Toxic Followership and Leadership: The Hidden Threat to Organizational Success

Ronald Dwinnells, MD, MBA, CPE


May 10, 2026


Physician Leadership Journal


Volume 13, Issue 3, Pages 30-31


https://doi.org/10.55834/plj.9571374799


Abstract

This article, the second in a two-part series on the topic of followership, examines toxic followership and its impact on organizational success, highlighting how manipulative and disruptive behaviors from followers undermine leaders and organizational goals. Factors such as poor leadership, dysfunctional culture, self-interest, insecurity, and personality traits like narcissism and psychopathy contribute to toxic followership, eroding trust and morale. The reciprocal relationship between toxic leadership and followership is explored, emphasizing their interconnected nature. Strategies for identifying and addressing toxicity, including open dialogue and reinforcing shared goals, are discussed to foster healthier workplace dynamics and improve organizational outcomes.




LESSONS IN LEADERSHIP AND LIFE


A colleague recently asked, “Can I sue my employees for harassment? They make my life miserable ... plotting against me and undermining my directives. I’m so stressed that it affects my health and gives me incredible mental anguish. I just want to quit my job.”

Although we’ve all experienced similar scenarios, I hadn’t thought about it as a harassment-in-reverse situation — where employees bully the employers, and the bosses become the victims. This topic led me down a rabbit hole of sorts, where the research literature was filled with endless tales of bad-employee behaviors, reminding me of my own experiences as a leader.

Most of these “counterproductive followers,” collectively known as toxic followership, are highly functional and capable people, but for some reason, they become self-absorbed and eventually engage in manipulative and disruptive behavior. They undermine organizational goals and do things for personal gain or create dysfunctional situations that often lead to unethical outcomes. Many even engage in sabotage using gossip. They often bypass the chain of command, which results in chaos.

What Causes Followers To Become Toxic?

Having bad leaders. Poorly prepared or inexperienced leaders characterized by abuse or incompetence often create poor work structures and bring out the very worst in people. Employees become defensive and sometimes launch their own offenses to get back at their “cruel” leaders. They spread malicious gossip, perform poorly, defy authority, and behave in a passive-aggressive manner. Sadly, in this scenario, the true victims are the consumers of healthcare programs.

Dysfunctional culture. A permissive culture and inconsistent application of the rules and policies, where some can evade consequences while others are punished or reprimanded, can bring about ill feelings and negativity, along with a pervasive expansion of gossip about why employees are so miserable. It certainly adds fuel to the fire and will bring out the worst in people and foster ongoing toxicity.

Bad employees. Some people innately have a corrupt disposition about them. The so-called dark triad personality, made up of Machiavellianism, psychopathy, and narcissism, is sometimes difficult to spot initially (such as in a screening interview) but will emerge later during the person’s time with the organization. Toxic followers frequently become manipulative and self-serving, and may cause considerable harm to a company.

Self-interest. Some people are interested only in power and money. They have no time for altruism or a sense of mission. They become bad followers because they are egotistical and are only interested in their goals, seeking maximum gain for themselves. These types of people do not contribute to the greater cause of the mission.

Insecurity. Many employees want validation for their work and accomplishments. They have a need to be constantly valued and praised. Absence of these accolades may lead to bad feelings and even poor work performances. Attitudes may become one of apathy and torpidity.

How Do Toxic Followers Destroy Organizations?

As doctors and people of science, we like to know how things work. We want to know the root causes of diseases and illnesses. Our logic is that if we understand the problem, then we can come up with the solution.

Examining the “pathos-physiology” behind these behaviors, we know that oftentimes, the initiating event is some negative social interaction that caused the person to feel offended, undervalued, or even embarrassed.

For example, recently, a payroll processing issue occurred at our organization in which our third-party payroll company made a mistake that was going to result in a one-day delay of employees’ payroll deposit. Several staff members immediately posted negative comments on social media, stating they felt undervalued and that the company had withheld payments for some sinister reason.

Although the payroll company was able to fix the problem promptly, employees felt slighted and took to their social media accounts to spread gossip. They posted details that were false and made derogatory accusations. Others soon added embellishments to the information, and eventually it became an out-of-control gossip mill. Ironically, no one’s paycheck was delayed.

These types of open criticism frequently result in portrayal of contempt about an event that soon leads to erosion of trust (with each other and the executives) and encourages negative perspectives about the leaders or the organization. This then weakens the team and often distracts from the main purpose or mission of the organization. If it goes undetected and uncorrected, a noticeable degradation in morale and a level of dysfunction occur that may become ingrained and difficult to end.

How Do We Deal With It?

There are certain things leaders can do to help avoid this type of escalation. The first obvious step is to recognize that it is happening. Be aware that there may be toxicity among your staff. Sometimes it can be an insidious onset and it may be a while before it’s recognized.

Once a leader identifies the problem as toxic, they should bring the group together and discuss it in an open forum setting. This openness encourages everyone to become accountable when the truth comes out. I know many leaders who ignore this process as they hope the problem will magically be fixed on its own. Sadly, it never is.

After the problem is identified and plans are made to resolve it, a discussion and review of the purpose of the organization’s mission and its raison d’etre should be conducted.

It’s always good to bring visual information to the group, such as patient or consumer testimonials. They can bring emotional elements to a situation. Supportive and positive data and statistics, photos, and videos are also powerful tools.

The truth is always more powerful than the lies perpetrated by the toxic followers, and hopefully, the excuses will result in the resetting of the work ethic.

It’s important not to belittle team members but to be positive about their contributions. Use statements such as, “That’s a good thought, and we will investigate it.” Or “That’s a great question we hadn’t thought about. Let’s explore this a bit more.”

Are Toxic Leadership and Toxic Followership One and the Same?

Yes! Remember, it goes hand in hand; one can lead to the other. When followers are passive, they can unintentionally support toxic leaders. Also, followers often start a framework that is unhealthy for the organization, steering leaders away from the common good. When followers contribute to the power of destructive leaders, it can be debilitating for the organization and others. So, yes, toxic followers can create toxic leaders, and toxic leaders can give rise to toxic followers.(1)

Toxic followers are not always obvious in their actions. While toxic leaders are destructive, toxic followers sometimes are subversive and can have greater and more lasting negative effects on an organization.(2)

Remember that toxic followership can be an insidious event and may emerge without your awareness. Vigilance and recognition of these circumstances are excellent anticipatory tools.

References

  1. Northouse PG. Followership. In Northouse PG, ed. Leadership: Theory and Practice. 9th ed. SAGE Publications, Inc.; 2021: 232–259.

  2. Leonard S. Toxic followers are everywhere: 5 ways to avoid getting derailed. Clearancejobs.com. November 16, 2021. https://news.clearancejobs.com/2021/11/16/toxic-followers-are-everywhere-5-ways-to-avoid-getting-derailed/ .

Ronald Dwinnells, MD, MBA, CPE
Ronald Dwinnells, MD, MBA, CPE

Ronald Dwinnells, MD, MBA, CPE, is a pediatrician and a certified physician executive. He is the CEO of ONE Health Ohio, an integrated community health center program serving the medically uninsured, underinsured, and underserved populations in northeast Ohio.

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