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A multidimensional model of legitim

A multidimensional model of legitimacy offers both theoretical and empirical benefits to organizational and, more broadly, social scientific inquiry. Much of the diversity in legitimation processes can be captured by closer attentiveness to the varying sources of legitimacy, the levels at which they operate, the institutional elements that they target, and the environments that contextualize their effects Armed with these distinctions, researchers can advance beyond simple, unitary conceptions of legitimacy to address the trade-offs faced by social actors in seeking public approval for their actions from diverse constituencies.

We have demonstrated how an empirical framework might be constructed around some of these distinctions. By considering the separate accreditation processes associated
with the managerial and technical layers of hospital organizations, this study has identified variation in both the benefits and antecedents associated with organizational legitimacy. Our analysis suggests that the salience of managerial and technical forms of normative legitimacy can fluctuate across different institutional regimes Hospitals whose managerial structures achieve a high degree of legitimacy may enhance their survival chances most significantly in regimes that are characterized by the presence of extensive formalized relations. In contrast, hospitals that enjov a high degree of tech- nical legitimacy may enhance their survival chances most significantly in regimes characterized by centralized regulatory and funding controls. While our findings are consistent with these predictions, more extensive study designs, incorporating larger samples and crossnational or crosssectoral analysis, are required to fully evaluate the relation between regime characteristics and the salience of diverse bases of normative legitimacy.
The results also suggest that antecedents of legitimacy vary, depending on the nature of the Institutional environment as well as the organizational function that is being legitimated. The mission of an organization, as reflected in its ownership characteristics, is particularly important for attracting managerial legitimacy. Its effects depend primarily, as Parsons once suggested, on the match between the mission and the logic of the overarching institutional regime within which an organization operates. In the healthcare sector, in particular, we found that the shift in dominant logic from one of providing collective goods (e.g., the Great Society programs of the 1960s) to one of profit maximization has had a major influence on the managerial legitimacy of hospitals with different ownership characteristics. The resulting legitimacy crisis of the nonprofit hospital in the era of managed competition raises important policy questions about confidence in eleemosynary healthcare organizations.
The analysis has shown that the degree of niche specialism markedly affects the legitimation of managerial structures. We found that general hospitals matched their managerial structures to normative expectations more readily than did specialized hospital forms. With the continuing drive toward universal administrative protocols, as typified by TOM and ISO-9000 standards, there will be increased pressures for specialists to join integrated provider organizations to maintain their managerial legitimacy. Whether such legitimacy measures real administrative advantages remains a separate issue (d. Westphal, Gulati, and Shortell, 1997). By coupling analyses of legitimacy with studies of efficiency or strategic adaptation (e.g., Huef's 1997 study of hospital service portfolio changes), it may be possible to separate true differences in managerial efficacy among generalists and specialists from the socially constructed aspects of accreditation.
Methodological limitations in the present analysis can also be addressed in future research. We have already noted that larger event samples are desirable in considering period specific legitimacy effects. More direct measures of variables such as centralization are also useful and may eliminate the need for broad based period characterizations. Our discussion of the impact of age on legitimacy has ignored the possible relevance of relative inertia as it affects organizational legitimation-e.g., the fact that an older hospital that is
highly legitimate in one period may be less so in another be- cause of difficulties in adapting to new standards of technicalor managerial excellence. The overlapping of legitimation sources is another issue that can benefit from further con- sideration. What pressures exist for sources to differentiate or combine the targets of their evaluation efforts? What accounts for the historical pattern of sponsorships between legitimacy sources? These questions must await a separate treatment.
