Katherine, give us a bit of background to your journey into HR. Like most people, I didn’t intentionally get involved in HR. I started off as a midwife and disillusioned with the long days and night shifts, wanted a nine-to-five job. I moved into recruitment, and then I saw an advert for a job at Médecins Sans Frontières. They were looking for someone with a medical background and recruitment experience, to recruit doctors and nurses. So I had the right combination of experiences and I relished the opportunity to travel and use my languages, so the job ticked all the boxes. I started work with MSF at the end of 1996. The role was focused on rapid and timely recruiting, operating from a very small office in London with just six people. And it was great! The UK quickly proved to be a rich seam of good, potential medical personnel at all levels, and we had the luxury of two tropical medicine schools, and this was very much the foundation for what has been an ever-changing, constantly growing organisation, with considerable organic growth. And for me, as I suspect for everyone that has been involved along the way, no one year has been the same.

Give us an idea of MSF as an organisation. Forty years ago this year,a group of French doctors, and in fact journalists, got together and they all had a commonality, concerns and frustrations that medical bodies were operating in the field with political bias and affiliations. The objective was clear, to set up an organisation that could respond to crisis anywhere in the world, whether that be in response to victims of conflict, or natural and humanitarian crisis, and provide timely and effective medical aid without any ties and regardless of political affiliation. And so MSF was created primarily on the basis of this premise. It sounds straightforward but, of course, it was anything but. In the early days, I think there were some well- intended missions that MSF personnel responded to, but they failed, to a degree, primarily because their endeavours were not backed up with cohesive support and, crucially, logistics. And so over the intervening years, as with all things, it has been a case of learning and development, a good example being the development of the MSF medical kits and developing a logistical network to make sure that the right equipment is delivered to the right areas.

Give us an idea of how MSF recruited in the early days and how it evolved. Even in the early days, the work that MSF was actively involved in was attracting good people that wanted to get on board, and what started off as a small group of doctors developed into five operational sections, across Europe, that were able to initiate and implement the medical programmes, and small offices, like the one I was working from in the UK, were set up to support those operations. At first, each office had a fairly specific focus. For example, the UK office was set up to raise funds, find people and raise awareness. At the same time, offices started to spring up all over the place; Japan, New York, and even today, there are new offices coming online throughout the world, such as Brazil and India.

When did HR really start to make a difference to the way the organisation was evolving? Well first of all, HR’s role in the UK was fairly administrative, setting up basic training programmes at the then five offices and organising employment contracts, but I certainly began to see gaps in the HR support, nobody was taking particular attention to things like career development and such issues needed and deserved attention, of course. A particular case in point was when people came back from call-of-duty, and it soon became clear that some struggled to integrate back into normality, and that was the point when I realised that an HR role, in this particular situation, needed to go much further than recruitment and getting the right people into the right places. And so HR pushed for change in the reward system, and just making sure that people had support, and the most direct way of getting together an overarching HR plan of support and operation was collating information, de-briefing people when they came back.

Did you have an idyll or a model about what HR would like at MSF? I don’t consciously remember having one sort of idea or model in mind, but I do remember thinking, as we started to rapidly grow, we’ve got to really start to put things into place. That’s thinking about what you’ve learnt and how it can be adapted and applied to the MSF context. But whatever you do, it’s a charity, so you can’t throw money at a problem, all our money is donor money and it needs to be wisely used. We have a policy of sending 80 percent of our donor money directly to field operations which means there isn’t much left for fancy recruitment campaigns and such luxuries. So I think you become quite creative, how you attract and motivate people.

That’s a key point, medical professionals can earn very good money in the private sector, in relative safety, so how do you attract people to work in such dangerous circumstances? It’s a good question, but I don’t believe that most medics go into medicine with the intention of making lots of money. I think people study medicine because they want to make a difference to people’s health, and that’s certainly the case in people’s motivation for working with MSF. As people’s careers progress and they have more commitments in the UK it becomes increasingly harder for them to work overseas. But I think for many, those motivations do stay, and they may go off and pursue a career and come back later in life, in a position where they can give their time and expertise back. For sure, the work MSF does is challenging, often dangerous.

Attitudes have changed a lot, in my experience. When I started working for MSF, we attracted a generation that were exposed to Band Aid and we were able to send fairly inexperienced junior doctors to provide medical support in refugee and displaced peoples camps. MSF has a great deal of experience in dealing with refugee situations and when the HIV epidemic hit we had to adapt our recruitment to meet the demands of expertise required to run HIV programmes. Over the years, contexts have changed and we now need highly experienced medics with highly-specialised capabilities. In the past our reputation in the UK hasn’t been as good as in France for example, where a year overseas on an MSF project looked great on a doctor’s CV. However, with time attitudes towards releasing doctors to work overseas is changing. It’s our 40th anniversary this year and nowadays we manage to come up with creative staffing solutions such as having trainee specialist doctors working for MSF and having that time accredited towards their higher training.

