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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 paper investigates how various emergent theoretical perspectives in entrepreneurship research, representing diverse decision-making logics, influence firm growth and evolution. It explores the interaction among decision-making logics, including experimentation, affordable loss, flexibility and pre-commitment as components of effectuation, alongside causation and bricolage and their synergistic effects on firm growth.

This study uses a multi-phase, discovery-oriented approach. Initially, insights from existing literature on decision-making logic were combined with in-depth interviews with 10 Iranian entrepreneurs within the food sector. This phase used alternative template research to evaluate the principles of effectuation, causation and bricolage within case study data depicting firm growth. Subsequently, a self-administered survey was developed based on these insights and distributed to 205 entrepreneurs in Iran. The survey data was analysed using fuzzy-set qualitative comparative analysis (fsQCA) to identify key factors and pathways influencing firm growth.

Using a discovery-oriented approach, this study formulates a comprehensive framework detailing decision-making logics that influence firm growth. Through fsQCA, 12 distinct paths are identified, highlighting the complex interplay of causation, effectuation and bricolage in high-growth firms within the food sector.

This study has limitations. FsQCA identifies only logically sufficient combinations, suggesting potential for exploring alternative pathways in future research. Given COVID-19’s impact on the food sector, examining decision-making logic across diverse contexts and industries is advisable. Additionally, exploring how bricolage, causation and effectuation affect outcomes like new product development and innovation is essential in a growth-focused context. It is also important to consider environmental and organizational factors influencing growth.

This paper pioneers the examination of emerging theoretical paradigms in entrepreneurship and their impact on firm growth. It identifies critical configurations of causation, effectuation and bricolage, providing actionable insights for navigating dynamic business environments.