Toxic Leadership to Healthcare Professionals
Evangelia Michail Michailidou*
Anesthesiologist - Intensivist, Life and Leadership Coach, Apollonion Private Hospital, Lefkosia, Cyprus, Greece
*Corresponding author
*Evangelia Michail Michailido, Anesthesiologist - Intensivist, Life and Leadership Coach, Apollonion Private Hospital, Lefkosia, Cyprus, Greece
DOI: 10.55920/JCRMHS.2025.10.001431
Definition of Toxic Leadership
Toxic leadership (Lipman-Blumen, 2004) is part of the dark side of leadership, along with the concepts: Petty tyranny (Ashforth, 1997), Abusive supervision (Tepper, 2000), Destructive leadership (Einarsen et al, 2007) and Bullying (Einarsen et al, 2003). The term “toxic” means poisonous. It comes from the Greek phrase “toxic medicine”, which essentially means poison for arrows. It is noteworthy that for the meaning of the term today, the word “toxic” was used, which comes from the bow, and not the word “medicine”, which actually means poison.
The first to use the term “toxic leader” in the literature was Dr. Marcia Lynn Whicker (1996), thus linking toxicity with leadership. Toxic leadership is associated with negative – dysfunctional behaviors, which harm both the business and the employees, who ultimately can only either endure the current situation or leave the company. Whicker (1996, p.11) defines toxic leaders as “maladaptive, malignant, often malicious or even vicious, who succeed by destroying others”. Other names that have been used for toxic leaders are: “toxic manager”, “toxic boss” or “boss from hell”. Then, confirming the negative effects of toxic leadership, Wilson-Starks (2003) presents it as “a leadership approach that harms people and companies by poisoning enthusiasm, creativity, autonomy and innovative expression” (Wilson-Starks, 2003, p. 2).
Toxic leaders believe that having absolute control is what defines leadership, and therefore they “take care” to exercise it on those under their authority. Colonel Reed (2004), based on research conducted by the US Army War College in various military structures, states that toxic leadership is a leadership style whose representatives cause long-term damage, directly to subordinates and indirectly to the business. Reed (2004) lists three key elements of toxic leadership which are related to “an apparent lack of concern for the well-being of subordinates” (only those who align with the leader thrive), “a personality that negatively affects the organizational climate” (restriction of autonomy and creativity), and “a belief by subordinates that the leader is motivated primarily by self-interest” (the leader’s self-interest is considered paramount) (Reed, 2004, p. 67). Although Reed studied the concept with a focus on the military, this does not diminish the validity of his definition in other settings.
According to Lipman-Blumen (2005), however, it is not always easy to define toxic leadership, which is due to the perceptions that each person has regarding the concept of leadership, as someone who is considered a “toxic leader” for one person may at the same time be considered a “savior-hero” for another. Nevertheless, as she states in her definition, which is found in most of the studies on toxic leadership, “toxic leaders are those individuals who, due to their destructive behaviors and dysfunctional personal qualities or characteristics, cause serious and lasting harm to other individuals, groups, businesses, societies and even nations they lead” (Lipman-Blumen, 2005, p. 2). Padilla and his colleagues (2007) argued that toxic leadership is a function of the leader, his followers (who are divided into ‘colluders’ and conformers) and the environment that facilitates this situation (The Toxic Triangle), (Padilla et al, 2007). In turn, A.A. Schmidt (2008) claimed that the term ‘toxic leadership’ is independent of the terms ‘petty tyranny’ and ‘destructive leadership’, while according to his study, he characterized toxic leaders as “narcissistic, self-centered, engaging in an unpredictable pattern of abusive and authoritarian leadership” (Schmidt, 2008, p. 57). Goldman (2009), finally, gives a rather simpler definition and refers to toxic leadership, referring to annoying and even destructive actions that come from the boss and target the workforce (Goldman, 2009).
According to all of the above, we could consider that toxic leadership is a leadership style applied by individuals whose personality (traits), views on leadership and the way they manage have serious negative impacts, mainly on employees and consequently on businesses.
Characteristics of Toxic Leaders
Toxic leaders are distinguished by the various mostly negative, personality traits they possess, which are evident in the way they behave. Kellerman (2004) uses seven general characteristics to distinguish toxic leaders. These characteristics could be said to scale from the mildest to the most intolerable. Therefore, according to her, the leader can be characterized as incompetent, i.e. incapable of performing his work or creating a positive result for the business, either on an interpersonal or practical level.
