Leadership in healthcare is often described in aspirational terms — vision, integrity, compassion, accountability. Yet, the reality is that not all leaders embody these values. Some rely on positional power, intimidation tactics, and coercion to get their way, even if it means asking employees to compromise their values, integrity, or breach the very policies designed to protect staff.
I’ve seen this dynamic play out first-hand. In moments where I have been pressured to stay silent, overlook poor behaviour, or accept decisions that clashed with my professional responsibility, I’ve felt the weight of intimidation more than collaboration. These experiences are not isolated — many senior healthcare leaders have faced situations where standing up for what’s right comes with not insignificant personal or professional risk.
The Hidden Costs of Intimidation
The damage that can be caused by this leadership style is twofold. First, it corrodes trust within teams. When staff feel bullied into compliance, innovation and open dialogue are lost. It silences constructive dissent, and creates cultures where employees prioritise self-preservation over patient care.
Second, it undermines the governance frameworks we rely on to keep patients and employees safe. Policies that are designed to protect staff wellbeing and uphold care standards become meaningless if leaders are allowed to sidestep them through positional power. Codes of conduct, and organisational values become hollow if employees believe the consequences of speaking up outweigh the protections on paper.
And in healthcare, this issue is particularly dangerous. When professionals feel bullied into compliance, errors go unreported, risks remain unaddressed, and moral distress escalates. Over time, this leads to burnout, turnover, and a decline in both safety and quality.
Lessons Learned: Integrity Under Pressure
From personal experience, there have been a few critical lessons that I’ve learnt and have taken forward:
Boundaries are non-negotiable.
Learning to say “no” when asked to compromise your integrity is one of the hardest but most necessary skills in healthcare leadership. It may feel costly in the short term, but the long-term cost of silence and consequent damage is far greater.
Courage is contagious.
Speaking up is never easy, but one act of integrity can give others the confidence to do the same. This can lead to building a network of trusted peers, mentors, and advocates which provides a safety net when resisting intimidation.
Policies are only as strong as the culture behind them.
A written safeguard means little if health leaders create environments where employees fear (and experience) retaliation. Authentic governance mechanisms can only work when backed by leaders who model and enforce them consistently.
True leadership is influence, not intimidation.
The best leaders I’ve worked with didn’t need to resort to ‘Directives’ or use fear —they brought people along through respect, empathy, and shared purpose.
How Healthcare Leaders Can Handle These Situations
At the end of the day, addressing intimidation requires more than individual courage — it demands systemic and cultural responses. Here are some approaches that healthcare leaders and organisations may find helpful:
1. Normalising speaking up.
Directors and executives should actively encourage dissenting voices in meetings, instead of shutting down those who speak up, by framing challenge as a sign of strength, and not as disloyalty.
2. Strengthening independent channels.
Whistleblower protections, confidential reporting lines, and independent services must be established, visible, accessible, and genuinely safe.
3. Shifting the accountability lens.
Leaders who tend to weaponise their positional power should be held to account not just for outcomes, but for how they achieve them. Measuring leadership behaviour alongside operational performance sends a very strong cultural signal.
4. Building governance resilience.
When board and executive oversight include independent culture audits, 360-degree leadership reviews, and tracking of staff wellbeing data, intimidation is harder to hide and harder to ignore.
5. Modelling integrity from the top.
The most effective antidote to intimidation is demonstrating visible, values-driven leadership. When senior healthcare leaders demonstrate that doing the right thing is non-negotiable, others gain the confidence to follow suit.
A Call to Courageous Leadership
Healthcare is complex, high-pressure, and full of competing priorities. But resorting to intimidation tactics is not a leadership strategy — it is a failure of leadership. If we want systems that truly value integrity, we need leaders who create space for diverse voices, difficult conversations, and principled decision-making. To break the cycle of power-toxicity, organisations must not only call out this behaviour but work to actively dismantle the conditions that allow it to thrive.
As leaders, we all face moments where the easy choice is silence. But the long-term health of our organisations, and the wellbeing of the people within them, depends on whether we choose integrity instead. True leadership is not about ruling through fear, but creating an environment where values are lived, policies are honoured, and voices are heard.
At the core of authentic leadership, is integrity-driven healthcare governance: the ability to make sound, accountable decisions across complex systems, in difficult situations. For health leaders and board directors who want to strengthen this capability, the AICD – AIHE Foundations of Directorship Health Variant program provides a practical grounding in governance — a skillset that is critical for ensuring your organisation leads, rather than lags, in the face of system stress. Register for the inaugural intake in October.
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