The Toxic Leadership Triangle on Health Care Organizations

The Leadership Quarterly, Volume 23, Issue 5, October 2012, Pages 897-917

Lost Souls: Lost souls are perhaps the most frequently mentioned group of followers in the literature. This type of compromised follower is plagued by negative self-evaluations and an unclear and volatile self-perception (Padilla et al. 2007, Weierter, 1997). Lost souls are attracted to charismatic leaders who they believe can provide them with increased self-esteem and a sense of belonging. In such cases, lost souls tend to attribute exceptional qualities (charisma) to the leader (Conger & Kanungo, 1987) and develop a personal identification with him and a strong desire to imitate him in order to gain his acceptance. However, their intense love, devotion, and idealization of the leader leads them to dependency and makes them vulnerable to manipulation, tending to obey immoral orders, given their devotion to the leader and their desire for acceptance (Barbuto, 2000). The main motivations of lost souls are mainly based on the desire for self-affirmation from others (self-concept external), especially from leaders, and the main trigger for influence is identification with the leader. They behave in ways that satisfy the leaders, in order to first gain acceptance and then self-improvement and self-esteem (Howell & Shamir, 2005). In lost souls, when the motivation for self-affirmation from others increases, their resistance to the leader's attempts to influence them decreases, and the leader's perceived power increases, then the likelihood of compliance with the leader increases (Thoroughgood et al., 2012).

According to Thoroughgood and colleagues (2012), the vulnerability of lost souls is due, in part, to the following factors, which increase the likelihood that these individuals will comply with the leader's orders. Non-satisfaction of basic needs. As Padilla and colleagues (2007) have argued, drawing on Maslow’s (1954) hierarchy of needs, followers’ basic needs must first be met before their higher aspirations can be met. When destructive leaders are able to fulfill the unmet needs of the lost souls, these followers often develop strong emotional bonds with the leader, an idealized perception of him, and a desire to imitate and gain his approval (Howell & Shamir, 2005). However, the personal identification of the lost souls with the leaders creates the possibility of blind obedience (Howell & Shamir, 2005, Lipman-Blumen, 2005). By offering a sense of belonging to a group, but also acting as a source of unconditional love and acceptance, destructive leaders are able to attract lost souls who will sacrifice their autonomy and obey unethical orders to please their leaders (Padilla et al., 2007).

Personal life anxieties: This is a factor related to the lack of satisfaction of basic needs. Lost souls' anxieties regarding their personal life seem to reinforce the need for power, companionship and meaning in their lives. In times of great need and confusion, lost souls seek simple solutions and immediate fulfillment of their needs, leading them to identify with destructive leaders, which makes them vulnerable to them (Thoroughgood et al., 2012).

Clear self-image: Research shows that individuals who lack a clear sense of self are more vulnerable to charismatic leaders. Without a mature and integrated self-image that is socially valued, lost souls are unable to evaluate the leader’s messages and influences. Furthermore, Howell & Shamir (2005) noted that individuals who lack a clear sense of self-image tend to be particularly weak followers who become confused and disoriented before entering the charismatic relationship. As a result, they tend to develop personal relationships with charismatic leaders and adopt a self-image based on that relationship. These followers accept the leader’s beliefs and values, identifying with them in order to gain self-confidence from this recognition (Thoroughgood et al., 2012). Negative self-evaluations. Research shows that lost souls have low self-esteem and tend to see themselves as worthless and empty. They are predisposed to being manipulated by charismatic leaders, in part because they believe they deserve it. They also have low self-efficacy ratings, which is why they need the leader to find simple solutions to problems that they cannot solve on their own (Thoroughgood et al., 2012).

The individual's belief that they control their own destiny. As mentioned, individuals who believe they cannot determine their own fate are more easily manipulated and are attracted to people who appear strong and willing to take care of them (Padilla et al., 2007). Neuroticism, which is related to anxiety and manifests itself in fear of new situations and feelings of dependency and cowardice. Lost souls derive a sense of relief from the charismatic relationship, but at the same time they become vulnerable to charismatic leaders who wish to exploit them (Thoroughgood et al., 2012). Individuals who share more characteristics of the Lost Soul Follower type, including high levels of unmet needs, high levels of anxiety about their personal lives, an unclear self-image, and negative self-evaluations, are more likely to conform to the leader than those who share fewer characteristics of the Lost Soul Follower type (Thoroughgood et al., 2012). Authoritarian: In contrast to Lost Souls, authoritarian followers have a rigid stance and believe in the legitimate right of leaders to exercise authority over them and a tendency to accept such influence unconditionally. Researchers have proposed that this personality type is characterized by fascist tendencies. Some individuals have strong internal values ​​that emphasize obedience to legitimate authorities and compliance with rules within the health-care organization. In contrast to the lost soul, the authoritarian feels an obligation to obey based on the leader's status and position, which reflects the legitimacy of his or her authority. Therefore, authoritarians do not obey because they seek approval or to avert fear, but simply because the leader holds a higher position in the health-care organization. Thus, the legitimate authority of a destructive leader can be a powerful influence on authoritarian followers to take actions of obedience. The dominant influence trigger for authoritarians is the legitimacy of the leader's role. As the leader's legitimate power increases and the authoritarians' resistance to the leader's influence decreases, their likelihood of compliance with destructive leaders also increases (Thoroughgood et al., 2012).

