Siu Mee Cheng | Toronto Metropolitan University (original) (raw)
Papers by Siu Mee Cheng
Médecine et Maladies Infectieuses, 2017
International Journal of Integrated Care
Journal of Palliative Medicine, 2012
Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted ... more Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted to patients with a short prognosis. Anecdotally, PCUs further restrict admission of patients with noncancer diagnoses out of fear that they will "oversurvive" and reduce bed availability. This raises concerns that noncancer patients have unequal access to PCU resources. To clarify survival duration of patients with a noncancer diagnosis, we conducted a retrospective review of all admissions to four PCUs in Toronto, Canada, over a 1-year period. We measured associations between demographic data, prognosis, Palliative Performance Score (PPS), length of stay (LOS), and waiting time. We collected data for 1000 patients, of whom 21% had noncancer diagnoses. Noncancer patients were older, with shorter prognoses and lower PPS scores on admission. Noncancer patients had shorter LOS (14 versus 24, p<0.001) than cancer patients and a similar likelihood of being discharged alive to cancer patients. Noncancer patients had a trend to lower LOS across a broad range of demographic, diagnostic, prognostic, and PPS categories. Multivariable analysis showed that LOS was not associated with the diagnosis of cancer (p=0.36). Noncancer patients have a shorter LOS than cancer patients and a similar likelihood of being discharged alive from a PCU than cancer patients, and the diagnosis of cancer did not correlate with survival in our study population. Our findings demonstrate that noncancer patients are not "oversurviving," and that referring physicians and PCUs should not reject or restrict noncancer referrals out of concern that these patients are having a detrimental impact on PCU bed availability.
International Journal of Integrated Care
International Journal of Integrated Care
International Journal of Integrated Care
International Journal of Integrated Care
International Journal of Integrated Care
Canadian Public Administration, 2021
The Changing Politics and Policy of Austerity, 2021
Social innovation (SI) has been widely embraced as a pragmatic problem-solving approach to social... more Social innovation (SI) has been widely embraced as a pragmatic problem-solving approach to social policy challenges. While framed as apolitical, this chapter demonstrates that the dominant SI agenda, which became prominent in the wake of the 2008 recession, is anything but. Instead, SI is illustrative of the ways in which the neoliberal project has adapted to its own crises, embracing policy ideas and processes needed to drive forward its agenda. This chapter explores the lineage of SI, including its amorphous definition, seemingly conflicting idea-sets, and associated tools and techniques to understand how it has been used to extend the neoliberal project through austerity and to identify conflicts that might be exploited to challenge austerity politics. We warn against the dominant version of SI as a solution to social policy challenges in a post-pandemic era and encourage academics, activists, and practitioners to explore and harness more radical orientations of SI.
Journal of Integrated Care, 2020
PurposeA conceptual framework for collaboratively based integrated health and social care (IHSC) ... more PurposeA conceptual framework for collaboratively based integrated health and social care (IHSC) integration is proposed to aid in understanding how to accomplish IHSC.Design/methodology/approachThis model is based on extant literature of successfully IHSC initiatives.FindingsThe model aims to identify enabling integration factors that support collaborative integration efforts between healthcare and social services organizations. These factors include shared goals and vision, culture, leadership, team-based care, information sharing and communications, performance measurement and accountability agreements, and dedicated resources and financing. It also identifies factors that act as external influencers that can support or hinder integration efforts among collaborating organizations. These factors are geographic setting, funding models, governance structures, and public policies. These factors are intended to ensure that a realist lens is applied when trying to understand and explai...
Journal of Integrated Care, 2018
Purpose The purpose of this paper is to undertake an examination of the Local Health Integration ... more Purpose The purpose of this paper is to undertake an examination of the Local Health Integration Network (LHIN) Health Policy proposal. This policy established a decentralized approach to health system management in the province of Ontario, Canada by creating 14 crown agencies, LHINs. Design/methodology/approach This policy is examined against the five policy stages of the Stages Model: agenda setting, formulation, legitimation, implementation and evaluation. The examination was based on a review of grey literature, including key government reports and briefs. Findings This policy did not follow the Stages Model sequentially: the policy was implemented while it was still undergoing its legitimacy phase. Formal reviews were undertaken following implementation and found areas for improvement: poor integration amongst all the LHINs; poor patient navigation persists; LHINs lack the capacity and competency to engage in regional capacity planning; and planning and integration is not cente...
International Journal of Integrated Care, 2019
Cheng; Core principles of integration of healthcare and social services that support continuity o... more Cheng; Core principles of integration of healthcare and social services that support continuity of care for vulnerable seniors with canadian case study: home-at-last monitoring among partners and greater vested interest in patient outcomes in the community among all integration partners.
