Theranos Scandal: Toxic Triangle

GUNARSO Nicholas

MSc International Business

Word Count: 4269 words

Similarity : 30%

Managing Organisations BUSI4316

Module Convenor: Dr Peter Lamb

12th December 2019

INTRODUCTION

Every organization is created to achieve certain objectives through a human group.

Achieving those objectives requires the organization to have good leaders. Leadership

becomes the primary driver for growth, development, and innovation in any organization.

However, being a good leader is not easy and not something that everyone can do.

Theranos Inc. scandal has directly damaged its investors, its employees, and also

the company itself, making the company has bad images in public. The case is caused by

internal factors, which are the leadership style and the followers, and external factors,

coming from the situation created around the company. Analysis of the case, to what

extent does the toxic triangle model can explain the reason behind an event can occur,

will be the scope of work in this case study. Also, giving constructive recommendations

to prevent the issue will be presented. First, an explanation regarding the literature of the

leadership, destructive leadership and toxic triangle will be presented. Secondly, there

will be an explanation about the case study and will be continued with discussion to

correlate the theories and the scandal provided in the case study. Thirdly, there will be a

summary and recommendation.

Early identification and preventive measures will save many people, including the

companies. The problems raised by the case study can be good learning for other leaders

so that the same mistakes are not repeated.

1
LITERATURE REVIEW

Definition and Importance of Leadership

Leadership is a concept that has been used countless times from scholars, but it is

still hard to describe the exact definition of it. In 2017, Sultan Aalateeg summarized some

leadership definitions by some scholars. First, Bartol and Martin (1998) described

leadership as the process of influencing people to achieve organizational goals (Bartol &

Martin, 1998, cited in Aalateeg, 2017). Second, Antokanis, Avolio, & Sivasubramaniam

(2004) defined leadership as the nature of the process of influence – and its resulting

outcomes – that occurs between the leader and the followers, and how this process of

influence is explained by the behavior, perceptions and attributions of the leader

(Antokanis, et al., 2004, cited in Aalateeg, 2017). Based on these explanations, leadership

can be expressed as an influencing process to drive other people to accomplish certain

goals using certain abilities possessed by the leaders, which is similar to the definition

suggested by Yukl (2010) :

“Leadership is the process of influencing others to understand and agree about

what needs to be done and how to do it, and the process of facilitating individual

and collective efforts to accomplish shared objectives” (Yukl, 2010).

One important aspect in leadership is the effectiveness of the leadership process.

The efficacy of the leadership process can be determined by how well a group canachieve

its objectives and how the leader has positive impacts on followers and society (Padilla,

Kaiser, & Padilla, 2007; Yukl, 2010). To achieve positive goals usually, a two-way

relationship between leaders and followers is required.

 Yukl (2000) proposed the concept of transformational leadership to describe

leadership efficacy, taking into account the interaction between leaders and followers

(Yukl, 2010). This theory explained that transformative leadership appeals to followers’

moral values in an effort to raise awareness of ethical issues and mobilize their energy

and resources to reform institutions (Yukl, 2010). This theory suggests that the leader

transforms and motivates followers by 3 ways, which are raising awareness of the

importance of task outcomes, encouraging followers to surpass their own self-interest for

the sake of the team, and activating their higher-order needs (Yukl, 2010).

The formula for transformational theory included four types of transformation

behaviour: idealized influence (behaviors that generates strong follower emotions and

identification with the leader), intellectual stimulation (behaviors that boosts follower

awareness of issues and affects followers to view issues from different perspective),

individualized consideration (behaviors that include providing support, encouragement,

and coaching to followers), and inspirational motivation (behaviors that include

communicating an appealing vision, and using symbols to focus subordinate effort)

(Yukl, 2010).

