PurposeThe COVID-19 pandemic continues to challenge healthcare systems worldwide. The authors examined the lived experiences and perceptions of healthcare workers (HCWs) in managerial and senior positions to explore the pandemic's effects on well-being and valued organisational responses.Design/methodology/approachUsing purposive sampling, the authors conducted 39 semi-structured interviews with senior staff including health service administrators, heads of department and senior clinicians at a designated COVID-19 facility in New South Wales, Australia. Interviews were conducted from November 2020 to February 2021 to reflect on experiences during the height of the pandemic in 2020 (mid-March to the end of May 2020).FindingsWorkplace experiences affecting HCWs' well-being included being shunned by others, fear of infecting family, fear of the unknown, concerns about personal protective equipment, lack of direction from above and increased workload. Organisational interventions to protect the health and safety of HCWs and their patients included redeployment, improved communication, effective management committees, education and mental health supports.Practical implicationsOrganisations can minimise worker-identified factors threatening their well-being during a health crisis by applying broad-ranging initiatives including inclusive and open communication, promoting flexible work practices, providing up-to-date guidelines and policies and fostering camaraderie between workers.Originality/valueThe voices of senior clinical and managerial staff have been largely unheard during the COVID-19 pandemic. The authors addressed this deficit by describing their experiences and insights regarding the pandemic's impact on well-being and the organisation's responses to simultaneously safeguarding its staff and providing quality patient care.