In many activities, professionals are sometimes confronted with a level of complexity that brings some irreducible uncertainty in their work. It is impossible to know with scientific certainty what should be done and what exactly would result from any action once completed. Working with people (e.g., in medical practice, social work, teaching) is emblematic of this type of difficulty. In medical practice, each patient is both biologically and psychically unique and in a specific socioeconomic situation, making it difficult for doctors to apply a comprehensive approach to each case. When faced with a given set of symptoms, they cannot always make a precise and definitive diagnosis. Two sets of symptoms may be difficult to distinguish although they correspond to different diseases. Even when a precise diagnosis has been reached, different people may still need varying treatments because of their other diseases, allergies, diverse tolerance levels or overall fitness. Thus, substantial uncertainty about the care process remains, and doctors may have to adjust treatments for many reasons. This singularity and complexity of patients call for particular vigilance.
The interactionist sociologist Anselm Strauss clearly understands that difficulty. In a collective work, he insists that “contingencies” vastly differ according to professions; in medical practice, they reach a much higher level than in other fields (Strauss, Fagerhaug, Suczek, & Wiener, 1985). This distinction among activities by level of complexity could have led to an original line of research of the sociology of professions. However, complexity has never been given a significant place in this field. One reason may be fidelity to the concept of professions that is dominant in the Chicago School (Becker, 1962; Hughes, 1971). Contrary to functionalists, the Chicago sociologists have tried to avoid rebuilding research programmes that would be adapted only to certain activities. Following Hughes’ work, they have continued to study all activities in the same way. Of course, complexity is mentioned when empirical work reveals its importance. Nonetheless, in the absence of an explicit break from the interactionist tradition, theorizing complexity and its effects on professional work has never been a priority for the sociology of professions.
Over time, sociology has moved away from the interactionist view of professions by focusing more on changes in work contexts, considered on different scales, than on the precise contents of work. This approach has resulted in research programmes on globalization, new public management and more generally, cultural or organizational changes, bringing new constraints for professionals. In comparison, sociologists have paid little attention to the evolutions at the core of work itself, that is, to the way that professionals manage to accomplish their work, the concrete difficulties they encounter or their dissatisfaction concerning the outcome of their work.
This special issue first aims at defending the idea that complexity should be placed at the heart of the study of professional work. It also intends to open new avenues for examining the issue. What then are the reasons for studying complexity?
Complexity: An underestimated issue
The first reason for focusing on complexity comes from changes in work contexts. Sociologists have been studying them for several decades, but they still pose a challenge for the social theory of professional work. Let us find out how the sociological discourse on professional autonomy is questioned by these evolutions. The interactionist tradition used to criticize how professionals used their autonomy (Freidson, 1970, 1986), and this criticism was part of the general break from the functionalist perspective on professions (Parsons, 1951). For that reason, it used to be so central to the interactionist concept of professions.
Nevertheless, the evolutions of work contexts have increasingly threatened professional autonomy. Thus, sociologists have more often focused on the factors that challenge the discretionary power of professionals, that is, new public management, bureaucratization or public distrust in professions and increasing demand for respect, rather than on autonomy itself. As far as new public management is concerned, many sociologists (who are also professionals and may feel personally threatened) seem to regret those evolutions. Most sociologists have adopted a critical view of new public management. Additionally, they often point out the threat to professional autonomy as one of its most serious consequences. However, their criticism of new public management cannot be based on an explicit defence of professional autonomy as they have never abandoned Freidson’s (1970, 1986) idea that autonomy could be misused. Actually, they could agree with managers that autonomy should be limited.
According to whether a sociologist considers professional autonomy as necessary or misused, its limitations may prove positive or negative for the users of professional services. It also definitely depends on both the circumstances and the type of limitations imposed. A lack of autonomy may prevent professionals from working properly in their clients’ interest, yet imposing a new rule may enable them to take into account their clients’ demands in a better way (e.g., when informed consent is required or when a rule aims to prevent discrimination against clients). It is thus obvious that despite the central role played by the theme of autonomy in the sociology of professions, it is not a clear issue for the users of professional services. A new way of dealing with the evolutions of work contexts and their possible impact on the quality of services, consistent with the interactionist tradition’s key findings on autonomy, is yet to be found.
