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In this viewpoint article, the authors recognize the increased focus in health systems on co-design for innovation and change. This article explores the role of leaders and mangers in developing and enhancing a culture of trust in their organizations to enable co-design, with the potential to drive innovation and change in healthcare.

Using social science analyses, the authors argue that current co-design literature has limited focus on interactions between senior leaders and managers, and healthcare staff and service users in supporting co-designed innovation and change. The authors draw on social and health science studies of trust to highlight how the value-based co-design process needs to be supported and enhanced. We outline what co-design innovation and change involve in a health system, conceptualize trust and reflect on its importance within the health system, and finally note the role of senior leaders and managers in supporting trust and responsiveness for co-designed innovation and change.

Healthcare needs leaders and managers to embrace co-design that drives innovation now and in the future through people – leading to better healthcare for society at large. As authors we argue that it is now the time to shift our focus on the role of senior managers and leaders to embed co-design into health and social care structures, through creating and nurturing a culture of trust.

Building public trust in the health system and interpersonal trust within the health system is an ongoing process that relies upon personal behavior of managers and senior leaders, organizational practices within the system, as well as political processes that underpin these practices. By implementing managerial, leadership and individual practices on all levels, senior managers and leaders provide a mechanism to increase both trust and responsiveness for co-design that supports innovation and change in the health system.

This study aims to examine decision factors for global sourcing, differentiated into transcontinental and continental sourcing to obtain insight into locational aspects of sourcing decisions and global trends. This study analyzed various country perceptions to reveal their influence on sourcing decisions. The country of origin (COO) theory explains why certain country perceptions and images influence purchasing experts in their selection of suppliers.

This study used a two-study approach. In Study 1, the authors conducted discrete choice card experiments with 71 purchasing experts located in Europe and the USA to examine the importance of essential decision factors for global sourcing. Given the clear evidence that location is a factor in sourcing decisions, in Study 2 the authors investigated purchasers’ perceptions and images of countries, adding country ranking experiments on various perceived characteristics such as quality, price and technology.

Study 1 provides evidence that the purchasers’ personal relationship with the supplier plays a decisive role in the supplier selection process. While product quality and location impact sourcing decisions, the attraction of the buying company and cultural barriers are less significant. Interestingly, however, these factors seem as important as price to respondents. This implies that a strong relationship with suppliers and good quality products are essential aspects of a reliable and robust supply chain in the post-COVID-19 era. Examining the locational aspect in detail, Study 2 linked the choice card experiments with country ranking experiments. In this study, the authors found that purchasing experts consider that transcontinental countries such as Japan and China offer significant advantages in terms of price and technology. China has enhanced its quality, which is recognizable in the country ranking experiments. Therefore, decisions on global sourcing are not just based on such high-impact factors as price and availability; country perceptions are also influential. Additionally, the significance of the locational aspect could be linked to certain country images of transcontinental suppliers, as the COO theory describes.

The new approach divides global sourcing into transcontinental and European sourcing to evaluate special decision factors and link these factors to the locational aspect of sourcing decisions. To deepen the clear evidence for the locational aspect and investigate the possible influence of country perceptions, the authors applied the COO theory. This approach enabled authors to show the strong influence of country perception on purchasing departments, which is represented by the locational effect. Hence, the success of transcontinental countries relies not only on factors such as their availability but also on the purchasers’ positive perceptions of these countries in terms of technology and price.