Leaders in perioperative and interventional procedure areas need to be able to initiate and sustain change to improve operational processes in their departments or service lines. Although available literature discusses change in health care organizations, there is a lack of published articles on the implementation and sustainment of change. This article provides a review of supporting literature on change management and an infrastructure model that we have successfully implemented to sustain change. An organizational case study focused on creating sustained improvements for first procedure on‐time starts and turnover times details the process of creating the accountability system for actualizing the performance targets in a perioperative environment. The case study examines the existing process and initial challenges with creating sustainable and quantifiable outcomes, describes the process of implementing the infrastructure discussed in the article, and evaluates the results. Perioperative leaders can use the information to improve processes in their work environments.