 Tenbensil et al. found that gaming was used by patients in New Zealand's EDs as a response to local hospital performance measurements. This finding is consistent with similar studies conducted in other countries, suggesting that these performance measurements are not effective at building trust among healthcare providers. Instead, they may be contributing to a loss of trust, which could further exacerbate the problem. A more successful approach to improving performance and rebuilding trust would involve collaborative efforts between local providers, central agencies, and patients to set and track appropriate local responses to higher-level national goals. This article was authored by Richard Hamblin and Carl Shucker.