Subsequently, he can be described as rigid, as he appears unyielding and refuses to adapt to any changes, or as intemperate, i.e. without self-control (Kellerman, 2004). He can also be characterized as callous, being rude, insensitive and indifferent to the needs and wants of subordinates, or corrupt, as he violates the rules, steals, cheats and only cares about his own interests. The insular leader is one who is generally indifferent to others, whether in his direct or indirect environment, as long as he has nothing to gain from them. The most,perhaps, odious characterization is that of the so-called evil leader who, by abusing his power, reaches the point of psychologically or even physically abusing his subordinates (Kellerman, 2004).
Key traits of toxic leaders are also that they are selfish, self-centered, aggressive, grumpy and greedy. They only care about their own happiness and self-interest, they want to be in control all the time and not only are they not interested in training and guiding their subordinates, but on the contrary, they enjoy belittling and insulting them, especially in front of other people (Mehta & Maheshwari, 2014). This view agrees with the statements of Schmidt (2008, 2014), who defines narcissism, authoritarian leadership, unpredictability, self-promotion and abusive supervision as the main characteristics of the toxic leadership model, claiming that these leaders tend to intimidate and demean others, consider themselves better and smarter than everyone else and are self-promoting, lacking sensitivity, humanity and understanding (Schmidt, 2014). 6 The characteristics of toxic leaders began to be recorded from the first moment the concept of the term was used. Whicker (1996) described them as maladaptive, malignant, malicious or even vicious, who do not hesitate not only to belittle but even destroy others in order to achieve their goals. They like to be dominant in their environment, maintaining absolute control. It is noteworthy that she mentions as a characteristic of toxic leaders the fact that “everyone feels inadequate, which distinguishes them from good leaders” (Whicker, 1996, p.53). The list of toxic leaders’ flaws grows if we add to them arrogance, selfishness, cruelty, disrespect, and pettiness, which their subordinates perceive as distinguishing them (Bullis & Reed, 2003; Steele, 2011). Toxic leaders are considered dishonest, corrupt, cynical, untrustworthy, narcissistic, and even paranoid. Their excessive ambition, their need for power and reward, and their oversized egos prevent them from recognizing their shortcomings and admitting their mistakes. They are immoral, greedy, and reckless. Being equally evasive, they avoid difficult situations, which makes them incapable of handling situations properly, while they are indifferent to the consequences of their actions, whether they concern themselves or their subordinates (Limpan-Blumen, 2005).
It should be noted, however, that toxic leaders do not only have negative characteristics. Their positive characteristics include self-confidence, the ability to impress their superiors, charm, and the fact that they build relationships relatively easily (Box, 2012). These elements, combined with the enthusiasm that the leader can demonstrate, can make him extremely effective. Unfortunately, however, the positive results will be short-term and will have a high cost for both the company and the employees (Tavanti, 2011; Hobman & al, 2009) as even the good aspects of his personality are used by the leader himself to achieve his personal goals and maintain his power. Therefore, pleasant and charming leaders or leaders who are considered good may present elements of toxicity or even be essentially toxic, as of course the opposite: a leader who is decisive and may occasionally present some of the aforementioned negative behaviors is not necessarily toxic (Lipman-Blumen, 2005; Tavanti, 2011; Reed, 2004; Decoster & al, 2013).
By observing the existing literature, we find that the characteristics that each researcher attributes to the toxic leader are in agreement with those of other researchers, unfortunately enriching the negative list. Of the characteristics mentioned, there are toxic leaders who combine many of them or even all of them (Lipman-Blumen, 2005), a fact that is reflected in their respective behaviors.
Behaviors of Toxic Leaders
We define as toxic those behaviors of leaders which, if systematically repeated, cause significant damage to employees and businesses. (Lipman-Blumen, 2005; Babiak & Hare, 2007; Pelletier, 2010; Clarke, 2005). Whether a leader is considered toxic has to do with the frequency with which these behaviors are expressed and with what he aspires to achieve by applying them.
