Work is a key social determinant of mental health, and adverse organizational conditions in healthcare settings increase psychosocial risks. Leadership influences workplace well-being, yet its impact on mental health and gender inequalities remains underexplored. Despite the feminization of the health sector, disparities persist in leadership access, role expectations, and work-family reconciliation, exacerbating occupational stress. Aims: This study examines leadership practices in public hospitals, focusing on their relationship with mental health, organizational dimensions (recognition and role stress), and gender disparities. It explores the perspectives of both workers and managers to understand how leadership shapes workplace conditions and well-being. Methods: A qualitative, cross-sectional study was conducted as part of the FONDECYT project 1220547. Semi-structured interviews were conducted with 64 workers from public hospitals in Santiago, Chile, including clinical and administrative staff. The analysis supported by Grounded Theory identified key categories: constructive and destructive leadership, recognition, role stress, and gender disparities in leadership. Results: Constructive leadership-characterized by communication, fairness, and recognition-was linked to a healthier work environment and improved well-being. In contrast, destructive leadership (characterized by abuse of power and imposition, or inaction, lack of support, and absence of effective direction) contributed to role stress, workplace mistreatment, and job dissatisfaction. Recognition was a crucial but insufficient motivator, as the lack of formal mechanisms led to frustration. Role stress emerged as a significant risk for well-being, with subordinates experiencing overload, ambiguity, and conflicting expectations. Gender inequalities persisted as women faced more tremendous barriers to leadership and difficulties balancing work and family responsibilities. Workers and managers had differing perspectives, with subordinates prioritizing fairness and recognition while managers emphasized operational constraints. Conclusions: Leadership training should emphasize trust, equity, and recognition to enhance workplace well-being. Institutional policies must address role stress, strengthen formal recognition systems, and promote gender equity in leadership. Future research should integrate quantitative methods to explore leadership's impact on organizational conditions and mental health outcomes.