Strong performance in both quality and finance is increasingly important for Critical Access Hospitals (CAHs). While previous research has identified structural characteristics of high-performing CAHs, less is known about the leadership and organizational strategies that support success across both domains. This brief presents findings from interviews with leaders at ten CAHs identified as high performers in both quality and financial metrics. Interview questions explored leadership practices, board engagement, strategic planning, and participation in value-based care programs. Responses highlighted several common themes, including active and visible leadership, a strong focus on patient and community needs, and clear internal communication. Board members were described as active contributors to hospital oversight, and many hospitals cited participation in Accountable Care Organizations (ACOs) and expansion of services as key strategies for improvement. These findings suggest that intentional leadership practices, combined with targeted external support, can help CAHs sustain strong performance in both quality and finance.