Even leaders who are generally considered exemplary and effective may have exhibited individual toxic behaviors. Similarly, no leader who is proven to be toxic operates in the same way all the time or in all situations, nor do all toxic leaders exhibit the same degree of toxicity even when events occur under the same circumstances (Lipman-Blumen, 2005; Whicker, 1996). Toxic leaders can be divided, according to these behaviors, the consequences of which can range from simply negative to disastrous, into intentionally toxic ones, who harm others deliberately and ‘step on dead bodies’ in order to remain in power, and unintentionally toxic ones, who bring about negative results mainly due to their incompetence and recklessness (Lipman-Blumen, 2005). Toxic behaviors range over a fairly wide range, from relatively mild (e.g, employee discouragement, petty theft) to absolutely destructive (e.g, subordinate terrorism or physical abuse) (Lipman-Blumen, 2005; Mehta & Maheshwari, 2014). Toxic leaders marginalize and alienate-isolate those employees who are not on their side or do not serve their interests.
They usually use any means to undermine them. Whether by hiding important information about the work, or by suppressing the truth about an event, or by using them as scapegoats for mistakes for which they are responsible, with the ultimate aim of demotion or even removal from the company (Lipman-Blumen, 2005; Pelletier, 2010; Lemmergaard & Muhr, 2013; Singh, Sengupta & Dev, 2018). At the same time, they tend to belittle them, criticizing their character and the way they think and work.
They doubt their abilities, reject their ideas, and stifle any initiative and constructive criticism, while demonstrating unethical behavior, showing a lack of respect for their subordinates and teaching them to obey rather than oppose leadership. In addition, they ignore incompetence and promote favoritism, while maintaining a competitive attitude towards employees, especially those whom they envy and perceive as a threat to their continued power (Lipman-Blumen, 2005; Pelletier, 2010; Reed, 2004; Mehta & Maheshwari, 2014; Kellerman, 2004; Box, 2012; Wilson Starks, 2003).
A toxic leader will not hesitate to violate the rights of his subordinates, even if they are his supporters. He usually acts in illegal ways, distorts the facts, blames others for his problems and mistakes that are due to him, while at the same time taking credit for successes that do not belong to him. His behavior is deeply moody, depressive, arrogant, and inappropriate. He often has unreasonable demands, at the same time as he himself is unable to successfully deal with difficult situations when required, but also to properly train his successors (Lipman-Blumen, 2005; Pelletier, 2010; Mehta & Maheshwari, 2014; Kellerman, 2004; Babiak & Hare, 2007; Clarke, 2005). In order to achieve their goals, toxic leaders use any means necessary. They promote division, pit employees against each other by creating conflicts, teach their followers to hate those who are not on their side, and are also known for racist behaviors (e.g, discrimination based on gender or color) (Lipman-Blumen, 2005; Pelletier, 2010; Kellerman, 2004). Perhaps the most egregious behaviors of toxic leaders are those related to the oppression of employees, the ever-increasing incidences of psychological and/or physical bullying and abuse, humiliation, and threats to job stability. In these cases, toxic leaders become increasingly aggressive, with frequent outbursts of anger. Due to the insecurity that actually possesses them, they ridicule, threaten and frighten subordinates (Lipman-Blumen, 2005; Pelletier, 2010; Goldman, 2009; Chua & Murray, 2015; Kellerman, 2004; Steele, 2011; Gangel, 2007). 9 We could say that toxic leaders are fully aware of the way they behave. They seek to be accepted and liked by their superiors, they seek victory at all costs and due to their egocentrism, they envy anyone who manages to surpass them (Whicker, 1996).
For the most part, they exploit the worst fears (fear of exclusion and powerlessness) and needs (need for security, power, need to be special and to belong) of the underclass in order to reinforce their illusions, thus managing to transform them into willful and heterosexual subjects. Most importantly, they do not reveal their intentions, which are guided exclusively by their own self-interest, but they mislead, presenting their goals as noble visions that cannot be realized without their presence (Lipman-Blumen, 2005; Pelletier, 2010). They are characterized, finally, by their manipulative behavior, micro-management and the exercise of absolute control, justifying their attitude as necessary for achieving the goals of the business (Goldman, 2009; Reed, 2004; Steele, 2011; Box, 2012).
It is reasonable, of course, that the toxicity of the leader is not seen simply by the list of his possible behaviors, but mainly by the results that these will have in the long term (Reed, 2004).
