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Our empirical investigation places

Our empirical investigation places primary emphasis on normative rather than cognitive or regulative legitimacy for both substantive and practical reasons. From a substantive view point, the healthcare field in the U.S. has long been subject to strong professional norms, as evidenced by the power of organizations such as the American Medical Association (AMA) and the American Hospital Association (AHA). In areas such as healthcare, where outcomes are often uncertain and difficult to assess, professional and industry trade associations develop "to collectively create and maintain institutional legitimating devices" that enhance public trust (Van de Ven and Garud, 1989: 211). These associations engage in regular and systematic efforts to evaluate the conformity of hospital organizations to industrywide professional standards and to provide assurance to the public that such matters receive careful scrutiny. The results of such evaluations are significant for the organization being evaluated: hospitals receiving favorable evaluations are likely to display them publicly to relevant audiences; conversely, the loss of accreditation is widely publicized in local or even national media, On the practical side, cognitive legitimacy at the population level (which we evaluate empirically) is well established by the
time of our study: hospitals are a taken for granted arrangement for providing healthcare services, and individual organizations rarely depart from the conventional format. There exist many sources of regulative authority over hospitals, including common law (negligence and liability, duties and responsibilities of corporate officials, the hospital's contractual agreements), labor law, personnel licensure, monitoring of financial operations, hospital licensure, and Medicaid certification (see Somers, 1969). Many of these especially licensure and certificationtend to be closely aligned with normative control systems.
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Our empirical investigation places primary emphasis on normative rather than cognitive or regulative legitimacy for both substantive and practical reasons. From a substantive view point, the healthcare field in the U.S. has long been subject to strong professional norms, as evidenced by the power of organizations such as the American Medical Association (AMA) and the American Hospital Association (AHA). In areas such as healthcare, where outcomes are often uncertain and difficult to assess, professional and industry trade associations develop "to collectively create and maintain institutional legitimating devices" that enhance public trust (Van de Ven and Garud, 1989: 211). These associations engage in regular and systematic efforts to evaluate the conformity of hospital organizations to industrywide professional standards and to provide assurance to the public that such matters receive careful scrutiny. The results of such evaluations are significant for the organization being evaluated: hospitals receiving favorable evaluations are likely to display them publicly to relevant audiences; conversely, the loss of accreditation is widely publicized in local or even national media, On the practical side, cognitive legitimacy at the population level (which we evaluate empirically) is well established by thetime of our study: hospitals are a taken for granted arrangement for providing healthcare services, and individual organizations rarely depart from the conventional format. There exist many sources of regulative authority over hospitals, including common law (negligence and liability, duties and responsibilities of corporate officials, the hospital's contractual agreements), labor law, personnel licensure, monitoring of financial operations, hospital licensure, and Medicaid certification (see Somers, 1969). Many of these especially licensure and certificationtend to be closely aligned with normative control systems.
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Investigasi empiris kami menempatkan penekanan utama pada normatif daripada kognitif atau regulatif legitimasi untuk kedua alasan substantif dan praktis. Dari sudut pandang substantif, bidang kesehatan di AS telah lama tunduk norma profesional yang kuat, sebagaimana dibuktikan oleh kekuatan organisasi seperti Asosiasi Medis Amerika (AMA) dan American Hospital Association (AHA). Di daerah seperti kesehatan, di mana hasil sering tidak menentu dan sulit untuk menilai, asosiasi perdagangan profesional dan industri mengembangkan "untuk bersama menciptakan dan memelihara perangkat legitimasi institusional" yang meningkatkan kepercayaan publik (Van de Ven dan Garud, 1989: 211). Asosiasi ini terlibat dalam upaya teratur dan sistematis untuk mengevaluasi kesesuaian organisasi rumah sakit dengan standar profesional industrywide dan untuk memberikan jaminan kepada publik bahwa hal-hal tersebut menerima pengawasan hati-hati. Hasil evaluasi tersebut signifikan bagi organisasi yang dievaluasi: rumah sakit menerima evaluasi menguntungkan cenderung menampilkan mereka secara terbuka untuk khalayak yang relevan; sebaliknya, hilangnya akreditasi dipublikasikan secara luas di media lokal atau bahkan nasional, Pada sisi praktis, legitimasi kognitif pada tingkat populasi (yang kita mengevaluasi secara empiris) mapan dengan
waktu penelitian kami: rumah sakit yang diambil untuk pengaturan diberikan untuk menyediakan layanan kesehatan, dan organisasi individu jarang berangkat dari format konvensional. Ada ada banyak sumber otoritas regulatif lebih rumah sakit, termasuk hukum umum (kelalaian dan kewajiban, tugas dan tanggung jawab pejabat perusahaan, perjanjian kontrak rumah sakit), hukum perburuhan, tenaga lisensi, pemantauan operasi keuangan, rumah sakit lisensi, dan sertifikasi Medicaid (lihat Somers, 1969). Banyak dari terutama lisensi dan certificationtend akan berkaitan erat dengan sistem kontrol normatif.
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