By Keith Bresciani, for SCM Professionals

In healthcare supply chain, we spend a lot of time measuring efficiency. We track fill rates, backorders, delivery times, and utilization. But one of the most expensive dynamics I’ve encountered doesn’t appear on any dashboard.

It’s the trust tax.

Every unexplained short, every delivery that blocks a med room, every product change made without notice quietly erodes trust. Individually, these moments may seem minor. Over time, they compound, until even well-designed initiatives are met with hesitation, resistance, or outright pushback.

This isn’t a post about systems or logistics. It’s about the human side of operations. Because if we’re serious about reform, trust can’t be an afterthought. It must be treated as infrastructure.

What the Trust Tax Looks Like

You’ve likely seen it, even if you never named it:

• Nurses hoard supplies because empty bins have become routine.
• Clinical leaders resist product changes, even when the data supports them.
• Supply chain is excluded from planning conversations because “they won’t understand the clinical impact.”
• Minor delays escalate quickly, not because they’re critical, but because they reinforce a pattern.

This erosion rarely comes from bad intentions. Most of the time, it’s the result of operational blind spots. When teams feel unheard or disrupted without explanation, they protect themselves. That protection shows up as resistance.

A Story from the Field

Several years ago, our health system rolled out a product substitution for an IV start kit. The specs were nearly identical. The change was approved at the system level and cleared by clinical governance. We expected a smooth transition.

Instead, the calls started immediately.

“This isn’t what we use.”
“The components are in the wrong order.”
“Nurses are bypassing the kit entirely.”

What we missed was workflow. The original kit aligned perfectly with a specific unit’s routine. The substitute disrupted it. The financial impact was minimal. The trust impact was not.

We didn’t just correct the product; we corrected the process. More importantly, we re-engaged that unit in future decisions. When people feel heard, they stop resisting and start partnering.

Why Trust Is Operational

Trust is often framed as emotional, and it is. But in healthcare logistics, trust is also procedural. It’s built through:

• Accurate, on-time deliveries
• Clear communication around product changes
• Rapid response to stockouts
• Respect for unit rhythms and clinical workflows
• Transparency when things go wrong

Each action sends a message: We’ve got you.
Ignore them, and the message becomes: You’re on your own.

Repairing the Damage

If you’re encountering resistance from clinical partners, pause and ask:

• What patterns have they experienced from us?
• Where have we created friction without realizing it?
• Have we genuinely asked for their perspective?

Start small. Own missteps. Communicate clearly. Build quick wins that show commitment.

One of the most effective tools we used was a Quarterly Performance Review Charter, structured conversations with nurse managers about waste, stockouts, service gaps, and shared improvement efforts. It wasn’t just reporting data; it was collaborative problem-solving.

Trust doesn’t return through apology alone. It returns through consistency.

What Leaders Can Do

To reduce the trust tax in your next initiative:

• Audit friction points – Where do supply chain actions intersect with clinical workflows?
• Build real feedback loops – Not surveys, but channels where frontline voices are truly heard.
• Respond like a partner – Lead with urgency and transparency, not defensiveness.
• Elevate operational empathy – A blocked hallway isn’t just a mistake; it’s a signal.
• Celebrate collaborative fixes – Recognize the people who help you see the problem.

Final Thought

Efficiency without trust is short-lived.

Supply chain teams don’t just move products, they shape the conditions under which care is delivered. Trust is a performance asset. It determines how quickly you can move, how deeply you can partner, and how far reform can go.

If your next initiative meets resistance, don’t just study the workflow. Study the history. Because the real barrier may not be the change itself, but the trust tax still being paid from the last one.

Field Notes from the Author:

Every initiative I’ve seen struggle had unspoken trust issues beneath the surface. Every success began with a conversation where people felt seen. We don’t just manage systems, we build relationships. And they matter more than we often admit.