What would you say are the fundamental things HR has changed at MSF? For us, HR had always been decentralised and disparate. But a few years ago, HR began what was essentially a coming together, predominantly because we needed to build more credibility in the organisation and we certainly needed to be united as a function in order to support operations more efficiently. So we are slowly moving towards a centralised approach, certainly in our attitude, and tackling areas of concern more as one. And, as a consequence, we now have a stronger voice and increased impact on operations. A few years ago, we didn’t have HR at field level which was clearly a necessity. Sure we had a lot of people in HQs, but what was needed was people on the ground working alongside locally recruited staff with local knowledge and language, and we needed HR where most of our employees are, overseas on our medical programmes.

What are the key challenges in quickly recruiting the right people to resource what needs to be done? Situations occur rapidly and our operations are temporary. It’s not like you can decide, there's a good untapped resource of relevant personnel somewhere, you need to go where the need is and make use of the labour market that’s available there and bring in the expertise if, and inevitably when, you can’t find it locally. And of course, often you engage in a programme somewhere and the situation looks like it is going on for a long time. This is an area we haven’t capitalised on enough in the past but we’re addressing now. One major development that HR has been responsible for is developing an international database of staff, which is up-to-date, so that we can call up the current details and start recruiting more accurately and speedily.

It seems to be an increasingly unpredictable and volatile world, how can you predict the unpredictable? We have to plan to be more effective, be more responsive, and know how to deal with what indeed appears to be an increasingly unpredictable world. There are many things you can plan for, I look at our resources and I look at our plans for 2012 for overseas projects, and we have a rough idea of things that are planned. But a few years ago we did that had a detailed plan, and then the earthquake in Haiti hit, and suddenly we needed to scale up dramatically and recruit badly?needed French speakers. You look at your environment and the context you operate in, over the next five-to-ten years and programmes look even more complex.

In crisis situations, how do you make sure that communication lines are clear and you set off with the right strategies? I look back at the tsunami, Boxing Day 2004, killing over 230,000 people in fourteen countries, and inundating coastal communities with waves up to 30 meters, one of the deadliest natural disasters in recorded history. Indonesia was the hardest hit, followed by Sri Lanka, India, and Thailand. We had no idea the sheer size of the intervention we would need to muster – it was really overwhelming. We worked with a register of fully engaged field experts that even years after they’ve left MSF are ready to leave at a moment’s notice. Once the information starts to flow from the ground, we get a better idea of what is required from a resourcing point of view, and it is then that HR starts liaising and relaying information, sorting out visas, flights, briefings and vaccinations. And they need qualitative up-to-date information about where they’re going, and what to expect, and in such a vast emergency, of course, you don’t have time to write an accurate job description to someone, so a free flow of information at all times is critical. It’s easy to say pace yourself, but not practical. I've been and done it myself, when there's a large scale emergency, you just can’t sit there and pace yourself, you do 16 hour days until you can’t physically stand upright anymore!

Health and wellbeing and all the rest of the HR issues must just seem irrelevant. That doesn’t mean that you just give up trying to improve things, you cannot just abandon things. For example, we have had people working in Sudan since the early 1980s, but when I was there in 2004, aid workers were having difficulties getting visas and travel permits so they could gain access to the areas where people needed medical help. A small exploratory team were there carrying out assessments on medical needs and also negotiating an increase in expatriate presence. Tens of thousands of people were on the move, villages were being burnt to the ground, and when you get camps of thousands of people living in close proximity, with no clean water, health risks increase and disease is rife. It all happens very rapidly, so issues like visas can literally mean the difference between life and death. Finally, we got visas and were able to scale up from a team of just five expats to around 80 expats and nearly 1000 locally recruited staff. It was an incredible sight to at last see around 30 MSF vehicles lined up on the road ready to transport staff and logistics supplies to where they were needed most.

In terms of health and safety, most of our readers will be familiar with making sure staff wear appropriate protective clothing, or that there are no wires on the floor. The comparison here is stark. Yes we send people to some pretty dodgy places, but we have a legal obligation to provide a safe working environment for staff, and for me personally, we have a moral obligation to do our utmost to provide the best level of safety and security we can to our overseas staff. It’s critical we have people who know what they're talking about with regards to security and we sometimes have very strict security rules in place, but what is also really important is we recruit the right people from the start. We don’t look to recruit heroes, they need an understanding of cross cultural issues as well as common sense and personal security. Saying or wearing the wrong thing can put you and your colleagues in danger. It is funny at times when you consider the health and safety issues we deal with in our overseas projects, exposure to serious diseases, serious threats, abductions etc, doing a risk assessment on a pregnant colleague in the UK office feels somewhat trivial.