Journal of Integrated Care, 2019
Purpose The purpose of this paper is to develop a case definition of integrated health and social... more Purpose The purpose of this paper is to develop a case definition of integrated health and social services initiatives that serve older adults, and will provide characteristics to aid in the identification of such initiatives. The case definition is intended to ease the identification of integrated health and social care initiatives. Design/methodology/approach A limited search was undertaken of both scientific and gray literature that documented and/or examined integrated health and social services initiatives. In addition, literature on well-documented and generally accepted integrated healthcare and social services models that reflect collaborations from healthcare and social services organizations that support older adults was also used to develop the case definition. Findings The case definition is as follows: healthcare organizations from across the continuum of care working together with social services organizations, so that services are complementary and coordinated in a se...
Healthcare Quarterly, 2007
The province of Ontario, as a result of the First Ministers&a... more The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems.
Journal of Health Organization and Management, 2006
PurposeA performance management system has been implemented by Cancer Care Ontario (CCO). This sy... more PurposeA performance management system has been implemented by Cancer Care Ontario (CCO). This system allows for the monitoring and management of 11 integrated cancer programs (ICPs) across the Province of Ontario. The system comprises of four elements: reporting frequency, reporting requirements, review meetings and accountability and continuous improvement activities. CCO and the ICPs have recently completed quarterly performance review exercises for the last two quarters of the fiscal year 2004‐2005. The purpose of this paper is to address some of the key lessons learned.Design/methodology/approachThe paper provides an outline of the CCO performance management system.FindingsThese lessons included: data must be valid and reliable; performance management requires commitments from both parties in the performance review exercises; streamlining performance reporting is beneficial; technology infrastructure which allows for cohesive management of data is vital for a sustainable perfor...
Dialysis & transplantation, 1999
... SIU MEE CHENG ; KINGSBURY L. ; ESTRIDGE C. ; CONLY JM ; ... University Health Network: Treva ... more ... SIU MEE CHENG ; KINGSBURY L. ; ESTRIDGE C. ; CONLY JM ; ... University Health Network: Treva McCumber, Lili-Ann Zatylny, and the Hemodialysis and Home Dialysis Unit Facility Management at the Toronto Western Hospital, Health and Safety, CANADA Cathy Kennedy of ...
Médecine et Maladies Infectieuses, 2017
International Journal of Integrated Care
Journal of Palliative Medicine, 2012
Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted ... more Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted to patients with a short prognosis. Anecdotally, PCUs further restrict admission of patients with noncancer diagnoses out of fear that they will "oversurvive" and reduce bed availability. This raises concerns that noncancer patients have unequal access to PCU resources. To clarify survival duration of patients with a noncancer diagnosis, we conducted a retrospective review of all admissions to four PCUs in Toronto, Canada, over a 1-year period. We measured associations between demographic data, prognosis, Palliative Performance Score (PPS), length of stay (LOS), and waiting time. We collected data for 1000 patients, of whom 21% had noncancer diagnoses. Noncancer patients were older, with shorter prognoses and lower PPS scores on admission. Noncancer patients had shorter LOS (14 versus 24, p<0.001) than cancer patients and a similar likelihood of being discharged alive to cancer patients. Noncancer patients had a trend to lower LOS across a broad range of demographic, diagnostic, prognostic, and PPS categories. Multivariable analysis showed that LOS was not associated with the diagnosis of cancer (p=0.36). Noncancer patients have a shorter LOS than cancer patients and a similar likelihood of being discharged alive from a PCU than cancer patients, and the diagnosis of cancer did not correlate with survival in our study population. Our findings demonstrate that noncancer patients are not "oversurviving," and that referring physicians and PCUs should not reject or restrict noncancer referrals out of concern that these patients are having a detrimental impact on PCU bed availability.
International Journal of Integrated Care
International Journal of Integrated Care
International Journal of Integrated Care
International Journal of Integrated Care
International Journal of Integrated Care
Canadian Public Administration, 2021
The Changing Politics and Policy of Austerity, 2021
Social innovation (SI) has been widely embraced as a pragmatic problem-solving approach to social... more Social innovation (SI) has been widely embraced as a pragmatic problem-solving approach to social policy challenges. While framed as apolitical, this chapter demonstrates that the dominant SI agenda, which became prominent in the wake of the 2008 recession, is anything but. Instead, SI is illustrative of the ways in which the neoliberal project has adapted to its own crises, embracing policy ideas and processes needed to drive forward its agenda. This chapter explores the lineage of SI, including its amorphous definition, seemingly conflicting idea-sets, and associated tools and techniques to understand how it has been used to extend the neoliberal project through austerity and to identify conflicts that might be exploited to challenge austerity politics. We warn against the dominant version of SI as a solution to social policy challenges in a post-pandemic era and encourage academics, activists, and practitioners to explore and harness more radical orientations of SI.