Here, I argue that autonomy is an unambiguous issue only for professionals and that considering the complexity of professional work is necessary to understand what is at stake for users of professional services in the current evolutions of work contexts. The reason is that occupational activities are affected unevenly by these developments, depending on the complexity of the cases and the situations that professionals deal with. The more complex the cases or the situations are, the more likely the professionals will be affected and unable to carry out their tasks properly. What is at stake for users is the professionals’ ability to adapt their work precisely to the concrete cases they handle. When a case or a situation is quite complex, rules, effectiveness indicators and any other abstract devices aiming at controlling the work from a distance (Evetts, 2003; Fournier, 1999) are more likely to be inadequate for the concrete case or situation, to miss the mark and to cause difficulties and damages than when easy work is concerned. For instance, a rule may have been established to bring about an intended effect and may be efficient in many cases. Nonetheless, the more complex the cases are, the more likely will the rule come across some of them that it has not anticipated. Similarly, the more complex the cases are, the more likely will the indicators provide a misleading assessment of the results of a task, as this will require a more detailed evaluation. Actually, tensions often arise between, on one hand, what should be decided and done in view of the concrete case when considered in its complexity, and on the other hand, what abstract devices, rules and indicators urge or allow professionals to do.
Additionally, in complex situations, pressures concerning productivity, performance and the precise anticipation of the work outcome are often impossible to handle. These demands from the management and the service users show that the complexity of professional work and its implications are unrecognized. Professionals are expected to work as they would if they dealt with more simple cases and situations. If they argue that the demands imposed on them are unrealistic, their argument will probably be understood as an opportunistic defence of their autonomy. For this reason, professionals are caught in the tension between the inner difficulty of complex work and the external demands from the management and sometimes the service users. These demands are often too abstract to address the diversity of complex cases that professionals have to deal with.
Among classical sociologists, Abbott (1988) comes closest to these themes of both complexity and tension between abstraction and concreteness. This fact is shown by how he defines the field of validity of his theory in The System of Professions. His theory focuses on activities that apply “abstract knowledge to concrete cases” (Abbott, 1988, p. 8). Studying this kind of activities, Abbott pays particular attention to the function performed by inference in professional work. The underlying idea is that in these activities, a professional cannot mechanically deduce what Abbott calls “treatment” from a “diagnosis.” A special consideration is needed to adapt work properly to the concrete cases that professionals have to handle. Here, concrete means both singular and complex. If the cases were simple, the proper treatment would be much easier to determine. If they were not singular, the same treatment would apply to several cases without a special examination. Inference is this extremely thoughtful process required to adapt abstract knowledge to each new case, grasped in its singularity and complexity. As Abbott shows, inference lends the activity its non-routine nature and unpredictability. For this reason, professional work cannot always fit in with the expectations of the public, the administration and more generally, all the parties that professionals are involved with because these groups neither understand such complexity nor to what extent it makes the work process unpredictable. This is why professionals often find it so difficult to come to terms with and meet those expectations. Furthermore, the difficulties that they encounter are unclear to them and all the more unsettling since they think that the demands for objectivity, predictability and performance do make sense1. Thus, it is difficult for them to identify precisely the problem that they face at work.