Destructive Leadership

A process that emphasizes negative behaviors such as narcissism and psychopathy,

manipulation, intimidation, coercion, and one-way communication is considered as

destructive leadership (Padilla, et al., 2007). They consider that this type of leadership

involves imposing goals on followers without considering their agreement or long-term

welfare. Over the long term, such a process is alienating because the process fails to make

followers have meaningful goals toward the outcome (Padilla, et al., 2007).
 Destructive leadership can be targeted to leaders (personal destructiveness) or the

company and its internal members and external stakeholders (Padilla, et al., 2007).

Personal destructiveness can be seen as unwanted things that have harmful consequences

for leaders, such as reprimands, criminal record, poor reputations, or even failure to

succeed in the career of leaders (Padilla, et al., 2007). While the destructiveness of

organizations can be seen as members when misery was added to followers, such as

demoralized labor and environmental disasters (Padilla, et al., 2007).

Padilla et al. (2007) explained that five instruments can be used to identify

destructive leaders, which are charisma, narcissism, personalized use of power, negative

life themes, and an ideology of hate (Padilla, et al., 2007).

Charisma & Narcissism Personalized Use of Power

In general, leaders are characterized by a need for power (McClelland, 1975, cited

in Padilla, et al., 2007). Charismatic and narcissistic leaders are mostly related to

destructive leaders, who often use their power for self-serving end in a different way

(Padilla, et al., 2007). Charismatic leaders use their visions, self-presentational skills, and

personal energy to manipulate others by exaggerating their positive achievements, taking

unwarranted credit, blaming others for their mistakes, and covering up their mistakes

(Padilla, et al., 2007). Narcissistic leaders, on the other hand, abuse their power by

claiming that they have special abilities inside them and wanting unquestionable

obedience from their followers (O’Connor, et al., 1995, cited in Padilla, et al., 2007). It is

known also that narcissistic leaders are self-absorbed, ignore others’ points of view, and

attention-seeking (Conger & Kanungo, 1998, cited in Padilla, et al., 2007).

 Both type of destructive leaders use their power unethically for personal gain and

self-promotion (Padilla, et al., 2007). These types of leaders use control and coercion to

impose their goals while censuring opposing views (Padilla, et al., 2007).

Negative Life Themes & Ideology of Hate

Destructive leaderships harm their organizations often by speaking about

themselves in terms of negative life stories, usually in the form of childhood adversity

associated with using coercive influence techniques (Padilla, et al., 2007). These bad

experiences can lead leaders to have an ideology of hate. Using hate, leaders legitimize

the use of violence and retribution to finish a job (Strange & Mumford, 2002, cited in

Padilla, et al. 2007).

In certain situations, destructive leadership can create “the toxic triangle” if

combined with susceptible followers, and conducive environments (Padilla, et al., 2007).

Figure 1 The Toxic Triangle Model cited in (Padilla, et al., 2007)

Susceptible Followers

The toxic triangle’s second domain is susceptible followers. Followers are divided

into two groups: conformers, followers who follow destructive leaders based on their fear,

and colluders, followers who participate actively in the plan of the destructive leader

(Higgins, 1997, cited in Padilla, et al., 2007). Each group of followers has different

purposes. Conformers try to mitigate the effects of not along while colluders pursue

personal gain by affiliation with a destructive leader (Higgins, 1997, cited in Padilla, et

al., 2007).

Conformers’ vulnerability based on unmet basic needs, negative self-evaluations,

and psychological immaturity while colluders’ vulnerability based on ambition and a

similar perspective with their leader’s point of view (Padilla, et al., 2007).

Unmet Basic Needs

According to Maslow’s hierarchy of needs, followers need to fulfill their basic

needs before self-actualization can be achieved (Maslow, 1971, cited in Lipman-Blumen,

2005). Providing higher salaries and offering a comfortable environment for the followers

are the main reasons why this type of followers still follow toxic leaders (Lipman-

Blumen, 2005; Padilla, et al., 2007).

