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The Impact of Leader Behavior on Employee Health: Lessons for Leadership Development

Posted by NEHRA  February 11, 2011 09:00 AM

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By: Richard Williams Ph.D., Wallace Higgins M.B.A. and Harvey Greenberg M.S., M.B.A. (of Nehoiden Partners)

Your boss should come with a warning label: May be hazardous to your health. Research once again has confirmed what we’ve always suspected - your boss can cause you stress, induce depression and anxiety or even trigger the onset of serious illness. It is not just bad managers who can negatively affect employee health, but it is also the lackadaisical and mediocre who can put employees on the sick list.

While the cost to employees is their health, welfare and sometimes their income, the cost to workplaces is lost productivity, turnover, training, disability payments and staggering health insurance premiums. Moreover, a whole new field of litigation is opening – lawsuits against “bad” bosses and the organizations that negligently allow them to supervise.

But hope is not lost. A careful review of the research on leadership behavior and employee health yields some important surprises about leadership development and its potential impact on employee health and performance. There appears to be a clear relationship between leader behaviors and employee health, which is a pre-requisite for good performance. Furthermore, those behaviors are specific enough to be part of an effective leadership development program.


The research on leadership and employee health research spotlights a lurking secret in the field of leadership studies. Despite a vast literature on leadership and more than fifty years of investigation, in reality we know very little about leadership.

There are generally two types of literature on leadership: the Mythic and the Academic. The Mythic consists of confident assertions about the nature of leadership, for example The Leadership Secrets of Genghis Khan. These writings, no matter how popular, are opinions, often insightful, but with little or no factual basis. A 2002 survey, done by Connie Vance and Elaine Larson, of the literature on leadership from 1970 to 1999 found that only 4% were founded on data.

The Academic type is either theoretical (which is often just Mythic presented in academic language) or research-based. However, the many thousands of studies that have been done have failed either to validate statistically the efficacy of any theory of leadership or to establish a clear relationship between leadership style and employee performance. The leadership and health research supports a fact-based approach whose foundation is specific leader behaviors, rather than leadership style.


The impact of leader behaviors on employee health is a new vein of leadership research. More than thirty studies conducted over the last decade show clearly that leader behaviors do affect employee health for good or ill. This employee health research falls into two general categories: physical health and mental health.

The research on physical health has focused on three main health issues: heart disease, musculoskeletal symptoms and sick leave:

  • Two studies found that certain leadership behaviors were associated with lower risk for two forms of heart disease.

  • Three studies found that specific leader behaviors were related to three contributors to heart disease: lower blood pressure and decreased serum cortisol (a steroid hormone) and serum GGT (a liver enzyme) levels.

  • Three other studies found that leadership behaviors are associated with increased musculoskeletal symptoms, such as pain in joints and muscles.

  • Three more studies found that positive leader behaviors are associated with reduced sick leave. The 2008 meta-analysis of the leadership and health research by Jaana Kuoppala and associates concluded that good leadership was associated with a 27% reduction in sick leave and a 46% reduction in disability pensions.

The research on the relationship between mental health and leader behaviors is more extensive and focuses on three issues: psychiatric distress, burnout and stress. The aspects of psychiatric distress that have been studied most are anxiety and depression.

  • Eleven studies found that positive leader behaviors were associated with lower levels of anxiety and depression while the lack of positive leadership behaviors was associated with higher levels of anxiety and depression. Kuoppala’s meta-analysis of the research on employee health and leadership behaviors concluded that employees with good leadership were 40% more likely to be in the highest category of psychological well-being, including lower levels of anxiety and depression.

  • Eight studies on burnout – physical or emotional exhaustion as the result of prolonged stress – found that positive leader behaviors led to lower levels of burnout.

  • Six studies on stress had mixed results. Four studies found a relationship between leader behaviors and stress; two did not. Taken altogether however these studies strongly indicate that positive leader behaviors can reduce stress while the lack of these behaviors creates an environment that increases stress.

The overall conclusions of the employee health research shows that the lack of certain leader behaviors can increase heart disease, promote musculoskeletal pain, foster sick leave, increase anxiety and depression, as well as, lead to stress or even burnout. Positive leader behaviors can reduce sick leave, increase attendance and reduce anxiety, depression, stress and burnout.

Put simply, your boss can give you a heart attack or precursors to one – high blood pressure, anxiety, stress and burnout. He or she doesn’t even have to be a “bad” leader but could be a “good” leader who is not demonstrating the right behaviors well. A leader, for example, who fails to establish clear goals for individuals in a workgroup, sets the stage for conflict between the group members, which leads to such health outcomes as stress, anxiety and burnout.


Leader behavior costs workplaces billions of dollars each year in employee health-related expenditures. An extensive literature documents the costs of those health issues associated with leader behavior:

Physical Health

  • Heart disease and stroke were estimated to cost over $400 billion a year, including health care expenditures and lost productivity (The Council of State Governments).

