The aim of this thesis is to study the impact on work of the managerial turn in healthcare organizations and to identify the organizational and managerial conditions favourable to occupational health. We adopt a double entry: at a micro level through the analysis of work and at a macro level through the increasing external regulations that constrain work in healthcare organizations. We propose an approach using gift theories. We consider that working contains a part of self-giving which has to be recognized and accepted as a gift by the organisation, otherwise it leads to a relationship without reciprocity that results in exhausting self-commitment. The research underlines the link between well-being at work and discussion forums. These forums allow local regulation of activity and expression of recognition. Middle managers play a central role in leading these discussion forums. The thesis is based on two ethnographic intervention-researches. The first one takes place in a follow-up care centre and the second one in a private hospital, both suffering from a managerial hyperactivity. The studies confirm that the malaise at work can be understood as a malaise of gift dynamics which need to be recognized. They show the essential role of first line and top managers, so that management tools do not replace relationship and dialogue but sustain commitment and cooperation, being true recognition forums for gift.