Abbott (1988) recognizes that the relationship between abstraction and concreteness is a key issue in professional work. His emphasis on inference also helps sociologists perceive how crucial reflexivity is in professional work. Abbott’s theory of professional work (independent of his theory of the competition for the control of jurisdictions, both being linked but analytically distinct) could have enriched the sociology of professions with new avenues of research. It could have inspired work about the social conditions required for facilitating this reflexivity to adapt work to concrete cases, considered in their uniqueness and complexity. Those avenues have not been opened, probably for two reasons. Abbott himself does not emphasize this point. He considers inference as a key point to explain the strength of jurisdictions, as if inference was mainly part of the professionals’ strategy in the competition. However, he pays no real attention to another aspect of inference; it is also crucial to perform the kind of work he studies. Additionally, Abbott’s theory of the competition for jurisdictions is popular in the current sociology of professions, but his theory of work has received far less attention. Similar to Strauss and colleagues’ (1985) work, Abbott’s is imbued with the idea of complexity; as shown earlier, his theory would not be the same if complexity was absent. Although Abbott is one of the most cited authors in the sociology of professions, the way that his ideas are interpreted leads readers to forget about complexity. This situation is an indication of the work that still needs to be done to understand this issue of complexity.
Why has this theme not become more central in the sociology of professions? The classic philosophical concept of practical wisdom sheds more light on what is fundamentally at stake in the difficulty of conceptualizing the role of complexity in professional work, as well as on the current challenges to deal properly with complex cases or situations.
Complexity and practical wisdom
In this section, I introduce the concept of practical wisdom. I explain how it allows the identification of an original ideal-type of professions and how it sheds light on the issues at stake in the current evolutions of the work conditions of practitioners.
According to the Aristotelian tradition (Aubenque, 1963; Broadie, 1991; Ricœur, 2007), practical wisdom (or prudentiality, another translation for the Greek concept “phronesis”) is precisely the way of thinking required to handle the kind of situations or cases described in the preceding section, that is, where complexity and uniqueness bring irreducible uncertainty. This irreducible uncertainty defeats the mechanical use of any abstract scientific knowledge, rules, protocols, and so on. This does not mean that these knowledge, rules and protocols are useless. Arguing so would be absurd. It does signify that in the face of irreducible uncertainty, a professional cannot solely rely on them to deduce what to do in concrete individual cases without risking severe damage, as previously highlighted in medical practice.
Let us find out why this concept can be useful for sociological research on a number of professions2. Which professions are particularly concerned? Providing an exhaustive list of the most prudential3 activities is not the point, as large variations can exist within a given profession. Nonetheless, activities where practitioners work with people (e.g., doctors, social workers, teachers), deal with highly uncertain situations (e.g., police officers, researchers) or manage complex projects (e.g., architects, industrial project managers) are those where practical wisdom is usually required. They are also those for which impediments to practical wisdom are the most likely to cause damage. Examples include maladjustment in treatments for patients or in teaching pupils, misunderstanding of tricky situations that may lead police officers to make the wrong decisions, researchers’ inadequate evaluation of the significance of a line of research compared with another, or buildings ill-adapted to their uses. As mentioned, although it would be difficult to provide an exhaustive list of prudential professions, as those issues are not so salient in all occupations, the concept is useful in illuminating the difficulties encountered in these activities and in asking research questions about them. One of the major benefits of using the concept of practical wisdom for sociological work is that it helps sociologists understand why complexity has not become a key theme of sociological research and more generally, why some issues associated with complexity are usually misunderstood and underestimated, not only by sociologists but also by other actors.
Few people understand that practical wisdom is required when complexity and singularity bring an irreducible uncertainty. First, the concept of practical wisdom has been absent from the common culture, even of highly educated people, for at least two centuries. Earlier, the concept used to be understandable by any educated person. For instance, it is present in the 17th-century French general literature in its Aristotelian meaning4. It has disappeared in the 19th-century literature. The idea itself has also become increasingly difficult to understand because of the dominant conception of rationality based on the benefits of science. Even in situations where practical wisdom is strongly needed (i.e., where uncertainty cannot be avoided), science and measurement are perceived as the dominant bases of rationality. This narrow conception of rationality recommends applying rules, knowledge or protocols as rigorously as possible to attain objectivity and make the work process and its outcomes foreseeable. It also leads actors to place significant weight on indicators that offer a hint of objectivity, even if they are too simple and provide a biased view of what they measure—either the situation or the results of the work.
