Abstract Background Modern healthcare ecosystems are shaped by rising service demands, structural workforce shortages, and heightened organizational complexity. While individual-level burnout has been widely evaluated, the underlying organizational determinants that systematically influence psychological safety and occupational stress require deeper investigation. This study explores how healthcare structures, leadership execution, and workload governance shape these dynamics within a transforming tertiary health system. Methods A qualitative, interpretive hermeneutic phenomenological design was utilized to examine the lived experiences of a multidisciplinary cohort. Twenty healthcare professionals ( N = 20) across fifteen distinct clinical departments were recruited via purposive sampling. Data were generated through concurrent qualitative streams consisting of anonymous open-ended surveys ( n = 12) and in-depth semi-structured interviews ( n = 8). Thematic analysis was executed using Braun and Clarke’s six-phase framework. Qualitative rigor was maintained via data triangulation, independent parallel coding, and database auditing. Results The thematic synthesis identified six core interconnected themes: (1) systemic workload velocity and staffing imbalances, (2) structural suppression of psychological safety and communication barriers, (3) perceived organizational injustice in resource allocation, (4) reactive and isolated managerial leadership styles, (5) compounding impacts on workforce performance and clinical safety, and (6) the critical mandate for system-level occupational interventions. The findings demonstrate that vertical hierarchies, inequitable workload distribution, and punitive management responses are primary drivers of occupational stress and directly inhibit employees’ willingness to voice clinical concerns. Conclusions Psychological safety and occupational stress are primarily determined by systemic organizational structures rather than individual resilience profiles. Mitigating healthcare workforce strain and protecting patient care quality requires moving away from individual-focused interventions and toward system-level reforms. Key recommendations include implementing transparent workload allocation models, establishing inclusive leadership frameworks, and institutionalizing psychologically safe reporting channels.