Ethical leadership is defined as the demonstration of normatively appropriate conduct through personal actions and interpersonal relationships, and the promotion of such conduct to followers [10]. Ethical leaders are characterized by integrity, honesty, fairness, and accountability. They act as role models, emphasizing transparency and the well-being of others. In healthcare and research institutions, where work involves human health and public trust, ethical leadership is non-negotiable [1]. It positively influences organizational climate, encouraging employees to act in ways that promote integrity and trustworthiness, which are the bedrock of credible science [11].

Unethical leadership refers to actions and behaviors that violate established moral norms and ethical standards in the workplace. This form of leadership is often marked by manipulation, exploitation, and favoritism, where leaders prioritize their personal gain or goals at the expense of the well-being of their subordinates and the integrity of the organization. A useful framework for understanding these harmful behaviors is the Harmful Leader Behaviors (HLB) Framework, which identifies several key actions that contribute to unethical leadership [7]. Among the most detrimental of these behaviors are intimidation, a lack of care, self-centeredness, and excessive pressure for results.

One of the most destructive forms of unethical leadership is intimidation, where leaders use threats, verbal abuse, or coercive tactics to instill fear and suppress dissent. This type of behavior creates an atmosphere of fear and anxiety, where employees feel powerless to voice concerns or challenge decisions. Intimidation not only damages morale but also erodes trust within the organization, leading to a toxic work environment that can significantly affect employee performance and well-being [12].

Another hallmark of unethical leadership is a lack of care for the emotional, psychological, and physical well-being of subordinates [13]. Leaders who fail to consider the needs and well-being of their employees contribute to an environment that fosters burnout and disengagement. When leaders neglect to provide necessary support or fail to recognize the impact of stress on their staff, they indirectly encourage unhealthy work habits and hinder the long-term success of both the individuals and the organization [14]. This lack of care reflects a fundamental disregard for the human aspect of leadership and can lead to significant turnover and a loss of talent.

Self-centeredness is also a key characteristic of unethical leadership. Leaders who prioritize their personal interests whether it be for personal advancement, credit, or recognition over the goals and values of the organization engage in behavior that undermines trust and collaboration [15]. Such leaders may take credit for the work of others, hoard resources, or make decisions based solely on how they benefit personally, rather than considering the broader impact on the team or organization [16]. This self-serving attitude can demotivate employees and create a competitive, rather than cooperative, workplace culture.

Excessive pressure for results can lead leaders to demand unrealistic outcomes without regard for ethical boundaries or the capacity of their staff. In such situations, leaders may encourage or overlook unethical shortcuts, such as dishonesty, cutting corners, or exploiting others, to meet targets. While high performance is often expected in organizational settings, when leaders prioritize results at all costs, they risk compromising the integrity of the organization and the well-being of their employees. This type of pressure often leads to unethical decision-making and fosters an environment where success is achieved through questionable means rather than through innovation, teamwork, or ethical practices.

Unethical leadership can manifest in various harmful ways that negatively impact both individuals and organizations. By understanding the key behaviors outlined in the HLB Framework, intimidation, lack of care, self-centeredness, and excessive pressure for results, organizations can better identify and address unethical leadership practices [7]. Creating a leadership culture that values ethical standards, empathy, and collaboration is essential for fostering a healthy, productive, and sustainable work environment.

Unethical leadership can be understood through various theoretical lenses, each offering a unique perspective on how and why leaders engage in morally questionable behaviors. Four prominent theories that explain unethical leadership behaviors include Social Role Theory, Pseudo-Transformational Leadership, Social Learning Theory, and Contingency Theory. These frameworks highlight how leadership styles and organizational contexts can shape the likelihood of unethical conduct occurring within an organization.

Social Role Theory suggests that leaders may engage in unethical acts by rationalizing such behavior as necessary to fulfill their role as primary goal-achievers for the organization [17]. According to this theory, leaders may feel compelled to prioritize organizational success, sometimes to the detriment of ethical considerations. The pressure to achieve organizational goals can lead leaders to justify unethical decisions as “just part of the job” or even view these actions as necessary sacrifices for the greater good. In such instances, the leader’s focus on achieving tangible results may overshadow moral or ethical concerns, creating a rationale for behaviors that would otherwise be considered unacceptable.

