The Trust Tax: How Operational Blind Spots Undermine Clinical Partnerships

By Keith Bresciani, for SCM Professionals

The “Trust Tax” in Healthcare Supply Chain Management

In the realm of healthcare supply chain management, we often find ourselves focused on numbers—fill rates, delivery times, and backorders. However, there’s an invisible barrier that affects us all, and it’s what we call the “trust tax.” This term captures the subtle yet significant impact on collaboration and morale when we encounter issues in our daily operations, even if they are not visible on our dashboards.

The Trust Tax Manifests in Familiar Ways

  • Nurses may begin to stockpile supplies, driven by the frustration of consistently encountering empty bins.
  • Clinical leaders might hesitate to approve new products, even when all the evidence points in the right direction.
  • Supply chain teams can feel excluded from critical conversations because they are perceived as lacking an understanding of clinical practices.

Individually, these responses may seem minor, but together, they signal a deeper issue: a gradual erosion of trust that builds over time. Often, these challenges stem from unintentional blind spots—areas where we may not be aware that we are causing friction in our partnerships.

A Personal Experience from the Field

Let me share a story from my experience that illustrates this point. A while ago, we made a product substitution for an IV start kit at the Colorado Health System, believing it was a sensible decision. The new kit was nearly identical to the old one and had received approval from the clinical governance board. However, we quickly learned that our assumptions didn’t account for the familiarity that the nursing staff had with the original kit.

The feedback was immediate and pointed:
“This isn’t what we’re used to.”
“The layout is wrong.”
“Some nurses are skipping the kit altogether.”

Despite the change being intended to improve, it disrupted established workflows and added unnecessary stress. Although it wasn’t financially impactful, the hit to trust was significant. Realizing this, we made a commitment to improve our communication and involve nurses in future decision-making processes. When people feel valued and heard, they are much more likely to collaborate willingly.

Understanding Trust as a Shared Foundation

Trust is often perceived as something built on relationships and communication; this is certainly true. But within healthcare logistics, trust is also about the processes we establish. It grows when:

  • Deliveries arrive at the expected time and place.
  • Changes to products come with clear communication and context.
  • We address issues promptly and transparently.
  • We respect established clinical routines and practices.
  • We openly acknowledge challenges when they arise.

Every interaction reflects our commitment to being in this together or, conversely, reinforces a feeling of isolation.

Taking Steps to Repair Trust

If you’re facing resistance from your clinical partners, it may be helpful to reflect on the following questions:

  • What patterns have we inadvertently created that could be contributing to this resistance?
  • In what ways might we be introducing friction without realizing it?
  • Have we genuinely asked for their input and listened with open hearts?

Start by embracing small yet meaningful changes. Acknowledge past missteps gracefully, share successes, and engage in open communication. For example, our introduction of a Quarterly Performance Review Charter was transformative; it allowed nurse managers to share their challenges and opportunities directly, fostering a solution-focused atmosphere rather than assigning blame.

Collaborative Approaches for Leaders

To decrease the trust tax in your next initiative, consider adopting these empathetic strategies:

  1. Identify Areas of Friction: Take a moment to examine how your processes impact clinical workflows. Are you easing their load or complicating their tasks?
  2. Establish a Meaningful Feedback Loop: Create a channel that goes deeper than surveys, allowing team members to express concerns and ensuring they feel genuinely heard.
  3. Embrace a Partnership Mindset: When issues arise, respond with empathy and urgency, focusing on understanding rather than making excuses.
  4. Cultivate Empathy in Operations: Help your team appreciate how their decisions affect patient care, emphasizing that logistical obstacles can translate into barriers for those they serve.
  5. Celebrate Collaborative Successes: When challenges are resolved together, take time to acknowledge the contributions of everyone involved, reinforcing a collective spirit.

Final Thoughts

Efficiency is undeniably important, but efficiency rooted in trust is even more vital in healthcare. Our supply chain teams significantly influence the atmosphere in which care is delivered, making trust a precious asset that we must nurture.

So, the next time you encounter resistance while implementing a new process, remember to look for the underlying trust dynamics. It is through understanding and empathy that we can foster stronger partnerships and create a more supportive environment for everyone involved.



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