Negative Self-Evaluations

Followers’ belief becomes the main contribution of followers to become

conformers followers. When people have a low-level of confidence towards their

capability (pictured as low self-esteem, low self-efficacy, and an external locus of control)

(Padilla, et al., 2007), it will be easier for destructive leaders to manipulate and control

them.
Low Maturity

Psychologically immature individuals are more likely to participate in destructive

acts (Padilla, et al., 2007). Followers who lack a clear sense of self can internalize

destructive charismatic leaders’ value (Weierter, 1997, cited in Padilla, et al. 2007).

Ambition & Similar Perspective

Ambitious people sometimes engage in projects in pursuit of status (Padilla, et al.,

2007). Some leaders invite others to do a project to exceed the achievements norms of

society (Lipman-Blumen, 2005). Followers sometimes are seduced by the possibilities of

gaining popularity by joining in this kind of project (Lipman-Blumen, 2005). When

followers have a similar concept with the leaders, a stronger bond between leaders and

followers will be created and followers will have more motivation to follow the leaders

(Padilla, et al., 2007).

Conducive Environments

The third toxic triangle field describes how rulers, followers, and their relationships

can be influenced by the environment (Padilla, et al., 2007). Padilla et al. (2007) propose

that disruptive leadership has four important environmental factors: instability, perceived

threat, cultural values, and absence of checks and balances and institutionalization

(Padilla, et al., 2007).

Instability

When there are demands for quick actions and unilateral decision making, leaders

are granted more authority to be the final executor (Padilla, et al., 2007). Once the

decision has been made, it is often difficult to evaluate the result (Padilla, et al., 2007).

Perceived Threat

Threatened people are more willing to accept assertive leadership (Padilla, et al.,

2007). They tend to follow and support the leaders more when given more threats, even

if the leaders are destructive (Padilla, et al., 2007).

Cultural Values

Destructive leaderships are known to emerge primarily in cultures that advocate

ambiguity, collectivism, and high power distance (Padilla, et al., 2007). The climate of

ambiguity involves the degree to which a community feels threatened by ambiguous

situations causing individuals to seek strong leadership (Padilla, et al., 2007). Cultures

that emphasize collectivism require strong leaders to unite people (Padilla, et al., 2007).

In high power-distance cultures, followers are more tolerant of the power asymmetries

that characterize tyranny and despotism (Padilla, et al., 2007).

Absence of Checks and Balances and Instituionalization

Strong organizations usually have strong institutions and strong countervailing

centers of power (Padilla, et al., 2007). To avoid the practice of abusing power, checks

and balances are required (Padilla, et al., 2007). Without balance control, any individual

or party will be able to usurp (Padilla, et al., 2007).

CASE NARRATIVE

Theranos Inc. is a consumer healthcare technology startup that was founded back

in 2003 by a nineteen-year-old Standford chemical and electrical engineering dropout,

Elizabeth Holmes (Stockton, 2016; Tun, 2019). Initially, when Theranos was founded,

the idea of this company was to revolutionize healthcare by making blood-testing

procedures cheaper and more convenient (Leiva, 2019). The first idea to develop the new

blood-testing method comes from her phobia of needles and also her mother’s and

grandmother’s experience who fainted at the sight of needles and the sight of blood

(Auletta, 2014).

The company developed a small device designed to draw, retain, and analyze a

droplet of blood from a patient’s fingertip and also its blood-testing machine, called

“Edison”, to run multiple tests on patient’s physiology within a short time and also at a

lower cost (Tun, 2019). Holmes, as the CEO of Theranos, even said that the tests would

be able to detect medical conditions such as cancer and high cholesterol (Carreyrou,

2015).

At first, Theranos seemed to be a quite promising company because the value of the

company in the market rose gradually (Tun, 2019). When Theranos was first founded in

2003, Holmes was able to secure not only high-profile investors but also strong

politicians, such as George Shults, Henry Kissinger, Betsy DeVos, Rupert Murdoch, and

many more (Leiva, 2019; Dunn, et al., 2019a). However, it turned out that the company

was using inaccurate technologies to run the blood test and was charged with “massive

fraud” in March 2018 (Hartmans & Leskin, 2019).

