The March 2012 article "Working Toward Perfection on the Pneumonia Core Measure"1 described the author's emergency department's (ED) approach to ensuring core measure compliance. While I appreciate their determination for improvement and applaud their process of restructuring to enhance performance, I was very concerned with the punitive actions brought against staff. ED physicians and nursing personnel were punished for process compliance fallouts, with fees being brought against doctors, and progressive discipline applied to nurses. Roark1 states that this was to ensure accountability for staff action and to emphasize the importance of delivering trie best clinical outcomes; however, with the call for increasing positive practice environments 2 and the professional movement toward a just-culture mentality3 to promote a culture of safety, it is prudent to question the use of punishment to command compliance widi the core measurement process.
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