A multidimensional model of organizational legitimacy: Hospital survival in changing institutional environments

Using data on 143 hospital organizations, this article examines the antecedents and effects of two forms of organizational legitimacy (managerial and technical) over a 46-year period. Results show that both the managerial and technical forms provide notable improvements in organizational survival chances but that the strength of each effect varies over time depending on the nature of the institutional environment. Variation also appears in the antecedents of legitimacy-for example, the ability of a hospital to secure approval for its managerial practices depends on the correspondence between its mission and the logic of the surrounding institutional environment. The results suggest that a multidimensional model can reveal nuances of organizational legitimacy that are missed by more unitary conceptions.(.)