Initially, these inaccuracies of technologies were identified when the company

unveiled a website that introduced its product to the world through press releases and

media features in 2013 after a decade of working in the dark (Leiva, 2019). Theranos’
products were first introduced to the consumers directly in September 2013 after the

company agreed with Walgreens to commercialize and use those products to the Arizona

area by opening “Theranos Wellness Centers” (Leiva, 2019; Sweeney, 2018). Since then,

many scientists started to question the technology which is used by Theranos because the

scientists believed that this blood tests may well turn out to be groundbreaking.

It turned out that Theranos has published little data regarding its technology to be

reviewed by other people (Auletta, 2014). The data that the company provided only giving

little information about the process in the device and also the quality of the result (Auletta,

2014). Holmes stated that the company is only trying to protect itself from competitors

while trying to do something unique and always avoiding to give actual information

(Auletta, 2014).

Before 2015, the company’s popularity remained unchanged and had positive

feedback. In fact, in 2014, Theranos was valued at almost $9 billion by Fortune magazine

(Tun, 2019). Following the increasing popularity of Theranos, Elizabeth Holmes, as the

CEO of this company also began to be regularly featured in high-profile media platforms

(Leiva, 2019). Hundreds of employees started to join the company to participate in an

ambitious mission of creating a cheaper and more efficient alternative to traditional

medical tests (Fiegerman & O'Brien, 2019).

On 15th of October 2015, John Carreyrou, a reporter from the Wall Street Journal

released an article regarding Theranos based on his interview with Theranos’ former

employees. In his report, the company ex-employees described that Theranos’

management is incompetent, has exaggerated the capability of its technology and is

deceiving the public (Carreyrou, 2015). The ex-employees exposed that during 2014,

Theranos was not able to deliver accurate results from its “Edison” machine, a machine

which is developed by Theranos to run multiple medical tests based on only a few drops
of blood (Carreyrou, 2015; Stieg, 2019). Moreover, it turned out that during 2014, the

company only managed to do 15 tests out of 190 tests using its “Edison” machine.

Based on Carreyou’s report, the results given by Theranos seemed inaccurate when

they were compared to hospital results (Carreyrou, 2015). The former employees stated

that the company is often not using the “Edison” machine to run the tests. The tests were

conducted in the traditional machine and done by manipulating the volume of the blood

samples taken from patients through a dilution process. Through this process, the

company increased the volume until it satisfied the volume specifications required. the

concentration of substances in the blood was changed and being measured to fall below

the machines’ allowable range which was causing a higher chance of erroneous results

(Carreyrou, 2015).

In the same report, John Carreyou was able to expose another leaders’ flaw

regarding the relationship between the leaders and the workers. In May 2013, Ian

Gibbons, who was the first experienced scientist hired by Theranos, was found dead by

committing suicide. Through the information given by Ian Gibbon’s wife, Rochelle

Gibbons, the scientist was afraid to get fired because of his argument towards the

company’s “Edison” machine (Carreyrou, 2015). Long before Theranos launched its

technology in Arizona, Gibbons had found out that the technology had flaws in 2010.

Hearing this news, the CEO was frustrated and decided to fire Gibbons. However,

Gibbons was quickly rehired with lower responsibilities (Dunn, et al., 2019a).

Gibbons remained vocal about the inaccuracies of the technology and was called to

meet Elizabeth on the 16th of May 2013. Being afraid to be fired again, Ian Gibbons finally

decided to commit suicide (Carreyrou, 2015). A week after Ian Gibbons’ death, the

company reached out to his wife and sent her two letters. The first one was a letter which

demanded all the intellectual property and any other data relating to the technology to be
returned to the company. The second letter consisted of a warning from the company’s

lawyers for not telling anyone what happened to her husband (Dunn, et al., 2019a).

