the boundaries of the individual requirement. In short, we could have a result where most of the participants vote YES, yet the collective experience after acceptance is on balance negative.

In one of the sessions, someone mentioned the possibility of a second session to go deeper into the module under review. I agree. The current process could be modified into a Delphi-like technique that would lead to a very informed decision.

One suggestion for implementing the above is that after receiving the results from this first round, participants would be asked to:

– review and re-score their initial replies
– set a priority order on which sessions require additional in-depth presentation and review
– submit their individual revised acceptance report to AOHC

AOHC would:

– identify the collective priorities for in-depth second round sessions from the revised individual reports
– share the re-scored reviews and comments from the revised first round
– conduct a second round with high priority topics receiving additional attention and time over lower priority ones
– compile and share the results including draft AOHC requirements acceptance
– provide a brief period for participant comment

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Communities work with co-operation and leaders like Ronny Yaron

http://www.theglobeandmail.com/partners/sponsorcontent/content/article31374948/?prx_t=enICA2ZcKALrMPA

The St Lawrence Neighbourhood is by many measures a great success. That success comes from a combination of community and political will power. What the article misses is that Ronny Yaron and many others like her have spent countless hours working with neighbours and local organizations and holding political representatives accountable. As a neighbour of hers for over 20 years, I saw her do all this while raising a family and gently engaging and helping others.

Much of the spirit and involvement comes from the many housing co-operatives in the St. Lawrence neighbourhood, including Woodsworth where Ronny lives. In these co-ops, which contain a significant number of rent-geared-to-income units, member responsibilities and rights are equal. Members elect Boards who are responsible for leading community life and for economic sustainability. And they get involved.

St. Lawrence was created from spent railroad and industrial lands. Mayors Crombie and Sewall with countless other urban activists led the move to create this new kind of community. Did the city learn anything? Your answer is right around the CN Tower.

Where is today’s political will to bank land and provide resources for genuine mixed income housing? Mixed-use condo and public services is a very small step. Subsidizing rent is another step. The outcomes may give the politically acceptable impression of “from the outside, you won’t know which is which.” The truly bold step would be another St. Lawrence-type initiativel

Current measures in Regent Park and Lawrence Heights promote social mix. That mix comes at the personal cost of thousand of families being disrupted, resettled, and most never to return. What about the neighbourhoods, development projects and public institutions where not even this limited social mix really applies?

Meanwhile affordability forces those with less income to move into the near urban suburbs and beyond.

To build the type of truly mixed community where people are listened to, where children know each other, where families thrive and where seniors can continue contributing comes when residents have a formal say in how their community works; where infrastructure like schools, libraries and support services receive proper funding. These communities attract people like Ronny for whom public service is for public good, not for business relationships, not for for votes. They are the community builders.

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