Another relevant framework is Pseudo-Transformational Leadership, which occurs when leaders use their charisma, vision, and persuasive abilities to manipulate followers for personal gain [4]. While true transformational leaders inspire and motivate their followers to achieve higher levels of performance through ethical means, pseudo-transformational leaders exploit their influence to create a façade of positive change. These leaders may appear to have a compelling vision and inspire their followers to strive for organizational success, but in reality, their actions are self-serving and aimed at furthering their own interests. This form of leadership can be particularly harmful because it misleads followers into believing they are part of a transformative movement when, in fact, the leader is using them as a means to an end.

Social Learning Theory offers another explanation for the perpetuation of unethical leadership behaviors. According to this theory, employees learn what behaviors are acceptable by observing their leaders [9]. When leaders engage in unethical conduct, their behavior sets a precedent for others within the organization. Employees, particularly those in lower ranks, may view unethical actions as acceptable or even necessary to succeed within the organization. As a result, unethical behavior can cascade down the organizational hierarchy, with each successive level of employees adopting similar behaviors as they observe and internalize the actions of those above them. This creates a toxic culture where unethical practices become normalized and perpetuated over time.

Contingency Theory emphasizes that the effectiveness and impact of a leadership style are contingent upon the specific situation or context in which leadership is exercised. In high-stakes environments such as research organizations or industries that deal with critical, life-altering outcomes, unethical leadership can be particularly damaging [6]. The theory argues that in such settings, the lack of “buffers” or checks on leadership behavior makes it easier for unethical decisions to take root and have widespread negative consequences. In complex environments where the pressure to deliver results is intense, leaders may feel justified in bending ethical guidelines, and their actions may have significant, far-reaching impacts on both the organization and society at large.

In summary, unethical leadership is not merely the result of individual flaws or failures but can be understood through multiple theoretical perspectives. Social Role Theory suggests that leaders justify unethical behavior as necessary to meet organizational goals, while Pseudo-Transformational Leadership explains how leaders use charisma for personal gain, masking their true intentions. Social Learning Theory highlights the dangers of unethical behavior spreading through an organization as employees model their leaders’ actions. Finally, Contingency Theory points to the heightened risks of unethical leadership in high-stakes, complex environments. By examining unethical leadership through these frameworks, we can gain a deeper understanding of how such behaviors emerge and spread, and how organizations can take steps to prevent and address them.

Manifestations of HLB, such as intimidation and excessive pressure, directly harm staff morale. In research settings, where complex tasks and vulnerable populations are the norm, this leads to burnout, anxiety, and high turnover of experienced personnel, crippling institutional memory and research continuity [19].

Through the lens of Social Learning Theory, unethical leadership at the top such as condoning protocol shortcuts or ignoring conflicts of interest, sends a powerful message that ethical rigor is secondary to results. This can trickle down, normalizing practices like data manipulation or unethical patient recruitment, as seen in historical scandals like the Tuskegee Syphilis Study, which was perpetuated by a broken institutional culture.

Health research in LMICs is deeply reliant on international partnerships and funding. Unethical practices, such as nepotism in hiring or misreporting of results, can trigger reputational crises. Donors, upon whom sustainability depends, are quick to withdraw support from institutions plagued by governance scandals [20].

Inefficiency arises when resources are allocated based on favoritism rather than merit, or when leaders engage in micromanagement. This creates operational bottlenecks and stifles the autonomy necessary for scientific innovation. Disengaged staff may exhibit counterproductive work behaviors, further reducing productivity [7].

Procurement fraud, fund misappropriation, or inflated budgets attract external audits and legal sanctions. For example, audits by bodies like the Global Fund have periodically suspended grants to partners over financial mismanagement, demonstrating how unethical leadership directly jeopardizes an organization’s financial lifelines.

The most severe consequence is the compromise of research integrity and public health. Leaders who prioritize prestige over rigor may encourage the suppression of adverse findings or the rushing of trials without adequate safety oversight. This not only endangers research participants but can also lead to the dissemination of faulty science, with long-term negative consequences for entire health systems.

