MSF logistician Jennifer Bock and her colleagues unload 58 boxes one ton of medical supplies, mainly malaria testing kits, destined for the MSF-supported health centre in Boguila.

To work

Judith Soussan

Graduated in International relations (Institut d'Etudes Politiques de Paris), Logistics in humanitarian settings (Bioforce-Développement) and Anthropology (University Paris I), Judith Soussan joined MSF in 1999. After missions in Sri Lanka, Ethiopia, Sudan and the Palestinian territories, she worked in Paris, in particular on protection of civilians. Following a few years break from MSF working as a radio reporter, she has come back to Crash in 2015. She contributed to the book "Saving lives and staying alive. Humanitarian Security in the Age of Risk Management" (chapter "Security Issues and Practices in an MSF Mission in the Land of Jihad" - London: Hurst and Co, 2016).

We’d like to share with you today some recommended reading around the issue of "management", work, or rather ways of working In this text, I use three types of accentuation. "Quotation marks with italics" refer to quotations from texts; italics are applied to words or concepts that I wish to emphasize or draw attention to. Finally, I apply "single quotation marks" (as for "management") to words or expressions that are extremely widespread and therefore seem obvious, in order to recall that these are concepts belonging to a certain field (generally, in this text, that of management or human resources). . This choice may surprise some regular CRASH readers; isn’t this a far cry from the usual subjects of our critical analysis? 

Far from being chosen at random, the selection that follows in reality grew out of several years of reading. In the course of our work on security See M. Neuman, F. Weissman, Saving Lives and Staying Alive: Humanitarian Security in the Age of Risk Management, Hurst, 2016. and medical quality at MSF See Rony Brauman, Michèle Beck, Médecins Sans Frontières and Medical Quality, 1 January 2017. From a workshop held in 2016. in 2016, we uncovered a rich literature that we were able to use to reformulate the problems we were having. On humanitarian security management, for example, the sociology of professions helped us find an alternative to the dominant security culture, which claims to control risk via standardized indicators and procedures. Instead of treating the “human factor” as a problem, the sociology of professions encouraged us to see it as a resource in deliberative mechanisms capitalizing on the experience and collective intelligence of our operational staff. With regard to our questions about quality (medical, in particular), we discovered that ergonomics had already asked them, and had even treated deviations from the norm and conflicts between different quality criteria a major subject of research and offered some possibilities for reconciling them.

Further reading was then stimulated by other topics under discussion at MSF (and certainly, in a more or less similar way, at other humanitarian organizations), whether the subject of efforts and initiatives or nagging complaints: e.g., "individualized performance evaluations", headquarters-field relationships, “delegation”, fuzzy decision-making, operational silos, the ubiquity of “validation”, the role of reporting in day-to-day field work, the need to improve “coordinators’ management skills”, the “quality of work life”, etc. As one thing led to another, we (re)discovered other authors from yet other disciplines – the psychodynamics of work, clinic of activity, sociology of work, social anthropology of development, etc.

What all these approaches have in common is that they rely on a thorough examination of real work situations. The authors of the articles below are interested in all of the things that prescriptions (strategic plans, job profiles, procedures...) miss, focusing their attention on interactions, deviations, and trial-and-error processes when – in the face of complex, difficult situations – we hesitate, try, fail, persevere, and argue in order to arrive (or not) at temporary decisions. Correspondingly, they all share the same distrust of generalizations, linear explanations, and simplistic solutions. While they don’t deny that there is a need for simplification when thinking through and intervening in situations, these researchers never lose sight of the fact that they are dealing with constructs. To them, contrary to popular belief, the instruments we use to capture and represent the real (concepts or numbers) and organize our work (models, tools, and techniques) are neither objective nor neutral. It is therefore important to denaturalize them in order to reveal the values and political choices they carry (and the tangible effects they produce). From that perspective, several of the authors are careful to describe their own theoretical moorings and assumptions.

One of those is found, more or less explicitly, in every one of the articles presented here: the affirmation of the value of that which is human – as opposed to seeing humans as a source of fallibility or error, in contradistinction to the supposed perfection of machines or models – and collective – as opposed to the idea that work should be gauged at the individual level.

As with security and quality, these texts seem to put our intuitions into words and lend legitimacy to shared experiences, private beliefs, and occasionally unauthorized practices, regarding both team dynamics and the conduct of a project. In sum, this literature gave us some ways to think about our work realities outside of, or alongside, the dominant framework of “management” approaches that are accessible to anyone via a few online clicks, and which often appear to be just common sense, and the only rational approach.

For example, in "What Are the Issues of Focusing on Irreducible Uncertainties in Professional Work?", sociologist of professions Florent Champy emphasizes the importance of human judgment in medical workA similar argument is developed in the book chapter "Pourquoi le soin n’est pas qu’une question de technique ?" (paid access only). . He shows that – as in all professions characterized by a high degree of uncertainty – medical work involves a specific type of rationality: “practical wisdom”. As Champy asserts, this “humble”, fragile rationality – a remarkable blend of audacity and due care that in a single gesture mobilizes what experience and science have taught – must be protected from the current trend that says that the undecidability of medical situations can be resolved through technical or scientific means alone.

