title: The impact of regional policies on emergency department management and performance: the case of the regional government of Sicily.
abstract: BACKGROUND
  Improvement in healthcare, seeking the correct balance between quality and costs, is an ongoing concern in many countries. Many countries have developed and implemented improvement programmes in health care, particularly in emergency departments (ED), which play a key role in terms of hospital resources and planning. The regional government of Sicily implemented a project 2010-2012 to improve ED care quality and patient safety.
  
  
  OBJECTIVE
  This paper aims to evaluate improvements implemented by the Regional Health Authority of Sicily in the 20 main EDs.
  
  
  METHODS
  Performance analysis of EDs was conducted on three levels: care quality (standard Joint Commission International evaluation), efficiency in terms of resources and output (by way of interviews and document analysis) and the role of management in efficiently promoting change (presence of a performance monitoring system).
  
  
  RESULTS
  The results show improvements in all areas and improved performance in all EDs. There is, however, room for improvement in certain areas, and improvement was not uniformly distributed.
  
  
  CONCLUSIONS
  The quality of local policy and management are key aspects of efficient promotion of performance improvement. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Department of Public Management, University of Parma, Parma, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Fanelli
authors.affiliation: Department of Public Management, University of Parma, Parma, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ferretti
authors.affiliation: Department of Public Management, University of Parma, Parma, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Zangrandi
mesh_terms: D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D006291:Health Policy; D007857:Leadership; D058996:Quality Improvement; D012802:Sicily
keywords: Italian healthcare system; emergency departments; performance improvement; public management; public policies