Purpose: The health service response to COVID-19 provided a unique opportunity to build our understanding of the leadership styles in use in managing a crisis event. Existing literature emphasises command and control leadership; however, there has been less emphasis on relational approaches and the behaviours necessary to ensure the agility of the response and minimise the risk of relational disturbances. The purpose of this paper is to understand leadership styles in use, as part of a health service response to COVID-19., Design/methodology/approach: This paper draws on data from semi-structured interviews with 27 executives and senior leaders from a tertiary health service in Australia. The data were analysed using thematic analysis. Notes and examples were coded according to deductively derived criteria around leadership styles and competencies from the literature, while remaining open to emergent themes., Findings: Health system leaders described examples of both command and control and relational leadership behaviours. This dually provided the discipline (command and control) and agility (relational) required of the crisis response. While some leaders experienced discomfort in enacting these dual behaviours, this discomfort related to discordance with leadership preferences rather than conflict between the styles. Both leadership approaches were considered necessary to effectively manage the health system response., Originality/value: Crisis management literature has typically focused on defining and measuring the effectiveness of behaviours reflective of a command and control leadership response. Very few studies have considered the relational aspects of crisis management, nor the dual approaches of command and control, and relational leadership., (© Emerald Publishing Limited.)