Rochelle Gibbons even stated that the company never send any condolences to her even

the fact that her husband has worked for the company for almost ten years (Dunn, et al.,

2019a). This story gives a glimpse of explanations that the relation between the leaders

and the workers are not reciprocal.

Based on Rochelle Gibbons’ story, it turned out that the company gave pressures of

lawsuit and intimidations to Ian Gibbons because he did not go along with the company’s

opinions about “Edison” (Dunn, et al., 2019a). Ian Gibbons stated that he did not like

Theranos for its fraud yet he also did not want to be unemployed and still looked to the

Theranos’ opportunity as a bright new chapter for him (Dunn, et al., 2019a).

On 14th of March 2018, the U.S. Securities and Exchange Commission (SEC)

charges Holmes with the accusation of raising more than $700 million from investors

through an elaborate, years-long fraud (Leiva, 2019). Holmes, then, is stripped of her

control of the company and the company was forced to close and return millions of shares

to Theranos (Leiva, 2019). Also, she is banned to serve as an officer or director of any

public company for ten years (Leiva, 2019).

After this incident, some former Theranos employees have not got their proper job

due to the stain of Theranos on their resume (Fiegerman & O'Brien, 2019). Some of the

former employees even stated that the company was able to keep its workers inside the

company’s bubble (Fiegerman & O'Brien, 2019). The scandal created by Theranos hurts

its employees, its investors, its consumers, and even its leaders and to anticipate such

occurrence further evaluation need to be conducted before giving possible solutions to

change the outcome of the whole process.

DISCUSSION

Sometimes theories have a problematic relationship with practice and can not fully

explain why some problems happen. The same issue occurs in the toxic triangle model

proposed by Padilla et al. (2007). Padilla et al. stated that there are three components in

the toxic triangle model, which are destructive leadership, susceptible followers, and a

conducive environment (Padilla, et al., 2007). Thus, how far can this model explain the

case of Theranos will be discussed.

Initially, when Elizabeth Holmes build the company, she wanted to give positive

contributions to society by trying to create a new cheaper blood-testing machine.

However, during the process, it turned out that Elizabeth Holmes possesses three

characteristics of destructive leaders: charisma, narcissism, and personalized use of

power.

The narcissism characteristic of destructive leaders. Her ex-employees stated that

Elizabeth Holmes does not want to listen to her employees' opinions and feedback about

the development of “Edison” machine, especially when the feedback is negative (Dunn,

et al., 2019b). Indicating that she does now want to listen to others’ opinions and force

other people to give the criticism she wants. Another indication of narcissism that can be

observed is that she wants full obedience from her followers. Ana Arriola, the former

chief design architect in Theranos, commented on Holmes' action towards her employees

who disagreed with her opinions. She said that every employee who disagrees with her

will directly be terminated which she thought as something unusual (Dunn, et al., 2019b).

Beside narcissism, it turned that Elizabeth Holmes has the characteristic of

charismatic leaders. She was able to convince many investors and many scientists to

induce new funding and workers into the company, by exaggerating the company’s

products (Bilton, 2018). Initially, in the eyes of some people, Elizabeth Holmes has the
charisma of someone who is brilliant and can revolutionize medical industries (Dunn, et

al., 2019b).

One important thing to be highlighted in based on Elizabeth Holmes’ leadership, is

that many people suffered. People who are willing to be the test subjects of the company

are given inaccurate data. This incident can endanger the live of those people. Moreover,

due to Elizabeth Holmes’ leadership, many former employees are facing a pretty difficult

future.

