1. Self organization through the interaction of social relations with place* Self organization through the interaction of social relations with place* Ayşe Nur ÖKTEN The 9th meeting of AESOP Thematic Group on “Complexity and Planning” Self-Organizing and Spatial Planning April 29-30, 2011, YTU, Istanbul *This paper is based on the research carried out jointly with Dr. Yiğit Evren.

2. Introduction This presentation focuses on the vital role of cultural and social factors, especially kinship relations and informal networks, in the adaptive behaviour of an organisation. The hospital management adapts to changing conditions in the organisational environment by employing varified strategies. The paper shows how family solidarity is a precondition for the successful functioning of a major public hospital in Istanbul.

6. RRRRR R R RR R RRR R R TRAMWAY H RETAIL CLUSTER R C R C

7. The hospital management adapts to changing conditions in the organisational environment by employing varified strategies. MAJOR QUESTION: What is the nature of the interaction between the hospital (the organization), the care giving families (social roles), the urban area (the space).

8. THEORETICAL FRAMEWORK interdisciplinary The organization theory The organization theory Basic elements of an organization Uncertainty reduction strategies Economic geography Economic geography Resource dependency Embeddedness Sociology Sociology Conceptualizations of space and place in sociology

9. BASIC ELEMENTS OF ORGANIZATION 1. SOCIAL STRUCTURE - 1. SOCIAL STRUCTURE - the patterned or regularized aspects of the relationships existing among participants in an organization. NORMATIVE STRUCTURE – values, norms, role expectations BEHAVIORAL STRUCTURE - actual behavior; activities, interactions, sentiments… 2. 2. PARTICIPANTS - SOCIAL ACTORS 3. 3. GOALS - desired ends 4. 4. TECHNOLOGY - machines and mechanical equipment; the technical knowledge and skills of participants. 5. 5. ENVIRONMENT – institutional; physical

10. HEALTH POLICIES INSTITUTIONAL STRUCTURE OF THE HEALTH SERVICE TASK ENVIRONMENT - Those features of the environment relevant to the organization viewed as a production system, e.g. sources of inputs, markets for outputs, competitors, and regulators (Scott, 1992) ECONOMIC POLICIES - FINANCIAL REGULATIONS SOCIAL NORMS AND VALUES BEHAVIOUR PATTERNS MATERIAL FORM, i.e. the urban tissue THE ORGANIZATIONAL ENVIRONMENT OF THE HOSPITAL

11. STRATEGIES OF ADAPTATION BUFFERING STRATEGIES – Intraorganizatioal techniques aimed at reducing uncertainty for the technical core. DE-COUPLING – When an organization operating in an institutionalized environment confronts inconsistent or conflicting conditions, it is likely to de-couple its normative structure from its operational structure. BRIDGING STRATEGY – Interorganizational relations aimed at reducing uncertainty for the technical core.

12. THE ADJUSTED / TRANSFORMED ORGANISATION BUFFERING BRIDGING THE ORGANISATION Change in the environment FRAGMENTATION OF THE PROCESS treatment care DE-COUPLING new actors in the system (the family; local businesses) Survival Strategies

13. The social dimension The social dimension of this adaptation process is woven within the norms, values, and behaviour patterns of the local network, which consists of the medical staff, health personnel, care giving families, retailers and their contact persons. The social dimension of this adaptation process is woven within the norms, values, and behaviour patterns of the local network, which consists of the medical staff, health personnel, care giving families, retailers and their contact persons. MEDICAL STAFF HEALTH PERSONNEL CARE GIVING FAMILIES RETAILERS CONTACT PERSONS NORMS, VALUES, BEHAVIOUR PATTERNS

14. Physical space works as an intervening actor which can either facilitate or obstruct social and spatial interaction between the hospital and its urban environment. HOSPITAL RETAIL CLUSTER PHYSICAL SPACE ORGANISATION ORGANISATION(S)

15. : Physical space interferes the change and adaptation process of the hospital organisation in three ways: 1. 1. It provides the adequate urban tissue for the location of small retail businesses across the hospital. 2. 2. It becomes an interface between the hospital and the retail cluster. 3. 3. It affects the feasibility, scale and nature of transactions between the carers and medical shops.

17. 120 km

19. H 960,565 in-patients 3000 beds IFM 8.5% of beds and 3.7% of all in-patients in Istanbul.

20. 960,565 in-patients 3000 beds

21. PATIENT P (68) MOTHER OF P’S SON-IN-LAW (68) Laboratories Dialogue with the medical staff Bureaucratic procedures Mobilising the patient Feeding PPreparing meals for PCleaning P Pharmaceuticals Medical utensils and materials for surgery Medical supplies for care and comfort Purchase of food SON-IN-LAW (36) Patient P, female (68) Length of stay: 35 days INSIDE OUTSIDE INSIDE

22. PATIENT T (male, 38) OLDER SISTER of T (40) Laboratories Dialogue with the medical staff Bureaucratic procedures Mobilising the patient Feeding TPreparing meals for TCleaning T Pharmaceuticals Medical utensils and materials for surgery Medical supplies for care and comfort Purchase of food Patient T, male (38) Length of stay: 18 days INSIDE OUTSIDE INSIDE

23. Inside the hospital Outside the hospital For treatment Paper work Paper work Bring and take Bring and take Helping the staff Helping the staff Buying pharmaceuticals Buying pharmaceuticals Buying medical devices Buying medical devices For better care Cooking Cooking Feeding, Feeding, Cleaning the patient; Cleaning the patient; Providing clean bed sheets and laundry; Providing clean bed sheets and laundry;  Providing hygienic dipers, bed cover etc.  Buying food