Healthcare organisations invest significantly in psychosocial risk frameworks, governance structures and leadership development. Yet a new international study highlights a type of organisational risk that most of those frameworks are not designed to detect. It is a risk that compromises leadership effectiveness, accelerates turnover, and goes entirely unrecorded in exit interviews.
A new international study of senior leaders has given this pattern a name, and the findings are difficult to ignore.
What the research reveals
Our report, Understanding and Addressing Upward Bullying, draws on survey responses from CEOs, executives, senior managers, and board members across Australia, the UK, North America, and other regions, spanning the public, private, and not-for-profit sectors, including healthcare.
Upward bullying describes sustained behaviour through which employees undermine, intimidate or strategically target their manager or senior leader. Unlike traditional workplace bullying, it doesn’t flow downward to subordinates. It operates through indirect or procedural mechanisms that can be difficult to detect. Perpetrators coordinate complaints or withhold information. They organise resistance to leadership decisions and use grievance processes strategically to constrain or discredit those in authority.
The prevalence data of upward bullying is striking. 71% of senior leaders surveyed reported personal experience of upward bullying. Nearly 80% had witnessed it happening to another leader. Almost three in four believe it is increasing, particularly in organisations that fail to act on early warning signs.
Why healthcare is especially vulnerable
Clinical and scientific organisations present particular conditions in which upward bullying can take hold and go undetected. They feature multidisciplinary teams and high levels of professional autonomy. They are environments where upward bullying tactics can be framed as concerns about safety or professional standards.
This is precisely the challenge. Upward bullying rarely presents as a single, obvious incident. It unfolds cumulatively, through repeated resistance, narrative manipulation, and tactics that, viewed individually, can appear procedurally reasonable. In its most damaging form, the behaviour is not incidental; it is intentional and often coordinated. Individuals may not act alone, but influence others, shaping perceptions and responses in ways that gradually erode leadership authority. When a concern is framed as a patient safety issue or a professional standards complaint, organisations may respond to the surface presentation rather than the underlying pattern.
The result is misdiagnosis, which has serious consequences for boards and organisations.
The cost of getting it wrong
When upward bullying is misclassified as a communication breakdown or interpersonal conflict, the organisational response is misaligned. Two-thirds of respondents in the study reported major negative impacts on organisational performance as a direct result, including loss of trust and morale, reduced productivity, leadership turnover and mental health strain on leaders.
Perhaps most relevant to healthcare and life sciences settings is that more than half of leaders reported delaying or avoiding decisions due to fear of backlash. Decision paralysis of this kind quickly becomes an operational and governance risk. Clinical outcomes, research integrity and regulatory compliance all depend on leaders’ ability to make timely and confident decisions. When leadership attention is diverted to managing persistent behavioural disruption, the risk extends beyond the organisation to the quality and safety of patient outcomes.
The leadership attrition findings further highlight this. Nearly three-quarters of respondents witnessed competent leaders being pushed out of their organisation due to sustained upward bullying. Departures are typically recorded as issues of organisational “fit” or restructuring rather than behavioural risk. 93% said the experience affected their confidence and reduced their willingness to return to senior leadership roles. For sectors already navigating workforce pressures and succession challenges, the erosion of the leadership pipeline is significant.
The response gap
Despite how widespread the issue appears to be, the study found that organisational responses are frequently weak, delayed or misdirected. Many organisations either fail to recognise the behaviour as bullying at all. Many manage it informally until it reaches a crisis point, or default to HR processes that address procedure rather than pattern.
Only 18% of senior leaders expressed confidence that their organisation would support them if they were targeted. That figure reflects a systemic absence of “upward protection” – the organisational equivalent of psychological safety, applied at the leadership level.
Prevention is possible
The findings are not entirely pessimistic. More than 94% of leaders we surveyed said earlier intervention and greater awareness could have reduced or prevented the behaviour in their organisation. Upward bullying is recognisable and manageable. But only by organisations willing to build the capability to identify it.
The leaders we surveyed identified their priority needs. Safe reporting pathways, clear escalation processes, and board and executive education will make the most difference. Our findings lead us to make three specific recommendations for managing upward bullying. The first is to name upward bullying as a distinct risk rather than conflating it with general conflict. The second is to develop the capability to identify behavioural patterns over time, rather than responding to isolated incidents. And the third is to intervene early, before leadership authority is compromised and capable people begin to disengage.
For healthcare, research and life sciences organisations operating under high accountability and complex governance structures, the findings represent a stark signal. The risk is real, it is present, and the organisations best positioned to manage it are those that choose to see it clearly – before another capable leader quietly walks out the door.
Author Bio
Maureen Kyne is a workplace culture and leadership expert who has advised organisations across healthcare, education and international institutions, including NHS England, the University of Melbourne and the United Nations. She specialises in organisational behaviour, leadership dynamics and psychosocial risk.