  • Pain, including musculoskeletal symptoms, accounts for one in four sick days per year and more than $3 billion in sick leave (Business & Health).

  • Absenteeism related to health may cost over $70 billion a year, when spillover expenses are taken into account such as overtime and overstaffing (Workforce Management).

Mental Health

  • Anxiety disorders cost workplaces over $4 billion annually (Journal of Clinical Psychiatry).

  • Depression costs over $43 billion a year in absenteeism, lost productivity and direct treatment expenses (Mental Health America).

  • Stress costs more than $300 billion each year in health care, missed work and stress reduction efforts (American Institute of Stress).

These estimates do not represent the total cost related to employee health because they do not include costs such as turnover, training new staff, disability payments and retirement benefits.

Although, the impact of leader behavior accounts for only a percentage of the health costs, even that small percentage represents billions of dollars. While the literature on health care costs does point to leader behavior as a cause, improving that behavior is never listed as a solution. Yet the research clearly shows that leader behavior can significantly impact the employee health and therefore health costs.


One of the most interesting conclusions from research on employee health is that leadership style has not been shown to affect employee health. The studies on employee health explored most of the major leadership style theories, including transformational, "consideration and initiation of structure” and situational leadership, as well as the work of Jim Kouse and Barry Posner. Five studies did find some relationship between leader style and employee health, but results were mixed; several did find a specific style was related, while others did not find a relationship with the same style. Twenty-one studies were clearer in that they found a relationship between specific leader behaviors and employee health.

The conclusion that leadership behaviors, not style, can more readily be shown to impact employees is consistent with findings from general leadership research. This research has failed to show a clear relationship between leadership style and employee performance. The research on employee health on the other hand, does show an indirect relationship with employee performance. A reasonable proposition is that if an employee is ill, his or her performance is likely to be negatively affected, and if an employee is not at work, his or her performance is definitely diminished.

The employee health research identifies specific leader behaviors that affect employee health. The leader behavior taxonomy of Gary Yukl is the best means to summarize and organize the research findings. Using Yukl’s terminology fourteen leader behaviors were cited by the employee health research, including Developing, Mentoring, Empowering, Motivating, Managing Conflict and Rewarding. Yukl defines these behaviors in several of his publications.


A focus on leader behaviors is a boon for those responsible for leadership development, since the current theories that focus just on style have serious weaknesses. First, there is little evidence in support of the various leadership style theories. Yukl states that “the field of leadership is … in a state of ferment and confusion.” Most of the theories are beset with conceptual weaknesses and lack of strong empirical support.”

Second, there is no convincing evidence that current concepts of leadership style affect employee performance. In 2008 Jaana Kuoppala concluded, after a meta-analysis of 27 studies, “the relationship between leadership and job performance remains unclear”. Other experts on leadership have reached the same conclusion. A very modest relationship has been found between leadership and job satisfaction and an even more modest relationship between job satisfaction and performance. But the link between leadership style and employee job performance has remained elusive.

The third reason that a focus on behavior is a boon for leadership development is that most leadership style theories are so broad and abstract that they are difficult to implement and, therefore to teach or to learn. How do you teach a leader style? Whereas, specific, well-defined behaviors can be taught, learned and measured. Additionally, as noted above, these behaviors have been shown to impact job performance. (Click on the following Sidebar Article title: Building a Behavior-Based Leadership Development Curriculum).

Developing leaders based on current leadership style theories may not be the best strategy, since those theories are unproven and their impact on performance is unclear. Developing leaders based on behaviors is more achievable, since behaviors are more easily taught and learned than style and research does show a link between leader behaviors and employee morale, satisfaction and performance.

Organizations are greatly motivated to develop effective leaders because of their impact on financial success, employee satisfaction and performance, and health care costs. Yet most organizations have given up this goal and abandoned leader development programs. One problem for these development programs has been that there is little or no evidence they work.

However, a leader development program based on specific behaviors that can be measured before, during and after training and development can demonstrate their effectiveness and investment in leader development is likely to grow. Also, like sexual harassment and ethics, firms in the future may provide leader development programs to inoculate organizations from lawsuits based on negligent supervision by toxic leaders. Leader development has the potential for a broad renaissance if organizations base programs on well-defined and specific leader behaviors.

The full list of references for this article can be found at:

About the Authors:
Richard Williams Ph.D. and Wallace Higgins M.B.A. are both Senior Consultants, and Harvey Greenberg M.S., M.B.A. is a Principal at Nehoiden Partners. For more information on their work, email

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About NEHRA - The Voice of HR Featuring articles and resources for Human Resources / HR professional and hiring managers from the Northeast Human Resources Association (NEHRA).

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