Priority setting and resource allocation are key management functions; however, there may be different understandings as to what makes for a high-performing organization in this area. To interpret how decision makers actually approach this question, our research looks at what might contribute to one's reputation as such. Two sets of qualitative data are used. Senior healthcare leaders were asked to nominate organizations which they considered high performers in priority setting and resource allocation and to justify their choices. This open-ended question was analyzed to identify themes. Rigorous process was most often cited. Six case studies were subsequently conducted; respondents were asked to comment upon why they thought their organization might be named by others as a high performer. These replies were analyzed qualitatively to identify prominent storylines: three distinctive narratives are summarized here. These help us to understand how organization leaders in particular contexts bring together stakeholders to pursue locally appropriate strategies for achieving contextually defined high performance.