In the case of Theranos, there is another domain of the toxic triangle model that can

be examined which is the followers. Colluders followers seem to be more dominant in

the case of Theranos. This type of follower can be identified by looking at Ian Gibbons

and other scientists in Theranos. Ian Gibbons is willing to stay in the company to develop

the company’s product even though he has been disappointed by the company several

times (Carreyrou, 2015). Ian Gibbons spends his ten years of life to develop the product

and based on his wife’s story, Ian seems to put deep thought about how to make the

machine work well (Dunn, et al., 2019a). Another good example can be examined from

some investors, such as David Boies and Sunny Balwani

The reason behind the ambition of the followers can not be fully explained by the

theory. Based on Padilla et al. (2007), colluders followers use their ambition to pursuit

status. However, in Theranos’ scandal, some scientists were encouraged to contribute to

society by inventing the machine and making improvements (Dunn, et al., 2019b).

Another implication that can be seen from this case is that not everyone in Theranos has

ambition, some of them may just have curiosities about the technology and started to join

the company, such as Tyler Shultz and Erika Cheung (Dunn, et al., 2019c).

Looking at the third domain in the toxic triangle model, which is conducive

environments, two distinctive characteristics can be identified. First, the situation which
is created in Theranos by hiring strong political figures to the company makes the

employees become pressured. They are forced to follow the company regulations and

whenever there are people who endanger the company, Elizabeth will try to get rid of

them. The pieces of evidence can be seen through what the company do to Ian Gibbons’

wife (given letter not to tell what happen with her husband to public otherwise she will

be sued), John Carreyou (given letters not to publicize his works into public otherwise he

will be sued), Tyler Shultz (given a letter to appear in the court after the company knows

that he revealed the story to John Carreyou), and Erika Cheung (given a threatening letter

signed by David Boies even after she left the company) (Dunn, et al., 2019c).

Second, there are no checks and balances toward the company. For a long time,

many investors and people would believe Elizabeth’s statements about the company. The

possible reason behind this incident is that during that time, Theranos becomes a rapidly

transforming industry. Elizabeth’s idea to create a new blood-testing method would be

the reason why most people become excited and forget to do checks and balances about

what happens in the company.

Based on the discussion, the main problem that actually occurs in Theranos comes

from the leader. The leader implement one-way communication in the company and does

not want to receive feedback from her employees, thus creating a situation where the

leader become very difficult to be resisted by workers and creates an unfavorable situation

in the company. This problem can be resolved only if there is two-way relationship

between the leader and the employees. Also the leader has to realize that her actions are

unethical and irrational.

Adapting the transformational leadership theory, proposed by Yukl (2010), can be

a solution that can be considered to solve the problem. In this theory, it is explained that

there is a two-way relationship between leaders and workers (Yukl, 2010). Moreover, this
theory also promotes positive moral values in the work environment to further develop

the company (Yukl, 2010).

CONCLUSION

The Theranos scandal has given a lot of negative impacts to a lot of people and even

claimed lives. Many parties are involved in this case and it is not good to blame only one

group. Therefore, improvements that must be made in this case have to be done by

multiple parties.

Using the toxic triangle model proposed by Padilla et al. (2007), an analysis of this

corporate case can be made even though there is some limitations. In this theory, the

limitations are the absence of clear indicators that can be used to analyze each component,

thus creating a situation where subjectivity becomes the main components to do the

analysis. Also, not all the characteristics for each domain are able to explain the problem

and sometimes even contradict. For example, the ideology of hate and negative life

themes proposed to describe destructive of leadership are not suitable to explain this case.

In this case, the dominant aspect of the toxic triangle model is the destructive

leadership. The leaders not only limit the two-way relationship between the leaders and

workers. However, the blame is not only directed towards the leader. The company also

suffers due to its employees. Some followers are still persistant to support the leaders in

developing this impossible machine and the reason maybe comes from their ambition.

Thus, this condition slowly makes the leader more confident to realize the products and

does not hesitate to move forward.

To counter measure this problem, it is better that the leaders start to receive input

from others and implement the transformational leadership theory proposed by Yukl
(2010) by building a situation where the leaders and the followers work in an ethical and

constructive environment.
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