To foster ethical leadership within organizations, it is essential to strengthen leadership selection and evaluation processes, ensuring that leaders not only possess technical competence but also demonstrate strong ethical potential. Traditional methods of leadership selection typically focus on a candidate’s qualifications, experience, and technical expertise. However, as organizations increasingly recognize the critical importance of ethical decision-making, there is a growing need to assess leaders’ ethical capacities as part of the evaluation process. According to Luo et al. [24], moving beyond technical competence to include assessments of ethical potential is crucial for selecting leaders who will uphold the values of the organization. This can be achieved through tools such as behavioral interviews, 360-degree assessments, and ethics-centered scenarios. Behavioral interviews allow evaluators to probe how candidates have navigated ethical challenges in the past, providing insights into their decision-making processes. 360-degree assessments, which gather feedback from peers, subordinates, and supervisors, offer a holistic view of a leader’s ethical behavior from multiple perspectives. Furthermore, ethics-centered scenarios can help assess how candidates would handle ethical dilemmas, allowing evaluators to see whether the candidate’s decision-making aligns with the organization’s values. By integrating these ethical assessment tools into the leadership selection process, organizations can ensure that leaders are not only technically capable but also possess the ethical judgment necessary for guiding the organization toward long-term success and sustainability.

In addition to strengthening leadership selection, organizations must also institutionalize ethics training and mentorship to reinforce ethical behavior and decision-making at all levels. Ethical leadership is not merely a matter of personal integrity; it is also shaped by the culture and values of the organization. One way to cultivate a culture of ethical leadership is through regular, context-specific ethics training [25]. Such training should be designed to address the real-world ethical dilemmas that leaders are likely to encounter in their specific organizational context. This can include issues such as conflicts of interest, whistleblowing, data integrity, and transparency. By regularly engaging leaders in ethics training that is tailored to their roles and responsibilities, organizations can ensure that ethical considerations remain at the forefront of decision-making, even in complex or high-pressure situations.

Furthermore, pairing emerging leaders with ethically grounded senior mentors is another effective strategy for reinforcing ethical values. Senior leaders who have demonstrated a strong commitment to ethical principles can serve as mentors, providing guidance and wisdom to younger or less experienced leaders. Through this mentorship relationship, emerging leaders learn not only from the successes and failures of their mentors but also from their ethical decision-making processes. This kind of social learning is vital for embedding ethics into the leadership pipeline, as it helps emerging leaders internalize ethical principles through observation and interaction with role models [12]. Mentorship programs can also create a space for open dialogue about ethical challenges, where emerging leaders can discuss difficult decisions and receive feedback from those with more experience [1]. By institutionalizing both ethics training and mentorship, organizations can build a strong foundation of ethical leadership, ensuring that ethical behavior is continuously modeled, reinforced, and integrated into the organization’s culture [26].

In summary, strengthening leadership selection and evaluation processes and institutionalizing ethics training and mentorship are essential strategies for cultivating a culture of ethical leadership. By incorporating ethical assessments into leadership selection and providing regular, context-specific ethics training, organizations can ensure that their leaders are equipped to handle ethical challenges with integrity. Pairing emerging leaders with ethically grounded mentors further reinforces these values, promoting social learning and fostering a leadership culture that prioritizes ethical decision-making. Through these strategies, organizations can not only enhance their leadership capacity but also build a more ethical and sustainable future.

Creating a robust and ethical organizational culture requires a multifaceted approach, focusing on clear guidelines, accountability mechanisms, and an environment that encourages transparency and open communication [27]. Key strategies to achieve this include developing enforceable codes of conduct, decentralizing ethical oversight, fostering a culture of openness, and integrating ethical metrics into performance reviews. Each of these elements plays a crucial role in promoting ethical behavior, ensuring that all members of the organization are held accountable for their actions, and creating a workplace that values integrity at every level.

One of the foundational steps in fostering an ethical organization is the development of clear, enforceable codes of conduct and accountability systems. Establishing a comprehensive set of ethical guidelines provides a clear framework for behavior, outlining expectations for how employees should conduct themselves. However, for these codes of conduct to be effective, they must be supported by robust anonymous reporting systems and independent ethics committees that can enforce accountability across all levels of the organization. As Hassan et al. [20] emphasize, these systems must allow individuals to report unethical behavior without fear of retaliation. In such an environment, all employees, regardless of rank or position, are held accountable for their actions. The presence of independent ethics committees adds another layer of oversight, ensuring that decisions about ethical breaches are made impartially and transparently, further reinforcing the organization’s commitment to ethical conduct.

In organizations with multiple branches or departments, it is also critical to decentralize ethical oversight. [7] argues that by empowering local ethics officers or committees, organizations can ensure that ethical issues are identified and addressed promptly, without the delays often caused by centralized bureaucratic processes. This decentralization allows for more timely responses to ethical challenges, enabling local teams to manage issues in a way that is context-specific and responsive to the unique challenges they face. By giving local units the authority and responsibility to address ethical concerns, organizations can reduce inertia and create a more dynamic system of ethical oversight that operates efficiently across all levels.