Authoritarian followers have some characteristics, such as a deeply rooted authoritarian ideology, a cognitive rigidity, and a belief in a just world, that enhance their likelihood of compliance with destructive leaders (Thoroughgood et al., 2012). Authoritarian ideology is based on three types of behavior: submissiveness, i.e., the uncritical acceptance of the leader's authority; conventionality, i.e., the strict acceptance and adherence to the rules and social conventions within the health-care organization; and authoritarian aggression, i.e., a general intolerance and punishment of dissent. Authoritarian followers, who support unethical leaders who seek to maximize their power, can create a toxic union. Authoritarians are also more likely to demonstrate unconditional respect and trust in legitimate authorities, engage in hostile acts against others in the name of power, willingly oppose non-group members, and are less likely to hold those who punish offenders accountable. Furthermore, their rigid ideology may be partly a product of a strict, authoritarian upbringing that emphasizes obedience at the expense of autonomy (Thoroughgood et al., 2012).

Cognitive rigidity: The literature suggests that people who implicitly accept legal principles are characterized by a rigid intolerance of ambiguity and a preference for a simple, clear, and unambiguous world (Rump, 1985). These individuals may be less motivated to process information and tolerate uncertainty, and are inherently more likely to support legal principles and social institutions that serve needs for stability, clarity, and order. Authoritarians do not seek and process information frequently, have a greater resistance to change, and prefer strict adherence to pre-existing social structures. In terms of leadership, it is not surprising that such individuals often adopt authoritarian ideologies, emphasizing compliance with strong leaders who desire stability, order, and discipline (Thoroughgood et al., 2012).

Belief in a just world (BJW) is associated with cognitive rationalization of inexplicable acts of violence and injustice through the devaluation of the victims involved, as victims are considered to deserve such behavior. It is also associated with authoritarianism, possibly because it is based on the idea that strong and powerful people are good and weak and powerless people are bad. As a result, these attitudes may be the cause of the blind trust and obedience that authoritarians display to destructive leaders and allow them to justify their participation in immoral acts committed at the behest of such leaders (Thoroughgood et al., 2012). Individuals who share more characteristics of the authoritarian follower type, including high levels of authoritarian attitudes, high levels of cognitive rigidity, and high levels of belief in a just world, are more likely to experience triggers of leader role legitimization influence than individuals who share fewer characteristics of the authoritarian follower type (Thoroughgood et al., 2012).

Bystanders: In contrast to lost souls and authoritarians, bystander followers are characterized by a passive attitude and are motivated primarily by fear (Padilla et al., 2007). They are perhaps the most common type of vulnerable follower. Followers try to minimize the costs of non-compliance with the leader, such as losing their job, by enabling destructive leadership (Kellerman, 2004, Padilla et al., 2007). Because their motivations are based on fear, they choose to comply with the leader in order to avoid possible punishment from the leader (Barbuto, 2000). In contrast to other followers, followers are often more independent and their feelings towards destructive leaders range from anger and disapproval to indifference and apathy. This type of follower may keep their negative views of the leader to themselves, but will often publicly support the leader in order to be seen as a “good” follower. Since the destructive leader does not tend to personally support the leader, but rather acts out of fear, his behavior can range from disengagement to obedience, depending on the degree to which he is forced to act (Thoroughgood et al., 2012). 43 Bystanders tend to comply with the leader’s orders because they believe that non-compliance will have negative consequences for themselves. The influence triggers used are based on obedience due to the fear that if they resist the destructive leader or if they fail to achieve his goals, then this will lead to revenge or some kind of punishment. Bystanders interpret the leader’s orders as threats, regardless of whether the leader intends to send such a message (Barbuto, 2000). The influence triggers that affect their compliance are those that are characterized as manipulative, while their motivations are characterized as instrumental. Therefore, as instrumental motivations increase and their resistance to the leader's influence attempts decreases, but the leader's coercive power increases, the more likely it is that manipulative triggers will lead to compliance by the bystander in destructive leadership (Thoroughgood et al., 2012).