Journal of Integrated Care, 2020
PurposeA conceptual framework for collaboratively based integrated health and social care (IHSC) ... more PurposeA conceptual framework for collaboratively based integrated health and social care (IHSC) integration is proposed to aid in understanding how to accomplish IHSC.Design/methodology/approachThis model is based on extant literature of successfully IHSC initiatives.FindingsThe model aims to identify enabling integration factors that support collaborative integration efforts between healthcare and social services organizations. These factors include shared goals and vision, culture, leadership, team-based care, information sharing and communications, performance measurement and accountability agreements, and dedicated resources and financing. It also identifies factors that act as external influencers that can support or hinder integration efforts among collaborating organizations. These factors are geographic setting, funding models, governance structures, and public policies. These factors are intended to ensure that a realist lens is applied when trying to understand and explai...
Journal of Integrated Care, 2018
Purpose The purpose of this paper is to undertake an examination of the Local Health Integration ... more Purpose The purpose of this paper is to undertake an examination of the Local Health Integration Network (LHIN) Health Policy proposal. This policy established a decentralized approach to health system management in the province of Ontario, Canada by creating 14 crown agencies, LHINs. Design/methodology/approach This policy is examined against the five policy stages of the Stages Model: agenda setting, formulation, legitimation, implementation and evaluation. The examination was based on a review of grey literature, including key government reports and briefs. Findings This policy did not follow the Stages Model sequentially: the policy was implemented while it was still undergoing its legitimacy phase. Formal reviews were undertaken following implementation and found areas for improvement: poor integration amongst all the LHINs; poor patient navigation persists; LHINs lack the capacity and competency to engage in regional capacity planning; and planning and integration is not cente...
International Journal of Integrated Care, 2019
Cheng; Core principles of integration of healthcare and social services that support continuity o... more Cheng; Core principles of integration of healthcare and social services that support continuity of care for vulnerable seniors with canadian case study: home-at-last monitoring among partners and greater vested interest in patient outcomes in the community among all integration partners.
Journal of Integrated Care, 2019
Purpose The purpose of this paper is to develop a case definition of integrated health and social... more Purpose The purpose of this paper is to develop a case definition of integrated health and social services initiatives that serve older adults, and will provide characteristics to aid in the identification of such initiatives. The case definition is intended to ease the identification of integrated health and social care initiatives. Design/methodology/approach A limited search was undertaken of both scientific and gray literature that documented and/or examined integrated health and social services initiatives. In addition, literature on well-documented and generally accepted integrated healthcare and social services models that reflect collaborations from healthcare and social services organizations that support older adults was also used to develop the case definition. Findings The case definition is as follows: healthcare organizations from across the continuum of care working together with social services organizations, so that services are complementary and coordinated in a se...
Healthcare Quarterly, 2007
The province of Ontario, as a result of the First Ministers&a... more The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems.
Journal of Health Organization and Management, 2006
PurposeA performance management system has been implemented by Cancer Care Ontario (CCO). This sy... more PurposeA performance management system has been implemented by Cancer Care Ontario (CCO). This system allows for the monitoring and management of 11 integrated cancer programs (ICPs) across the Province of Ontario. The system comprises of four elements: reporting frequency, reporting requirements, review meetings and accountability and continuous improvement activities. CCO and the ICPs have recently completed quarterly performance review exercises for the last two quarters of the fiscal year 2004‐2005. The purpose of this paper is to address some of the key lessons learned.Design/methodology/approachThe paper provides an outline of the CCO performance management system.FindingsThese lessons included: data must be valid and reliable; performance management requires commitments from both parties in the performance review exercises; streamlining performance reporting is beneficial; technology infrastructure which allows for cohesive management of data is vital for a sustainable perfor...
Dialysis & transplantation, 1999
... SIU MEE CHENG ; KINGSBURY L. ; ESTRIDGE C. ; CONLY JM ; ... University Health Network: Treva ... more ... SIU MEE CHENG ; KINGSBURY L. ; ESTRIDGE C. ; CONLY JM ; ... University Health Network: Treva McCumber, Lili-Ann Zatylny, and the Hemodialysis and Home Dialysis Unit Facility Management at the Toronto Western Hospital, Health and Safety, CANADA Cathy Kennedy of ...