Conceptualising toxic public leadership and public value creation in health care services

The paper offers critical review of theories of toxic leadership to better understand their relationship with “public value” and “value creation” and how and why these constructs impact on public service delivery in the NHS. While these binary concepts are not well understood within the literature, we draw on historical discussion of public service leadership and public administration in health care to shift the debate beyond outdated traditional beliefs of leadership that progress productivity and e9ectiveness. In doing so, we aim to advance novel understandings of public value creation in the pursuit of quality of care and improved patient safety. It is against this backdrop that we conceptualise toxic leadership as destructive and dysfunctional behaviours which influence negatively on followers in the context of organisational culture, and similarly contribute to harm to patients and public receiving substandard care.
This paper is set within the context of a public service (i.e., healthcare) under pressure from a persistent dearth of national government funding, underinvestment and increasing regulatory scrutiny. Such scarcity, alongside a changing political landscape, and the ongoing devastation arising from the COVID-19 pandemic has seen insurmountable challenges placed on the NHS (Willan et al., 2020). Meanwhile, rising healthcare costs, stretched financial budgets and heavy workloads are influencing healthcare professionals’ wellbeing, and decision-making capacity in enabling the optimal delivery of public health care services that are robust, transparent and inclusive of patient care and safety. The paper highlights that toxic leadership is a contentious term with no absolute clear definition within the literature. The concept inspires negativity through toxicity, which runs counter to the principles of public value creation and the founding values of the NHS. This concern remains under-investigated with a lack of empirical evidence and evolves to influence patient involvement in public health service outcomes. Within the health literature, perceptions of toxic leadership in public health care demonstrate lack of understanding of issues yet remains a thread though public inquiries since the Francis report into health failings (Francis, 2013) . Despite this, there is a need to evaluate and draw insights from public service health care leaders and followership behaviour to evaluate perspectives and inform public policy changes. From this perspective, we are interested in exploring the views of health care service professionals and practitioners creating value in public service delivery. The paper concludes by calling for further empirical investigation and studies which can address the gaps associated with toxic leadership theory and its influence on the healthcare profession and to counteract public value destruction in the health care sector. This paper notes traditional concepts of leadership dominating the published literature and aims to address shortcomings to enable novel public and practitioner perspectives.