The philosophical tradition about practical wisdom helps provide an understanding of the limits of this conception of rationality, which is highly ambitious but also naïve because of its unrealistic aspiration. What is expected of it is out of reach. For instance, this philosophical tradition shows that irreducible uncertainty makes bets often unavoidable. Thus, objectivity is impossible. Actually, objectivity is dependent on certainty. Where irreducible uncertainty remains, objectivity is out of reach. The claim for objectivity in an uncertain world is an illusion that prevents handling problems properly. Of course, this does not mean that anything is equally relevant, as I shall discuss further.
Nevertheless, many people can no longer understand that practical wisdom is a crucial issue in some situations, and they ignore what conditions are necessary to allow a prudential approach so as to act accordingly. Consequently, requirements are quite likely to be brought in that cannot be satisfied. In other words, prudential work on complex cases is being jeopardized by the epistemic gap between two conceptions of rationality. For people who believe that objectivity and measurement are central components of rationality, objectivity and foreseeability are normal requirements. As this narrow conception of rationality is now increasingly prevailing, notably in the management of organizations, the conditions for practical wisdom are often missing.
Having identified this epistemic gap, a sociologist understands better why the evolutions of professional organizations are likely to place their practitioners working there in difficult situations. The concept of practical wisdom makes it easier to grasp why new public management is thwarting professional thinking and to study precisely to what extent it is doing so. A sociologist also more clearly comprehends why some activities are more vulnerable to the demands of managers than others. The more complex the work is, the more practical wisdom is needed, and the more abstract control from a distance is likely to make proper work (i.e., prudential work) difficult. Because practical wisdom requires flexibility, it poses a major challenge in the current evolutions of professionals’ work conditions. Organizations, rules and managers’ rigid approach to work are liable to hinder the prudential adaptation of work to unique cases or situations. For this reason, these rigidities appear as serious impediments to practical wisdom.
However, the issue is not that simple. It would be so only if professionals always used their autonomy to act prudentially and in their clients’ interest. As such is not always the case, or at least, not as much as professionals could or should, rules and control from a distance may also be beneficial for the quality of work. Likewise, abstract indicators are often overly simple and encourage professionals to pursue certain aims at the expense of others. On the other hand, indicators may also be useful in helping assess the work and improving it. Obviously, sociologists should avoid jumping to conclusions about the relationships between organizations and rules, on one hand, and practical wisdom, on the other hand. Such relationships depend on specific contexts that ought to be further investigated.
The concept of practical wisdom: Observing situations at work from a different angle
Philosophers have already described the prudential way of thinking and the social conditions required to make it possible (Aubenque, 1963; Broadie, 1991). This description is useful in guiding empirical research on professional work, as it enables researchers to study whether these required conditions are met (Champy, 2012). The key social conditions for allowing practical wisdom are as follows:
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an overall view of a case (versus an oversimplification of it, considered in one dimension only or in a small number of its dimensions);
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sufficient attention paid to evidence (even minor details) showing that the case may be more complex and difficult than it appears at first sight;
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enough time to deliberate on the case as required;
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the ability to deliberate, not only on the suitable means to achieve the goals of professional work, but also about the way that these goals should be prioritized, as complexity often prevents professionals from fully meeting them all; and
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the ability to criticize, avoid and replace the usual solutions when there are justifiable reasons to believe that they are ill-adapted (i.e., freedom from automatism, whether arising from routines, bureaucratic rules or scientific knowledge).
This list of conditions does not claim to be comprehensive. On the contrary, it is only a quick presentation of the rich philosophical work describing how prudential people deal with situations of irreducible uncertainty. Nonetheless, using this list as a starting point definitely helps in formulating specific research questions on the numerous social objects that will likely either foster or hinder practical wisdom, such as cultures, rules, division of labour, professional training, technical devices, and so on. The description of the conditions that are conducive to practical wisdom is useful in guiding investigations on any of these social objects. Let us take the example of rules. Understanding the relationship between rules and practical wisdom implies avoiding two opposite traps, as discussed regarding the use of the concept of autonomy. The first one would involve defending autonomy and as a result, would systematically criticize rules for their limitation of autonomy. As explained, this view is irrelevant since Freidson (1970, 1986) has shown that autonomy is often misused. The opposite position would entail approving rules because they limit autonomy and its misuses. The latter perspective is also unsatisfactory because rules imposed from above may prove ill-adapted to concrete work. Some rules are highly suitable for prudential work, while others may bring difficulties, all the more so as they are established from a distance. Fieldwork is needed, and the description of the conditions that are conducive to practical wisdom provides an adequate basis for guiding investigations on precise rules, avoiding both these traps.
The research questions to be addressed concern both the formulation and the use of rules. Do the people who have formulated the rules know the concrete cases that these will apply to and the kind of difficulties that professionals have to deal with? Are new rules experimented on or imposed from above? Rules are general, but cases are singular. Thus, even a well-articulated rule may sometimes be ill-suited to a given case. If so, is it possible for a professional to deviate from the rule in order to adapt his or her work to the case? Provided that the rule is useful in most cases, deviations should remain the exceptions. Consequently, how is work organized to check whether deviations are defensible? Are professionals asked to provide justifications? Who decides whether these justifications are sufficient?
Likewise, the concept of practical wisdom could help sociologists address specific questions concerning the division of labour. The first series of questions comes from the need for an overall view of the cases that professionals handle. Does the division of labour allow this overall view? When professionals from various specialties are involved, is interprofessional collaboration adequate to arrive at a decision that would be respectful of all points of view? Other questions arise from the need to pay attention to the evidence that a case may be more complex than it appears at first sight. When a junior employee has justifiable reasons for anticipating a problem, do reporting lines allow him or her to express them without fear of punishment or disapproval (even if he or she is mistaken)?
Some of those issues have already been addressed in research, notably in management and organizational sciences (Hufty, 1998). However, the concept of practical wisdom makes it possible to draw up a systematic research programme that can be broken down into complementary subquestions about rules, division of labour, training, and so on. Additionally, the systematic approach sheds light on the reasons why these conditions are not always met by making it clear that what is at stake is the tension between two ideas of rationality. While practical wisdom should be a major social issue, managers and sometimes professionals conceive of an organization with reference to a conception of rationality that is irrelevant to situations of irreducible uncertainty. Finally, as illustrated with the example of rules, the concept of practical wisdom permits a fresh look at the classic sociological question of autonomy. It helps provide an understanding of the limits that should be set for professional autonomy, in the sense that some autonomy is necessary to adapt to singular cases and situations, but its possible misuses ought to be prevented by the establishment of appropriate social settings.
Far from dictating general conclusions, the concept of practical wisdom is an invitation to continue empirical work on the way that professionals deal with uncertainty and complexity. The papers in this issue present studies that provide stimulating thoughts and findings about developing this line of research. Studying general practitioners dealing with antimicrobial treatments in Denmark, Inge Kryger Pedersen and Kim Sune Jepsen show that no jurisdiction has been properly defined to deal with the increasingly important issue of antimicrobial resistance. This brings difficulties in taking all the dimensions of the work into account while using antibiotics. Patrick Brown and Nicola Gale’s paper on the theorizations of risk work shows how a narrow conception of rationality based on formalization takes a strong hold and impacts the way that people deal with risk work. Katarzyna Wolanik Boström’s research on Swedish physicians working for aid organizations in the global South and returning to Sweden shows the kind of practical wisdom required to work in situations of strong economic constraints, as well as the difficulty in using this acquired experience to question routines once the physicians are back to a rich country. Finally, Marlot Kuiper examines the use of standardized work processes in critical care in the Netherlands. Her ethnographic study shows that this standardization aims at organizing “collective professionalism”; it also underlines how difficult it is to integrate it into actual practice.