A final comment is in order concerning the generalizability of our findings. Hospitals are somewhat atypical among organizations in confronting so many kinds of formalized accreditation sources. While all organizations require some level of legitimacy as a condition of their viability, and all must confront and relate to varied sources of legitimacy, few face as exacting an evaluation as hospitals currently do. Nevertheless, the last decade has witnessed the rapid spread of formal technical and managerial standards (e.g., ISO certification), even in those sectors that have not traditionally been subject to strong institutional demands. Although the loss of accreditation or certification in other sectors may not introduce the crisis that it can for hospitals, it is worth noting that formal normative approval clearly conveys important strategic advantages to many other organizational types. As Oliver (1991) and Such man (1995) have proposed and Elsbach and Sutton (1992) have demonstrated, organizations are not simply passive recipients in legitimation processes but work actively to influence and manipulate the normative assessments they receive from their multiple audiences.


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A multidimensional model of legitimacy offers both theoretical and empirical benefits to organizational and, more broadly, social scientific inquiry. Much of the diversity in legitimation processes can be captured by closer attentiveness to the varying sources of legitimacy, the levels at which they operate, the institutional elements that they target, and the environments that contextualize their effects Armed with these distinctions, researchers can advance beyond simple, unitary conceptions of legitimacy to address the trade-offs faced by social actors in seeking public approval for their actions from diverse constituencies.We have demonstrated how an empirical framework might be constructed around some of these distinctions. By considering the separate accreditation processes associatedwith the managerial and technical layers of hospital organizations, this study has identified variation in both the benefits and antecedents associated with organizational legitimacy. Our analysis suggests that the salience of managerial and technical forms of normative legitimacy can fluctuate across different institutional regimes Hospitals whose managerial structures achieve a high degree of legitimacy may enhance their survival chances most significantly in regimes that are characterized by the presence of extensive formalized relations. In contrast, hospitals that enjov a high degree of tech- nical legitimacy may enhance their survival chances most significantly in regimes characterized by centralized regulatory and funding controls. While our findings are consistent with these predictions, more extensive study designs, incorporating larger samples and crossnational or crosssectoral analysis, are required to fully evaluate the relation between regime characteristics and the salience of diverse bases of normative legitimacy.The results also suggest that antecedents of legitimacy vary, depending on the nature of the Institutional environment as well as the organizational function that is being legitimated. The mission of an organization, as reflected in its ownership characteristics, is particularly important for attracting managerial legitimacy. Its effects depend primarily, as Parsons once suggested, on the match between the mission and the logic of the overarching institutional regime within which an organization operates. In the healthcare sector, in particular, we found that the shift in dominant logic from one of providing collective goods (e.g., the Great Society programs of the 1960s) to one of profit maximization has had a major influence on the managerial legitimacy of hospitals with different ownership characteristics. The resulting legitimacy crisis of the nonprofit hospital in the era of managed competition raises important policy questions about confidence in eleemosynary healthcare organizations.The analysis has shown that the degree of niche specialism markedly affects the legitimation of managerial structures. We found that general hospitals matched their managerial structures to normative expectations more readily than did specialized hospital forms. With the continuing drive toward universal administrative protocols, as typified by TOM and ISO-9000 standards, there will be increased pressures for specialists to join integrated provider organizations to maintain their managerial legitimacy. Whether such legitimacy measures real administrative advantages remains a separate issue (d. Westphal, Gulati, and Shortell, 1997). By coupling analyses of legitimacy with studies of efficiency or strategic adaptation (e.g., Huef's 1997 study of hospital service portfolio changes), it may be possible to separate true differences in managerial efficacy among generalists and specialists from the socially constructed aspects of accreditation.
Methodological limitations in the present analysis can also be addressed in future research. We have already noted that larger event samples are desirable in considering period specific legitimacy effects. More direct measures of variables such as centralization are also useful and may eliminate the need for broad based period characterizations. Our discussion of the impact of age on legitimacy has ignored the possible relevance of relative inertia as it affects organizational legitimation-e.g., the fact that an older hospital that is
highly legitimate in one period may be less so in another be- cause of difficulties in adapting to new standards of technicalor managerial excellence. The overlapping of legitimation sources is another issue that can benefit from further con- sideration. What pressures exist for sources to differentiate or combine the targets of their evaluation efforts? What accounts for the historical pattern of sponsorships between legitimacy sources? These questions must await a separate treatment.