Causes - Origin of Toxic Leadership
Leaders do not suddenly develop toxic behaviors. There is a background, which is due to the creation of toxic leaders and the causes that trigger their attitude. The toxic leadership style develops and evolves over time and needs a system that is conducive to its maintenance and strengthening ( Aubrey, 2012 ; Mehta & Maheshwari, 2014 ). The toxic behavior of the leader may originate, first of all, from him (Steele, 2011). His desire to gain power and authority slowly turns into an obsession. Due to this obsession, his personal ambition is placed above the well-being of the business and he does not hesitate to adopt any behavior in order to consolidate or strengthen his power and satisfy his huge ‘ego’, which essentially constitutes a brake on the recognition of his imperfections and deprives him of the possibility of self-criticism. Thus, if he is asked to resign from this position, he can become even more toxic (LipmanBlumen, 2005; Atkinson & Butcher, 2003; Mehta & Maheshwari, 2014). The ideology and way of perceiving leaders also play an important role in the birth of toxic behaviors. Their distorted view of the concept of power makes them believe that excessively strict control is necessary, as a result of which they fail to understand that it is this (control) that causes toxicity. In addition, they develop such behaviors, especially if they are vulnerable, mainly as a defense in case they interpret the change in a situation as a threat to their authority, power and reputation (Atkinson & Butcher, 2003).
The personality of each leader also plays a major role in the appearance of toxicity. A toxic leader may have unresolved psychological problems, such as a sense of inadequacy, fear of the unknown or failure and a lack of trust in others, or be anxious and impatient. Usually, the success of other executives makes him feel pressured and even more disadvantaged, resulting in him adopting toxic behaviors (e.g, angry outbursts, unreasonable demands) in order to hide what he feels (Wilson-Starks, 2003; Ludeman & Erlandson, 2004; Macklem, 2005). According to both Whicker (1996) and Williams (2005), the main cause of toxic behavior is the inability of leaders to reach ‘level 4’ in Maslow’s hierarchy of needs, which is related to esteem, or ‘level 5’ which is related to self-actualization and contribution. Instead, they remain attached to ‘level 2’ which has to do with safety needs or more rarely to ‘level 3’ of love and belonging needs (Whicker, 1996; Williams, 2005).
Subsequently, the presence of toxic leadership in may be due to other causes, such as the attitude and behavior of the followers, the environment of the company and the system it follows (Steele, 2011). As for the employees, the weakness and fear they feel and the lack of maturity they usually have, prevent them from questioning the superiority of the leader and from coming into confrontation with him. In this way, however, they give him the opportunity to exploit the power he has and become even more toxic (Whicker, 1996; Aubrey, 2012; Mehta & Maheshwari, 2014). In addition, the psychological needs of subordinates (such as the need for security, the need to belong somewhere or the need to feel special) provide leaders with the same opportunity (Lipman-Blumen, 2005).
However, there is also the case that followers have the same values and beliefs as their superiors, thus considering this management style acceptable and necessary for the smooth functioning of the company, in which case toxic leaders become role models (Steele, 2011; Williams, 2005). The company environment, finally, and the system it follows both in attracting and selecting personnel and in controlling departures, are of major importance for the development of the toxic leader. In an unstable environment, where the company cannot control its staff, set limits on power, and recognize toxic behaviors, it makes sense to quickly confront them (Audrey, 2012; Steele, 2011). Usually, these leaders are not accountable anywhere. The misplaced trust on the part of their superiors and the fact that the latter often accept or overlook negative behaviors for the sake of financial results, give the toxic leader the opportunity to act freely. In addition, however, the share of responsibility that falls on the superiors of toxic leaders and, by extension, on the company, also has to do with the culture of the company. For example, if senior management focuses more on results than on the effort, performance and commitment of the leader, it creates feelings of frustration. If the policies followed by the company include unjustified goals and excessive internal competition, toxicity finds fertile ground to thrive (Lipman-Blumen, 2005; Aubrey, 2012). Changing the structure of the company by transferring the toxic leader or employees who do not agree with him to another department is not a solution, but on the contrary contributes to the perpetuation of toxicity in the organization. The insufficient development of a business, mainly regarding the part of its lack of mentors and positive examples to imitate, is another reason that supports the presence of toxic leaders, who may ultimately be nothing more than ‘creations’ – continuations of previous bad models. (Wilson-Starks, 2003 ; Williams, 2005).