Bystander followers are vulnerable because they mainly make negative self-evaluations, high self-monitoring, while they have low extraversion and assertiveness and a lack of strong social positive attitude.

Negative self-evaluation: Like lost souls, bystanders make a negative self-evaluation. However, there are differences between them, as the low self-esteem of bystanders leads them to passivity rather than identification with the leader. In addition, people with low self-esteem are less likely to report irregularities due to fear of possible retaliation from the leader, are more trusting, adaptable and cooperative, and may be more easily victimized in the workplace. Low self-esteem is associated with a fear of confrontation and weakness to social pressures, especially when they come from people in power. People with low self-esteem are less able to defend themselves against aggression, deal constructively with conflicts, or resist those who seek to exploit them. Therefore, while followers may be critical of leaders who conflict with their values, resisting the leader’s commands causes them anxiety and challenges their low self-esteem (Thoroughgood et al., 2012). Also, their low self-efficacy, combined with their belief that their fate is determined by external factors, makes them unable to confront the destructive leader, as they believe that fate determines the type of leadership they must tolerate and submit to (Padilla et al., 2007). Their neuroticism leads them to try to avoid conflict, punishment, and negative evaluation by passively complying with authority out of fear. Such individuals often become easy targets of aggression (Thoroughgood et al., 2012).

High self-monitoring: Self-monitoring refers to the extent to which people monitor their social environment and adjust their behavior based on how others perceive them, in order to present a positive self-image to their environment. These individuals can change their behavior to adapt to the situation, but these attitudes can also conflict with their personal values. People who are not subject to high self-monitoring want to have continuity between their personal values ​​and their actions and are less likely to care about what others think of them, and therefore are less likely to obey unethical orders that are incompatible with their values. Bystanders, however, tend to be high self-monitoring individuals who view passive compliance as necessary to avoid punishment. These people, because they fear retaliation, do not offer their help to others and are less likely to report ethical violations. Thus, high self-monitoring individuals, because they cannot bear the costs of non-compliance, are likely to change their behavior (Thoroughgood et al., 2012).

Low extraversion and assertiveness: People with low extraversion tend to be quiet, reserved, more shy, calculating, and cautious. They are less likely to report ethical violations, while on the contrary they are more likely to remain silent in cases of ethical misconduct, as they are vulnerable to pressure and are more easily victimized in the workplace. Studies also show that these individuals are more sensitive to punishment or warnings of punishment. Therefore, they may be more likely to weigh and choose to passively comply rather than suffer the consequences of resisting a destructive leader (Thoroughgood et al., 2012).

Lack of strong prosocial attitude: Bystander followers are unlikely to engage in strong prosocial behavior, such as participating in a protest that goes against the leader’s intentions, due to fear of the personal and professional costs they may incur (Thoroughgood et al., 2012). Individuals who score more on the bystander follower type, including negative self-evaluation, high self-monitoring, low extraversion and assertiveness, and a lack of strong prosocial behavior, are more likely to experience manipulative triggers from the leader than individuals who score fewer on the bystander follower type (Thoroughgood et al., 2012). Opportunists: Followers who are characterized as opportunists belong to the category of colluders. Their dark personalities resemble that of the destructive leader (Thoroughgood et al., 2012). These followers see their alliance with the leader as a vehicle for personal gain and willingly follow him in order to obtain financial, political, or professional benefits (Lipman-Blumen, 2005, Padilla et al., 2007).

Opportunists carry out the orders of the destructive leader because they believe that there is an intermediate link between their compliance and the potential rewards they will receive (Bass, 1985). The influence triggers that make them vulnerable to the destructive leader are those that have to do with transaction (Barbuto, 2000). Therefore, as organic motivation increases and resistance to the leader's influence attempts decreases, but the leader's reward power increases, the more likely transaction triggers are to lead to compliance by the opportunistic follower with destructive leadership (Thoroughgood et al., 2012). According to Thoroughgood et al. (2012), although additional research is needed on this specific type of follower, their research showed that factors such as personal ambition and antisocial traits, namely Machiavellianism, greed, and lack of self-control, increase the likelihood of destructive leaders activating transaction triggers for opportunists. 46 Personal ambition: Opportunists, due to their insatiable ambition and willingness to conspire with those who can reward them for their services, are able to promote the leader's destructive plans in order to advance. Research shows that highly ambitious employees are more likely to violate codes of conduct, backstab their colleagues, and engage in corruption (Zyglidopoulos et al., 2009).

