How loyalty and legitimacy tensions unfold among managers in Norwegian hospitals: Developing the notion of flexible legitimacy

This article explores how managers of publicly owned Norwegian hospitals legitimise their actions and decisions, and how the legitimising processes affect their ability to make decisions and lead. Based on interviews and observations, I show that individual managers legitimise their formal power towards professionals with ideas of supportive leadership and democratic ideals. In order to conceptualise this dynamic and add to legitimacy theory, I suggest the notion of flexible legitimacy. The notion highlights the idea that legitimacy construction is always contextually bound, situational and dependent on the possibilities for a flexible negotiation between different social frameworks. This idea is confirmed by comparison with the collective of managers who are limited in their ability to negotiate legitimacy with professionals. The managerial collective justifies its decisions based on principles of management and control, driven by expectations of loyalty within the managerial team and the necessity to comply with political regulations, norms, and values. However, this approach may be a bad match when communicating with autonomy-seeking professionals. The analysis indicates that gaining legitimacy as an individual manager versus a collective of managers cannot build on similar strategies for constructing legitimacy. It highlights the fact that the collective of managers faces particular challenges in terms of legitimacy, mainly due to a lack of flexibility in constructing relational and situational legitimacy when compared to individual managers. These types of legitimacy challenges should be of interest to managers, professionals, politicians, and researchers, because they illuminate tensions that can arise between political requirements, professional norms, and the need to ensure effective healthcare.