Workplace violence against healthcare workers is a serious threat to safety, efficiency, and health system performance worldwide. This study looks at the causes and effects of workplace violence in Pakistan’s hospital sector, where public and private facilities face very different challenges. We surveyed 768 healthcare workers from six hospitals in Peshawar—three public and three private. We collected detailed information on their experiences with violence, the quality of their institutions, how they report incidents, and the personal effects over a twelve-month period. Our findings show a clear divide between public and private hospitals. Workers in public hospitals face physical violence more than four times as often as those in private hospitals. More than half of public hospital staff reported experiencing attacks, compared to just 12 percent in private facilities. This divide appears in all areas: Witnessing violence, how incidents are reported, and the availability of safety measures and formal complaint systems. We created a model to explain how poor institutional quality leads to high levels of violence and low reporting, and we confirmed these predictions with our data. Statistical analysis shows that factors like hospital type, security measures, and reporting procedures account for almost all variations in violence outcomes. Individual characteristics such as gender, profession, and experience do not have an independent impact. Having formal reporting systems increases the actual reporting of incidents by nearly ten times. We also found that workers who are physically attacked face significant psychological issues, including heightened fear of work and dissatisfaction with their jobs. This suggests serious challenges for keeping workers in their roles. These findings indicate that structural problems, rather than individual weaknesses, are the main cause of workplace violence in healthcare settings in Pakistan. Policymakers should focus on creating mandatory reporting systems, investing in visible security measures, and offering psychological support to affected staff, especially in the public hospital sector, which is severely under-resourced.