They are also more likely to exploit others and pursue coercive policies to advance their own interests (McClelland, 1975, Padilla et al., 2007). Antisocial traits: There is a psychological overlap between opportunistic followers and destructive leaders, indicating that they share certain antisocial traits such as Machiavellianism, greed, and lack of self-control (Padilla et al., 2007). Machiavellianism refers to a tendency to deceive, manipulate, and engage in ostentatious attitude to achieve personal results. Individuals high in Machiavellian traits tend to display cunning, manipulation, deception, and strong persuasion to gain personal power and control, just like opportunists.

They use their influence tactics and methods of deception to gain power and status (Padilla et al., 2007), while they flatter their leader and do not express their criticism of him. Machiavellianism may initially lead opportunists to conspire with the destructive leader, but then to cause him to fail in order to gain their own power. Thus, opportunists may become destructive themselves (Thoroughgood et al., 2012). Greed refers to a selfish desire to accumulate goods, social status, or power beyond any reasonable limits, without regard for others or the common good. Finally, lack of self-control is a major explanation for criminal behavior and refers to the “tendency to avoid actions whose long-term costs exceed immediate benefits” (Hirschi & Gottfredson, 1994, p. 4). Self-control theory suggests that individuals with high levels of self-control refrain from engaging in deviant activities because they adequately process the long-term consequences of their behavior (Thoroughgood et al., 2012).

Individuals who score higher on the opportunistic follower trait, including high personal ambition, high levels of Machiavellianism, high levels of greed, and low levels of self-control, are more likely to experience transactional triggers from the leader than individuals who score lower on the opportunistic follower trait (Thoroughgood et al., 2012). Helpers: Lipman-Blumen (2005) argued that opportunistic followers support their loyalty to destructive leaders because they have the potential for personal reward. Kellerman (2004) and Padilla et al. (2007) reported that some cooperate because they share the same values ​​and goals as the leader. Thus, in addition to opportunists, we encounter a second type of complicit follower, the helper (Thoroughgood et al., 2012). In contrast to lost souls, helpers have a stable sense of self and seek the expression of their ideological values ​​and beliefs through the leader's mission (Howell & Shamir, 2005, Padilla et al., 2007). Thus, the helpers' motivations to follow the destructive leader are rooted primarily in the goal internalization motive, which causes the helper to behave in ways that are consistent with his or her personal values ​​(Barbuto, 2000, Barbuto & Scholl, 1998).

Followers are “warm supporters,” who do not require strong persuasions from the destructive leader to help organize and achieve his toxic goals (Barbuto, 2000). The influence triggers that the leader uses to get followers to comply with him have to do with the identification of the individual’s goals with the health-care organization’s vision and the belief that compliance will facilitate its goals. Since, therefore, these goals are in line with the followers’ values ​​and their pursuit serves the followers’ values. Furthermore, when followers believe that the leader has the qualifications and skills needed to achieve the health-care organization’s toxic goals, this further increases the chances that followers will comply with the destructive leader (Thoroughgood et al., 2012).

Therefore, as the motivation to internalize their goals increases and their resistance to the leader's influence attempts decreases, and the leader's specialized power increases, the more likely it is that goal and value identification triggers will lead to follower compliance with destructive leadership (Thoroughgood et al., 2012). Individuals who share more characteristics of the follower type of helpers, including a high correlation between their goals and values ​​and those of the leader, are more likely to experience goal and value identification triggers from the leader than individuals who share fewer characteristics of the follower type of helpers (Thoroughgood et al., 2012).

Contributing Environment: The third leg of the toxic triangle is the appropriate environment in which the leader and followers interact. According to Padilla et al. (2007), four factors, namely instability, potential threat, cultural values, lack of checks and balances, and institutionalization, are important and contribute to an health-care organization's destructive leadership.

Instability: In times of instability, leaders can enhance their power by arguing that a radical change can restore the lost order (Bass, 1985, Burns, 1978). Leaders who thrive in unstable environments also gain more power because instability requires rapid action and unilateral decision-making (Vroom & Jago, 1974). However, when decision-making becomes centralized, this is difficult to reverse over time (Kipnis, 1972). The extent to which governance rules are clearly defined and consistently applied over time, i.e. the structural stability of the social system, is also important (Conger & Kanungo, 1998). Astute leaders can therefore exploit fluid and transitional structures that are not subject to control (Padilla et al., 2007). 49 3.4.2 Potential threat The perception of potential threat is related to structural and health-care organizational instability. A potential threat can be as simple as feeling mistreated by a superior or when a person’s company faces bankruptcy. When people feel threatened, they are more willing to accept strong leadership (Padilla et al., 2007).

