One of the most important goals in healthcare today is reducing costs while maintaining high-quality care. This article focuses on a triadic relationship that is responsible for a significant amount of nonlabor spending in hospitals: physician preference items. The triadic relationship among salespeople, physicians, and hospitals' supply managers has a direct influence on costs. Regarding some key purchases, the physician-salesperson relationship is closer than the physician-supply manager relationship even though the latter two entities work for and within the same company and strive for the same mission. This reality creates a type of conflict that is perplexing to solve and costly to ignore. To better understand the sources of friction and opportunities for collaboration in this triad, personnel across hospitals, suppliers, and healthcare consortiums were interviewed. Herein, we introduce strategies to help resolve the conflict. It is essential that hospital supply managers continually negotiate for best solutions that consider both long-run costs and quality of patient care. Yet, salesperson motivations and close salesperson-physician relationships place barriers that prevent negotiations more common to other areas of spending. The strategies offered in this article highlight ways to mute negative and amplify positive effects of the physician-salesperson relationship. (C) 2017 Kelley School of Business, Indiana University. Published by Elsevier Inc. All rights reserved.