| The health care system in the United States is in a process of transformation exemplified by the Affordable Care Act (ACA), a move to value-based care, and a review of the overall quality of the health care system and its ability to serve all citizens. Community health centers are key players in the transformation of the U.S. health care system. Federally Qualified Health Centers (FQHCs) are federally funded community health centers dedicated to the delivery of primary medical, dental, behavioral, and social services to medically underserved populations in medically underserved areas. This research study based on the social enterprise body of knowledge investigated how stakeholders' perception of legitimacy impacted the overall organizational sustainability strategy of FQHCs. Additionally, this study examined the role of community need in moderating the relationship between legitimacy and organizational sustainability.;A mixed methods approach was used to analyze quantitative and qualitative data from a sample of 330 employees, patients, board members, and interested community members from five FQHCs in Ohio and Michigan. Operational data were collected from archival publically available reports. Hypothesis testing of quantitative data used linear regressions to determine if legitimacy, as measured by perception of reputation, values, benefits, and organizational identity, was a positive predictor of organizational sustainability, as measured by financial performance, grant support, endowment growth, and patient volume. Additionally, hierarchical regression and simple slopes analyses tested the moderation effect of community need on the relationship between legitimacy and organizational sustainability. Qualitative data were analyzed using thematic analysis to provide further insights to the quantitative survey responses.;The results of this study strongly suggest legitimacy is a positive predictor of organizational sustainability in the five FQHCs participating in this study. Additionally, community need does provide a moderating effect on the relationship between legitimacy and organizational sustainability. The qualitative data based on stakeholders identifying specific benefits they receive from the organizations helped to clarify the study hypotheses.;This study is the first of its kind to investigate the relationship between legitimacy and community need and the impact on the organizational sustainability of FQHCs. As a result of this study, four major recommendations were offered: increase attention in strategic plans to the four factors of legitimacy, increase community awareness beyond stakeholders, create marketing programs targeting elements of care and services offered, and improving the potential for new sources of funding. |
