Leadership,  Nursing and Healthcare

A Culture of Fear in Leadership – It’s Effect, But Is It Healthy?

I think most of us have been there. A new manager, director, CEO, or whatever comes in and seems to feel a need to shake things up. Before you know it a member of the team has been let go or, at least, encouraged to leave. Now the entire team is scared. Who will be next?

This scenario has been played out over and over again in companies all over the country, probably all over the world. No industry is immune to this, even nursing. I have personally seen it in both the hospital and outpatient settings. It almost certainly leads to increased compliance and decreased cost for a period of time, but is it healthy.

Increased compliance

Fear has always been a powerful tool to get people to do what you want them to do. This is why we see images of Egyptian slave drivers from thousands of years ago carrying whips and standing menacingly over their slaves. This is a classic theme in gangster movies where local business pay “protection money” to the gang that “owns” that area of the city. The truth is that what the people need protected from the most is the very gang offering to “protect” them.

In this instance fear is used to motivate people to pay what the gang is asking. Fear is used to gain compliance from the business owner.

In just about every industry fear is a great way to increase compliance, but only for a short time. You see, the people who are there now find themselves uncertain about the security of their job. As a result they toe the line for a season. They fear getting the attention of the new “leader” and perhaps risking their job. So, they do what they are told. They try to fly under the radar. But, this only lasts for a short time.

You see, fear is a terrible motivator. Sure it will motivate a person hiking in the woods to run from a bear, but that person can only run for so long. Likewise, an employee that becomes more compliant out of fear is only going to stay that way for a short period of time. At the very least they will eventually drift back into the habits they had before. At this point the only way to get compliance back to where it was would be to turn the fear factor back up.

Inspiration can also increase compliance, and has the potential to be long lasting. Help staff to understand why the rules are there and why they matter. Help them understand that outcomes can be improved by following the rules. If you can inspire a staff member to WANT to comply, then they are much more likely to comply over a longer period of time.

Decreased cost

A common way for a new person in a leadership position to show improvement is by decreasing cost. This ALWAYS looks good on paper. When reporting to executive level leaders or to a board of directors, this is the kind of thing that looks good. Sadly, in my experience, these high level leaders seldom ask HOW those savings were accomplished. Similarly, they seldom take time to consider the cost of those savings. They’re just glad to see the company making more money.

In any industry, in any business the number one expense is personnel. Therefore, the quickest way to decrease overall cost, to show a “savings” on paper, is to decrease staffing. While new “leaders” would seldom admit that their goal was to decrease cost by getting rid of people, this is often what happens. This may not be overt. It may simply come by making people feel so uncomfortable that they choose to leave.

The end result is the same: people leave and costs are decreased.

Then the new “leader” pats themselves on the back. Brags about their accomplishments, and are congratulated by the executive team and the board of directors. But, the company is often weaker as a result.

Is it healthy

We’ve demonstrated that fear can motivate people to be more compliant. It can lead to decreased cost. But, is it healthy? The clear answer is a resounding NO! The type of culture I discussed above is never healthy. It will lead to a staff that is demoralized. It will eventually lead to your best people leaving. Good employees don’t want to work in a culture of fear.

I remember being involved in a conversation with a group of fellow employees once. A team member had recently been let go. Admittedly she had some attendance issues. Still, she did a good job and was, in our minds, a valued member of the team. A new “leader” had recently come on and next thing we know this coworker, team member, friend is gone.

In the wake of that the staff are left feeling that this person was let go as an example, as a show of strength.


Years ago a friend gave me some of the best leadership advice I’ve ever received. “Perception is reality.” The truth is that the firing of the employee may not have been as an example, or as a show of strength. Chances are there were a variety of other things going on that the staff are not aware of.


The perception of the staff is that this employee and friend was used as an example and that this was a show of strength for the new leader. For the staff this is their perception and, therefore, their reality. The staff are left wondering who will be next, wondering if it will be them. The staff are left wondering if they will soon be training their replacement. They are afraid for their jobs.

In the short term this will cause them to become more compliant. They will follow the rules for fear of losing their job. However, in the long run they will become discouraged and moral will drop. This will lead to a loss of efficiency. Eventually, many of these disheartened employees will leave.

Sadly, this culture of fear is becoming more and more common. I have personally seen it in more than one instance, in more than one company. Executives and boards are often not even aware that this is happening. There is such a disconnect between them and the staff that they have no idea and most of them will never take the time to find out. Instead they will be blinded by the increased performance and compliance and the decreased cost and will have no ideas that these are actually signs of a cultural cancer that will end up harming, if not completely killing their organization.

Husband, father, pastor, nurse, freelance writer, overall nice guy. "I believe the healthcare experience can be great for patients, families, and all members of the healthcare team." - Matt Norman

Leave a Reply

Your email address will not be published. Required fields are marked *

%d bloggers like this: