A Toxic Triangle of Destructive Leadership at Bristol Royal Infirmary: A Study of Organizational Munchausen Syndrome by Proxy

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Although leadership literature increasingly recognizes that leadership is a complex, co-creational process among leaders, followers, and context, destructive leadership scholarship has only recently embraced this paradigm. This article contributes to the toxic triangle debate by linking destructive leadership theory and disaster research in a case study of Bristol Royal Infirmary, a UK hospital that experienced a crisis in its pediatric cardiology unit resulting in the death of dozens of babies undergoing surgery. Thus, the article expands the literature on organizational failure by offering an assessment of how seemingly good, well-intentioned professionals can nonetheless create destructive leadership dynamics and proposes a new, more nuanced theoretical framework called organizational Munchausen syndrome by proxy as a way to analyze what went wrong.


Original languageEnglish
Pages (from-to)34-52
Number of pages18
Issue number1
Early online date23 Jul 2014
Publication statusPublished - 1 Feb 2016


  • Destructive leadership, toxic triangle, idealized goals, organizational Munchhausen syndrome by proxy