Equally important is the need to foster a culture of openness and psychological safety within the organization. Leaders play a crucial role in setting the tone for how ethical issues are handled, and they must be trained to listen non-defensively and to reward honesty rather than penalize it [28]. When employees feel safe to speak up about ethical concerns, without fear of retribution or being marginalized, they are more likely to report unethical behavior and contribute to a culture of transparency [29]. Regular “ethics town halls” can provide a platform for open discussions, where employees at all levels of the organization can raise concerns, ask questions, and share ideas. These forums encourage active engagement with ethical issues, allowing for dialogue about challenges and solutions. In turn, this transparency helps to build trust within the organization, ensuring that everyone feels their voice is heard and that ethical standards are taken seriously.

Integrating ethical metrics into performance reviews is an effective way to align individual incentives with ethical behavior [30]. When staff members’ feedback on leadership ethics and compliance records is included in performance evaluations, it signals to everyone in the organization that ethical behavior is just as important as technical performance or productivity. Including these ethical metrics in promotion criteria ensures that leaders and employees alike are recognized and rewarded for upholding ethical standards, creating an incentive structure that encourages ethical behavior. This approach not only reinforces the organization’s commitment to ethics but also encourages individuals to take ownership of their actions and to hold their colleagues accountable as well.

Fostering an ethical culture within an organization requires a comprehensive approach that includes clear, enforceable codes of conduct, decentralized ethical oversight, a culture of openness and psychological safety, and integration of ethical behavior into performance reviews [27]. By implementing these strategies, organizations can create an environment where ethical conduct is prioritized, accountability is built into the system, and individuals feel empowered to contribute to a culture of integrity. As these practices become ingrained in the organizational fabric, they help to ensure that ethical behavior is not just encouraged but expected at all levels of the institution.

To strengthen the ethical foundation of an organization and enhance its credibility, it is essential to collaborate with external ethics and governance bodies [31]. By partnering with national ethics councils, such as the Uganda National Council for Science and Technology, as well as global organizations like the World Health Organization (WHO) and other international bioethics forums, an organization can benefit from external audits and peer reviews that provide objectivity and transparency. These collaborations offer several key advantages, including the opportunity to receive unbiased evaluations of the organization’s ethical practices, improve internal governance structures, and enhance reputational trust both domestically and internationally.

One of the primary benefits of engaging with external ethics bodies is the objectivity they bring to the evaluation process [32]. Internal assessments of ethical practices, while valuable, can sometimes be influenced by organizational biases or blind spots. External audits and peer reviews, conducted by independent bodies with expertise in ethics and governance, provide a more impartial and comprehensive analysis of an organization’s ethical standards and practices. These external evaluations allow for the identification of potential ethical issues that might otherwise go unnoticed, ensuring that the organization adheres to the highest standards of integrity and transparency.

Moreover, collaboration with recognized ethics and governance organizations enhances the reputational trust of the organization. When an institution partners with respected national and global bodies, it signals to stakeholders including funders, regulatory authorities, and the public that the organization is committed to upholding rigorous ethical standards [13]. The involvement of external ethics councils and international forums in audits and reviews demonstrates a commitment to transparency and accountability, which is critical for maintaining the trust of both the public and key stakeholders [13]. For organizations involved in research or health-related initiatives, this trust is especially important, as it ensures the integrity of their work and fosters positive relationships with external partners, including governments, donors, and collaborators [12].

In addition to enhancing objectivity and reputational trust, partnerships with external ethics bodies also contribute to continuous improvement in organizational practices. These bodies often provide valuable feedback, recommendations, and best practices that organizations can use to refine their ethical frameworks and governance structures [33]. By engaging with these external forums, organizations can stay up-to-date with evolving ethical standards, emerging global trends, and new regulatory requirements. This ongoing dialogue helps ensure that the organization remains at the forefront of ethical practices and is responsive to the challenges and opportunities that arise within its field.

Collaborating with external ethics and governance bodies such as national ethics councils and international organizations like the WHO is a strategic approach to strengthening an organization’s ethical standards and enhancing its credibility. External audits and peer reviews provide objective evaluations that highlight areas for improvement, while also bolstering the organization’s reputational trust among stakeholders [25][33]. Furthermore, these partnerships foster continuous learning and adaptation, ensuring that the organization remains committed to the highest ethical practices in an ever-changing global landscape [12]. By engaging with these external entities, organizations can not only enhance their internal governance but also demonstrate their dedication to ethical excellence and transparency.