According to Steele (2011), toxic leadership is not permanent. Proper and timely education and training of the individual from the very first steps of his career, will prevent possible upcoming toxic behaviors (Steele, 2011).
Impacts - Consequences of Toxic Leadership
The existence of toxic leadership within a company seriously harms primarily the employees and subsequently, the company itself. The attitudes and behaviors of toxic leaders have negative consequences, both in the short and long term, on individual, managerial and organizational performance (Jowels, 2015). Whicker (1996) in her book “Toxic Leaders - When Organizations Go Bad” presents a model for highlighting these consequences, categorizing them essentially into 7 different stages. In the first stage, it refers to a healthy company, without obvious signs of toxicity in leadership, where there is cooperation and trust between members. During the second and third stages, toxic leadership makes its presence felt, followed by frustration and disappointment in employee expectations, and anger and contempt, respectively.
In the next two stages, the situation worsens as division occurs, with subordinates forming cliques (for or against the toxic leader), while those who can react start a kind of secret war that quickly turns into open conflict. This conflict reaches its peak during the sixth and seventh stages, where, after the final move of appealing to higher authority (siege mentality - usually without positive results for subordinates), isolation and alienation (complete division) follow, revealing the ineffectiveness of the business (Whicker, 1996). Toxic leadership has serious consequences at both the individual and organizational levels. Moreover, the negative effects of its presence are often irreversible. At the organizational level, toxic leadership reduces productivity, job performance, and job engagement, and increases employee turnover and intention to leave (Lipman-Blumen, 2005; Kellerman, 2004; Schmidt, 2008, 2014; Reed & Bullis, 2009; Burns, 2017; Mehta & Maheshwari, 2014). At the same time, it destroys the cohesion of the team and leads to the inability to develop productive relationships and loss of trust between the employee and the company and to deviant behaviors in the workplace, such as refusal to cooperate and provide feedback (Gallus et al. 2013; Reed, 2004; Ashforth, 1997; Wilson-Starks, 2003).
The communication and effectiveness of the organization are reduced, while its culture is severely damaged, allowing the development of immorality and corruption that comes from the cooperation of the toxic leader with his followers – budding toxic leaders (Wilson-13 Starks, 2003; Steele, 2011; Aubrey, 2012; Ashforth, 1997; Mehta & Maheshwari, 2014). Leaving or remaining with reduced performance and loyalty to the company equally affects the organization both from a financial point of view and from a human resource ‘investment’ point of view (loss of capable and creative employees)(Wilson-Starks, 2003 ; Lipman-Blumen, 2005 ).
At the individual level, toxic leadership has innumerable and more obvious effects on employees, psychological, emotional, and even physical. In the light of such a situation, employees are not motivated to work constructively, while creativity and job satisfaction are significantly reduced ( Wilson-Starks, 2003 ; Pelletier, 2014 ; Ashforth, 1997 ; Schmidt, 2008, 2014 ).
Their morale is weakened and they become distrustful and disrespectful towards the company, as they find, to their disappointment, that it fails to support them. The fact that they themselves are often unable to defend themselves, reduces their self-confidence and self-esteem and makes them develop feelings of shame and guilt. Main effects that are observed quite frequently, according to studies, are also distraction, excessive stress, exhaustion, despair, isolation, anger, depression, lack of enthusiasm and autonomy, constant absences from work, conflict with the family environment, and even increased use of alcohol or pills (Wilson-Starks, 2003; Ashforth, 1997; Reed, 2004; Kellerman 2004; Padilla et al, 2007; Tepper, 2000; Webster et al, 2014; Lubit, 2004).
The physical effects that manifest as a reaction of the human body to the emotions that overwhelm it are not negligible. The most frequently observed, according to research, are: insomnia, anorexia, chronic fatigue, dermatological problems, stomach disorders, hair loss and headaches, while more serious health problems are predicted in the long term, in case the employee does not leave the toxic environment (Ashforth, 1997; Kellerman, 2004; Mackie, 2008; Padilla et al, 2007; Tepper, 2000). As can be seen, toxic leadership affects the well-being of both employees in the short term and the company in the long term. It is, therefore, the responsibility of the company itself, with proper training and monitoring of the performance of its executives, to ensure the proper management of its personnel, to support its employees and to prevent their exposure to toxic behaviors (Webster, Brough & Daly, 2014)
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