Research on the theory of terror management shows how threat increases followers’ support for and identification with charismatic leaders, especially those who do not support participative leadership (Solomon et al., 1991). It is worth noting that potential threats are not necessarily objective threats. All that is needed is the perception of threat. Leaders also often use the perception of threat or an external “enemy” (Padilla et al., 2007). 3.4.3 Culture and Values ​​Hofstede (1991) defines culture as the collective programming of the mind that distinguishes members of a group or category of people from others. Researchers seem to agree that culture can be an important factor in determining how well an individual fits into an health-care organizational context (Kilmann et al., 1986, Schein, 1985).

Schneider (1987) argued that individuals may be attracted to health-care organizations that they perceive to have values ​​similar to their own. Furthermore, health-care organizations try to select and recruit individuals who are likely to share their values. New employees are then more socialized and assimilated, and those who do not fit leave. Thus, core individual values ​​or preferences for specific ways of behaving are expressed by individuals by choosing specific health-care organizations that suit them, and then these values ​​and preferences are reinforced within health-care organizational contexts (O'Reilly et al., 1991). Research has shown that individuals from similar backgrounds and with similar attitudes and experiences have mutual liking (Tsui & O'Reilly, 1989). Similarly, health-care organizations, by rewarding behaviors and characteristic outcomes, may become more or less attractive to different types of people (O'Reilly et al., 1991). Values ​​are the starting point, with common methods of selection and socialization acting as complementary means to ensure the individual's adaptation to the health-care organization (Chatman, 1991). Thus, the congruence between an individual's values ​​and those of an health-care organization may be the essence of the individual's adaptation to the health-care organization's culture (O'Reilly et al., 1991).

According to Hofstede (1991), culture shapes emergent leadership. Luthans et al. (1998) comment that “dark leaders” are likely to emerge in cultures that support collectivism (as opposed to individualism), uncertainty avoidance, and high power distance. Cultures that emphasize cooperation and group loyalty, as well as discrimination within and outside the health-care organization, are defined as collectivistic. Power distance is one of the dimensions of Geert Hofstede’s (1991) theory of cultural dimensions. It is defined as the extent to which the less powerful members of a country’s institutions and health-care organizations accept that power is distributed unequally. It relates to the fact that inequality in a society is supported by followers as well as by leaders. It is a term that describes the way in which people in a particular culture view power relations between superiors and subordinates, as well as relationships between people, including the extent to which people who are not in power accept that power is distributed unequally.

People in cultures with high power distance are more respectful of forms of power and generally accept an unequal distribution of power, while people in cultures with low power distance directly challenge it and expect to participate in decisions that affect them (Hofstede, 1991).

Lack of controls and procedures and institutionalization Strong health-care organizations, like nations, tend to have strong institutions and strong countervailing centers of power. Madison in the U.S. Federalist Papers proposed the need for checks and balances to prevent abuses of absolute power, emphasizing the dangers of unilateral control (Hamilton et al., 2000). In this model, multiple branches of government have independent authority and responsibility. Each branch can also set limits on the power of the others. Systems that lack such checks, such as corporations without independent boards of directors, allow individuals or parties to abuse power (Gandossy & Sonnenfeld, 2004). In the management literature, “discretion” refers to the degree to which managers are free from institutional constraints (Finkelstein & Hambrick, 1990). Although leaders need discretion to do their job, discretion allows destructive leaders to abuse their power (Kaiser & Hogan, 2007). The concept of managerial discretion suggests that destructive leadership is more likely to occur in senior positions where there is less supervision, in smaller health-care organizations with limited oversight mechanisms, and in high-growth industries (Hambrick & Abrahamson, 1995). When followers are dominated by a culture of dependency and apathy, this can also contribute to the concentration of power. Such attitudes, especially when combined with instability and ineffective institutional bodies, lead to the concentration of power in a leader, leading to greater dependence on followers and the weakening of opposition and dissent. When decision-making in an health-care organization is at the top, i.e., there is centralized management, then structures based on autonomous units with effective and professional institutions that share responsibility and authority for governance do not exist (Padilla et al., 2007).