Many authors on servant leadership (SL) claim that there exists a direct positive relationship between SL and organizational performance, but empirical evidence for this has thus far been lacking. There are indications, however, that introducing SL in an organization has a positive influence on mediating factors of performance, which in turn lead to better organizational performance. There is empirical evidence that applying the high-performance organization (HPO) framework does lead to increased organizational performance. As SL deals with behaviors and attitudes of managers, it is a reasonable assumption that SL has a certain influence on management quality, one of the factors of high performance included in the HPO framework.In this respect, one or more HPO factors might be mediating factors between SL and organizational performance. This article evaluates empirically the relation between SL, organizational performance, and the HPO framework. A theoretical proposition of these relations was made and, based on a sample of 116 managers and employees of Vrije Universiteit medical center, the levels of SL, HPO, and performance in Vrije Universiteit medical center were measured. This case study showed no evidence of a direct positive relation between SL and organizational performance. There was evidence of SL having an influence on the factors in the HPO framework but this influence was different on various organizational levels. It was concluded that the role of SL in the case organization was inconsistent.