# Machiavellianism in Healthcare: A Literature Review

## TL;DR

This paper reviews how Machiavellian traits affect healthcare, showing they can create toxic work environments and reduce organizational commitment.

## Contribution

The paper provides a structured synthesis of Machiavellianism in healthcare, highlighting its implications and research gaps.

## Key findings

- Machiavellianism is linked to emotional coldness and manipulative behaviors in healthcare settings.
- High-Mach individuals show low commitment to organizations and teams but high career commitment.
- Machiavellian traits can lead to toxic work environments and unethical behaviors in healthcare.

## Abstract

Background/Objectives: Machiavellianism has long been associated with unethical tendencies and behaviors. High-Mach people have been stereotyped to choose business-related professions, contrary to low-Mach individuals choosing the helping professions. There has been a clear shift in scholarly focus, such as Machiavellian leadership and Machiavellian personality traits in healthcare. The objective of this narrative literature review was to provide a structured synthesis of empirical evidence on Machiavellianism within healthcare settings, focusing on its prevalence, manifestations, and organizational implications, while identifying conceptual and research gaps in the field. Methods: Literature research was conducted for articles published in PubMed, Scopus, and Google Scholar from 2014 until 2025. Articles written in English, examining Machiavellian traits in healthcare workers and students, were included in this review. Results: The search strategy produced 347 items, of which 11 original studies were included. Machiavellianism was described as a personality trait featuring emotional coldness and manipulativeness for the achievement of one’s own ends; individuals exhibiting those traits may prioritize personal gain over collective welfare. Machiavellian tendencies manifesting in organizational culture often lead to a toxic work environment where manipulation might become normalized. Machiavellians show high commitment to their careers, but low commitment to their current organizations, supervisors, and teams. Conclusions: Machiavellianism emerges as a relevant but underexplored personality trait in healthcare, associated with unethical behaviors, reduced organizational commitment, and toxic work environments. Addressing its impact requires ethical leadership development, supportive organizational environments, and early identification during professional training to safeguard workforce well-being and patient safety.