Uncertainty is also central to Philippe Lavigne-Delville’s critical analysis in “Facing Uncertainty?" (also available in French here). A specialist in the social anthropology of development, Lavigne-Delville points out the contradiction between what characterizes a project (the unknown) and the "project management” planning-based approach so prevalent in the development sector, which uses tools and concepts borrowed from industry (i.e., the project cycle and logical framework, although these have long been considered inadequate even in that domain). "Comprendre le ‘succès’ et l’‘échec’…" extends this line of thought with in-depth questioning of our ideas about what constitutes a “successful” project, and offers a different way to judge the trajectory of a project – and thus to conduct it.

While Champy and Lavigne-Delville talk about something specific to our métier, the authors of the texts below look at work in general. And despite the wide range of situations they examined (including some that might seem far from our realities), there were some constants, these two basic observations, in particular: first, everyone, no matter what their field, feels a need to find meaning in their job by trying to do good, and do good work; and second, there is an irreducible gap between people’s real work and their prescribed work (as reflected in their job description, current procedures, etc.).

The distinction between prescribed work and real work is one of the fundamental achievements of so-called French-language ergonomics, and helps us think about work situations in a new way. This is what "Qualité réglée, qualité géréeshows regarding the now-widespread quality requirement in the working world. In this brief, educational summary article, ergonomist Pierre Falzon and his co-authors present a number of situations (in the healthcare, aviation safety, and civil service fields) in which that requirement comes into play. They describe how, behind the apparent obviousness of the quality concept, actors actually have to make a new and different trade-off, every time, between conflicting quality, safety, and performance criteria, or deal with instructions that violate their own idea of what quality work is.

The gap between prescribed and real is also critical to psychoanalyst and ergonomist Christophe Dejours Dejours founded the discipline called “psychodynamics of work” at the Conservatoire National des Arts et Métiers. He is well known in France for his writings and the stands he takes on suffering at work.. Other psychoanalytic concepts inform his view of humans at work (which he presents in a series of short, easy-to-understand videos excerpted from the documentary J’ai très mal au travail). As explained more specifically by Bénédicte Vidaillet and Parisa Dashtipour in "Christophe Dejours’ psychodynamic theory of work and its implication for leadership", this view offers an alternative understanding of the manager’s role, one at odds with the ideas currently in vogue about "leadership". Rather than a leader of men, the manager is someone who pays attention to his team members’ real work and to the difficulties and resistances they face in doing it, and whose main responsibility is to lay out and carefully manage the discussion about the work.

Mathieu Detchessahar, a researcher in management science, continues along the same lines with "Faire face aux risques psycho-sociaux : quelques éléments d’un management par la discussion". Drawing on ergonomics and the sociology of work and acknowledging his debt to Dejours, he borrows Dejours’ notion of spaces for discussing work – which must become central again to managers’ work – and attempts to define that notion more precisely: what are these spaces, and what are they not? Under what conditions are they possible? Why are they lacking today?

In "Décalages socio-cognitifs en réunions de concertation participative" research psychologist Béatrice Cahour narrows the focus via a detailed analysis of the interactions that occur during meetings. She describes the complexity of what plays out for the different protagonists in a discussion, depending on their place, what they think is expected of them, and their experiences of past discussions – leading some participants to actually not participate. (She is also the author of "Les cadres surchargés par leurs emails : déploiement de l’activité et expérience vécue" ; which, while offering no miracle solutions, does give some suggestions for dealing with the scourge of excessive emails.)

The work of ergonomists Jeanne Thébault and Catherine Delgoulet, which also relies on observations of very concrete situations, focuses on the issue of practical knowledge transfer (a major issue for us, given the importance placed on experience in conducting humanitarian projects). In “La transmission à l’épreuve des réalités du travail”, they suggest a number of new directions for us to look in. In contrast to the widely-held notion of “skills transfer”, the transfer at issue here turns out to be a convoluted process that “cannot be dictated”, but should instead “be supported.” A striking example of this can be found in "La place du care dans la transmission des savoirs professionnels entre anciens et nouveaux à l’hôpital" also by Jeanne Thébault, with Corine Gaudart. These texts, like the previous ones, show that we need to stop slicing reality into different problems to be “managed”; the transfer process cannot be considered separately from the work situations or real conditions in which it takes place.

To end (and for the more intrepid), we offer a look at the broader issue of the role numbers play in our lives. In the discussion "A propos de l’emprise du chiffre" (paid access only), though opinions sometimes differed, all agreed that behind the attraction of numbers lays the fantasy of a world governed by science. And that we therefore need to recognize that every choice of direction is political and (in an echo of the very first article in this selection) rehabilitate the idea of prudence – another name for “practical wisdom”.  

Happy reading!

To cite this content :
Judith Soussan, “To work”, 16 décembre 2019, URL :

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Merci Judith pour cette incartade dans le domaine du "bien-être" (ou de la souffrance) au travail, qu'il est essentiel de conscientiser puis de mettre en mots afin que la définition de priorités, par définition trop nombreuses et irréconciliables, par les managers soit moins perçue comme un renoncement que comme une véritable prise de décision, prenant en compte dès le début la "capacité" réelle (au sens large) d'une équipe au lieu "d'ambitions" et "d'espoirs " assez virtuels, mais qui peuvent conduire à différentes formes de détresses et de fuites. 

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