A final comment is in order concerning the generalizability of our findings. Hospitals are somewhat atypical among organizations in confronting so many kinds of formalized accreditation sources. While all organizations require some level of legitimacy as a condition of their viability, and all must confront and relate to varied sources of legitimacy, few face as exacting an evaluation as hospitals currently do. Nevertheless, the last decade has witnessed the rapid spread of formal technical and managerial standards (e.g., ISO certification), even in those sectors that have not traditionally been subject to strong institutional demands. Although the loss of accreditation or certification in other sectors may not introduce the crisis that it can for hospitals, it is worth noting that formal normative approval clearly conveys important strategic advantages to many other organizational types. As Oliver (1991) and Such man (1995) have proposed and Elsbach and Sutton (1992) have demonstrated, organizations are not simply passive recipients in legitimation processes but work actively to influence and manipulate the normative assessments they receive from their multiple audiences.


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Sebuah model multidimensi legitimasi menawarkan manfaat teoritis dan empiris untuk penyelidikan ilmiah sosial organisasi dan, lebih luas,. Banyak keanekaragaman dalam proses legitimasi dapat ditangkap oleh perhatian lebih dekat dengan sumber berbagai legitimasi, tingkat di mana mereka beroperasi, unsur-unsur kelembagaan yang mereka targetkan, dan lingkungan yang mengontekstualisasikan efek mereka Berbekal perbedaan ini, peneliti dapat maju melampaui sederhana, konsepsi kesatuan legitimasi untuk mengatasi trade-off yang dihadapi oleh aktor sosial dalam mencari persetujuan publik atas tindakan mereka dari konstituen yang beragam. Kami telah menunjukkan bagaimana kerangka empiris mungkin dibangun sekitar beberapa perbedaan ini. Dengan mempertimbangkan proses akreditasi terpisah terkait dengan lapisan manajerial dan teknis dari organisasi rumah sakit, penelitian ini telah mengidentifikasi variasi dalam kedua manfaat dan anteseden terkait dengan legitimasi organisasi. Analisis kami menunjukkan bahwa arti-penting dari bentuk manajerial dan teknis legitimasi normatif dapat berfluktuasi di berbagai rezim kelembagaan Rumah Sakit yang struktur manajerial mencapai tingkat tinggi legitimasi dapat meningkatkan peluang kelangsungan hidup mereka yang paling signifikan dalam rezim yang dicirikan oleh adanya hubungan formal yang luas. Sebaliknya, rumah sakit yang enjov tingkat tinggi-teknik legitimasi te dapat meningkatkan peluang kelangsungan hidup mereka yang paling signifikan dalam rezim ditandai dengan kontrol regulasi dan pendanaan terpusat. Sementara temuan kami konsisten dengan prediksi ini, desain penelitian yang lebih luas, menggabungkan sampel yang lebih besar dan analisis crossnational atau crosssectoral, diperlukan untuk sepenuhnya mengevaluasi hubungan antara karakteristik rezim dan arti-penting dari beragam basis legitimasi normatif. Hasil penelitian juga menunjukkan bahwa anteseden legitimasi bervariasi, tergantung pada sifat dari lingkungan Kelembagaan serta fungsi organisasi yang sedang disahkan. Misi organisasi, sebagaimana tercermin dalam karakteristik kepemilikannya, sangat penting untuk menarik legitimasi manajerial. Efeknya tergantung terutama, sebagai Parsons sekali disarankan, pada pertandingan antara misi dan logika rezim kelembagaan menyeluruh di mana sebuah organisasi beroperasi. Di sektor kesehatan, khususnya, kami menemukan bahwa pergeseran dalam logika dominan dari salah satu menyediakan barang kolektif (misalnya, program Great