PurposeThis study aims to determine the influence of the role of hospital leaders, the COVID-19 budget and health service facilities at regional general hospitals (RSUDs) to Indonesia on hospital responses in overcoming the COVID-19 pandemic, moderated by hospital class level.Design/methodology/approachThis research was designed as quantitative research using partial least square-structural equation modeling (PLS-SEM) to test hypotheses.FindingsUsing a sample of 185 RSUDs, it was found that the role of hospital leaders, the COVID-19 budget and health service facilities in RSUDs had a positive and significant effect on the hospital's response to the COVID-19 pandemic. The findings show that the role of hospital leaders, in this case, the RSUD director, is essential in improving health services during the COVID-19 pandemic. The COVID-19 budget and health service facilities at RSUD can run effectively during the COVID-19 pandemic if the RSUD director issues appropriate policies during the COVID-19 pandemic crisis.Originality/valueThis study is the first to determine the influence of hospital leaders, the health budget for COVID-19 and hospital health service facilities simultaneously on the hospital's response to the COVID-19 pandemic. This study also provides empirical evidence regarding the idea of stewardship theory, which suggests the role of leaders in supervising organizations to achieve organizational goals effectively in times of crisis.