The purpose of this qualitative descriptive study was to explore how hospital administrators and managers describe their understanding and practice of leadership during a prolonged public health crisis in the Southwestern United States. This study included 12 semi-structured interviews and two focus groups of four participants. In addition, this research utilized Wooten and James' (2008) model of leadership competencies in crisis as a guide in developing research questions, analyzing the findings, and as a foundation for the study. The two research questions were: How do hospital administrators and managers describe their understanding of leadership (1) and their practice of leadership (2) during a prolonged public health crisis? Using inductive thematic analysis, the researcher identified five themes from the research data regarding how hospital administrators and managers described their understanding and practice of leadership during COVID-19. The findings of this study indicate that leadership within the context of hospitals is a service to others (1) and highly relational (2). In addition, leadership presence was required to support their teams, leaders, and the community providing communication and education honestly and transparently (3). While hospital administrators and managers reflected on the emotional toll and the fatigue that the pandemic created for them as individuals and the teams they supported during that time, they also described the resultant leadership practice change focusing on wellbeing and self-care (4). Lastly, participants expressed the need for creativity and flexibility in their leadership and leadership practice (5). [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]