title: Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.
abstract: OBJECTIVE
  This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management.
  
  
  METHODS
  A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change.
  
  
  RESULTS
  Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval.
  
  
  CONCLUSIONS
  Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.
authors.affiliation: Department of BioSurgery and Surgical Technology, Imperial College London, UK. e.oborn@imperial.ac.uk
authors.forename: Eivor
authors.initials: E
authors.lastname: Oborn
mesh_terms: D004739:England; D006739:Hospital Administration; D006779:Hospitals, Public; D006801:Humans; D019982:Organizational Case Studies; D009936:Organizational Innovation; D020415:Personnel Downsizing; D013222:State Medicine