Purpose
The COVID-19 pandemic has reignited the debate on effective leadership during a crisis. The study examined healthcare leaders' experiences, challenges and responses amid the COVID-19 crisis in India and the USA.

Design/methodology/approach
Thematic analysis culminated in developing a thematic framework that encapsulates the behavior of operational healthcare leaders in India and the USA to illustrate how they responded to the global pandemic. Twelve hospital leadership experiences were collected through in-depth Interviews.

Findings
The study highlighted comparable experiences and leadership responses from the USA and India. Thematic framework induced from three themes and eight sub-themes to illustrate how leaders handled unknown challenges of the pandemic, which they countered with increased accountability as a leader, extended need-based networking with inevitable experience of self-role distance, leading to their pragmatic approach and reinforcement of self-belief.

Research limitations/implications
The study findings provide a way forward for revisiting existing crisis management frameworks and cross-cultural leadership theories in terms of behavioral aspects integration with the technical or operational aspects of crisis management.

Practical implications
Healthcare leaders aiming to rebuild hospital systems would benefit from the study by incorporating identified skills such as coping with emotional labor, self-role distance, perseverance, pragmatic approach, networking with extended stakeholders, and extra-role behaviors into training and mentoring programs.

Originality/value
Using a thematic analysis approach, the study’s two-country research design identified a homogeneous leadership response despite a distinct countrywide context.