Society dari tahun 1960-an) ke salah satu keuntungan sebesar-besarnya telah memiliki pengaruh besar pada legitimasi manajerial rumah sakit dengan karakteristik kepemilikan yang berbeda. Krisis legitimasi yang dihasilkan dari rumah sakit nirlaba di era kompetisi yang dikelola menimbulkan pertanyaan penting tentang kebijakan kepercayaan dalam organisasi kesehatan amal. Analisis menunjukkan bahwa tingkat niche spesialisasi nyata mempengaruhi legitimasi struktur manajerial. Kami menemukan bahwa rumah sakit umum cocok struktur manajerial mereka dengan harapan normatif lebih mudah daripada itu khusus bentuk rumah sakit. Dengan drive terus menuju protokol administrasi universal, seperti yang ditandai oleh TOM dan standar ISO-9000, akan ada peningkatan tekanan untuk spesialis untuk bergabung dengan organisasi penyedia terintegrasi untuk mempertahankan legitimasi manajerial mereka. Apakah legitimasi seperti mengukur keuntungan administrasi nyata tetap menjadi isu yang terpisah (d. Westphal, Gulati, dan Shortell, 1997). Dengan kopling analisis legitimasi dengan studi efisiensi atau adaptasi strategis (misalnya, 1997 studi Huef tentang perubahan portofolio layanan rumah sakit), dimungkinkan untuk memisahkan perbedaan benar dalam keberhasilan manajerial antara generalis dan spesialis dari aspek sosial dibangun akreditasi. Keterbatasan metodologis dalam analisis ini juga dapat diatasi dalam penelitian masa depan. Kami telah mencatat bahwa sampel acara besar yang diinginkan dalam mempertimbangkan periode efek legitimasi tertentu. Langkah-langkah langsung lebih dari variabel seperti sentralisasi juga berguna dan dapat menghilangkan kebutuhan untuk berbasis luas periode penokohan. Diskusi kita dari dampak usia pada legitimasi telah mengabaikan kemungkinan relevansi relatif inersia karena mempengaruhi organisasi legitimasi-misalnya, fakta bahwa rumah sakit yang lebih tua yang sangat sah dalam satu periode mungkin kurang begitu dalam menyebabkan menjadi- lain kesulitan dalam beradaptasi dengan standar baru technicalor keunggulan manajerial. Tumpang tindih sumber legitimasi adalah masalah lain yang bisa mendapatkan keuntungan dari pertimbangan yang lebih lanjut. Tekanan apa ada untuk sumber untuk membedakan atau menggabungkan sasaran upaya evaluasi mereka? Apa yang menyebabkan pola historis dari sponsorship antara sumber legitimasi? Pertanyaan-pertanyaan ini harus menunggu pengobatan yang terpisah. Sebuah komentar terakhir adalah dalam rangka mengenai generalisasi dari temuan kami. Rumah sakit agak atipikal antara organisasi dalam menghadapi begitu banyak jenis sumber akreditasi formal. Sementara semua organisasi memerlukan beberapa tingkat legitimasi sebagai syarat kelayakan mereka, dan semua harus menghadapi dan berhubungan dengan berbagai sumber legitimasi, beberapa wajah sebagai menuntut evaluasi rumah sakit saat melakukan. Namun demikian, satu dekade terakhir telah menyaksikan penyebaran cepat dari standar teknis dan manajerial formal (misalnya sertifikasi ISO), bahkan di sektor-sektor yang belum tradisional telah tunduk pada tuntutan kelembagaan yang kuat. Meskipun kehilangan akreditasi atau sertifikasi di sektor lain mungkin tidak memperkenalkan krisis yang dapat untuk rumah sakit, perlu dicatat bahwa persetujuan normatif resmi jelas menyampaikan keunggulan strategis penting untuk berbagai jenis organisasi lainnya. Sebagai Oliver (1991) dan manusia tersebut (1995) telah mengusulkan dan Elsbach dan Sutton (1992) telah menunjukkan, organisasi tidak hanya penerima pasif dalam proses legitimasi tetapi bekerja secara aktif untuk mempengaruhi dan memanipulasi penilaian normatif yang mereka terima dari beberapa penonton mereka.










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