Articles reviewing the characteristics of high-performing organizations will typically identify several organizations that have performed substantially better than others in terms of a clinical outcome, a process improvement measure, or patient satisfaction scores, and then identify certain characteristics shared by these organizations. As discussed in this commentary, this approach can be misleading in at least two important ways. First, one does not know which of these characteristics can also be found among poorly performing organizations. Second, and perhaps more concerning, this approach rewards risky strategies. A strategy that leads to some spectacular successes but to many more dismal failures will come across as worthy of widespread implementation. This commentary fleshes out these possibilities in greater detail and provides some interesting concrete examples.