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To this date, research on tensions has been carried out on business networks and value co-creation, with no studies exploring tensions within the marketing services context. This study aims to use the three tension categories proposed by Toth et al. (2018) and Pressey and Vanharanta (2006) to address this gap by identifying the tensions experienced in the market research agency (MRA), creative agency (CA) and client relationship, as well as the processes that increase or minimize these tensions.

A total of 25 in-depth interviews were carried out with MRA, CA and client employees. NVivo 12 was used to conduct a thematic analysis to identify the overarching processes that influenced tensions.

Six second-order codes were identified, designating processes that exacerbated or minimized each of the three tensions experienced. Two new processes were identified (“adopting governance processes” and “aspects of identity formation”) which have not been previously reported. An empirical framework was developed pinpointing processes that influenced each tension category, also highlighting complex interdependencies between behavioral, emotional and structural tensions.

This study presents the perspectives of all actors within the marketing services triad providing a more nuanced understanding of tensions at the triadic level, as previous literature predominantly focused either on dyads or on networks. Furthermore, this study highlights important interdependencies between tension categories, providing novel contributions, as well as directions for future research.

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.