HR-wise, what is occupying your thoughts right now? I'm very focused on our next strategic plan, and how HR will implement it over the coming years. We are also working on succession planning of key UK personnel. One of the greatest challenges at the moment is retaining overseas staff, as working in remote areas of the world and warzones is not something people tend to do long-term. The longevity of engagement in our organisation never fails to amaze me, but actually working and living overseas, often in pretty basic accommodation, isn’t something people want to or should be doing long-term – you can’t keep a doctor living in a hut, working in a remote area for 20-30 years, it brings a whole different meaning to improving retention. Whilst you can keep people a bit longer, there is of course, a high turnover. And of course, we need good leadership. So at the moment my focus is on improving leadership for the future.

What are the other issues that you need to address? There's so many! I think reward, how will we reward people as it becomes more challenging. We’re seeing a new generation coming into the sector, people are investing a lot in academic qualifications. I have never come across anyone in this organisation who is attracted by money. The spirit of MSF is that it is a voluntary organisation and we want to keep that spirit, but it’s hard to maintain that when you need to attract highly specialised staff and the best people. You have to work on the fact that people will only be involved for a relatively short period, and so dealing with attrition is a constant challenge. I do often think, why do people want to get involved in this? It’s great that they do, and I’ve met some of the most amazing people and worked alongside some really inspiring people too. The mindset and motivations are the complete opposite of how we've been brought up to believe what makes people tick.

The world does seem to revolve around money. As the song says, “money can’t buy you love”, and no amount of money can replace that feeling you get when you know you’ve really helped someone, saved somebody’s life. I remember when I was working in the Sudan as a nurse and midwife and you see how your interventions and those of your peers really make a difference, and you played a part in that.

But at the end of the day, whatever people’s motives are, they are people with the same issues. Yes they are ordinary people doing extraordinary things, working sometimes in horrendous conditions and pressures. They are significantly more at risk of stress-related illness and we recognise that and try to reduce that risk. We provide support and put people’s physical and mental health at the top of a very long list of importance. I am always amazed at people’s resilience, their capacity to cope and it is of course important that we don’t take that for granted and that we provide useful support. But people come into contact with situations that no amount of training can prepare you for, and of course that does affect them.

Where do you think you are in the HR journey at MSF? I think the significant difference for HR is that we are planning and working internationally to improve efficiency. As I said, we’re developing a new database, and we’re looking at uniformity and harmonisation, a bit like the medical packs, so that you know what to expect. And when we implement something new at MSF nowadays, it is often for universal use, so it is important to understand that to bed something in is going to take more time and effort. At the same time we need to be responsive, flexible and agile to manage and cope with situations as they happen. Having said that, although a lot of our work is on standardisation, we are also working hard to trying to build a flexible model of the way we recruit, because at the same time we have to think about HR management at field level.

And good communication and qualitative information must be crucial. In order to react quickly and capably, information and communication is of course essential. There's a lot of communication by satellite phone, emails and Skype, people can still access social networks in remote places, they are in touch with the outside world and we can ask questions. It’s very different to the days when we were relaying information by airmail.

Is MSF on the graduate radar? It used to be but that’s changed. Interestingly, the average age has gone up, partly because we increasingly needed specialised doctors, and it takes a while to get to that level of training. The average age is now about 38, but when I started it was mid-to-late 20’s. We don’t have an upper age limit, but there's a lot of older doctors who have a lot to offer and older people are well respected in countries with low average life expectancy. Doctors who are coming up to retirement age now have had a more general training but now medical training is more specialised and there’s no such thing as a general surgeon, and it’s hard to recruit junior doctors.

If you could wave an HR magic wand and could make one thing happen what would it be? I’d have the most amazing talent management programme in place for our field staff, with a team of HR specialists focused on their specific fields. Specialism in HR is something that would be desirable to evolve internationally but as individual offices we’ve always been too small to have HR specialists in the UK. I have an interest in employment law and I make sure the team keeps on top of things in terms of things like legislation, but here, having 19 different areas of expertise in employment law just wouldn’t be practical. But as we grow internationally, specialisation will undoubtedly develop.

And what of the future for MSF? Increasingly, we are recruiting staff from countries where we don’t have MSF offices or presence. That in itself presents challenges and so this focus is on planning and strategy on a global scale. We don’t pay big salaries, the organisation is based on the volunteer spirit. We have always relied on the spirit of humanity and for most people in the organisation, the reward is working in the kinds of places we work, making that difference. However, when you start looking to the future, salaries for aid workers appears to be low and we need to remain competitive in order to achieve our ambitions.