The University of Iowa Hospitals and Clinics is a recognized leader in evidence-based practice. Creating organizational excellence in evidence-based practice takes leadership and a committed effort at all levels. Building the capacity, culture, and vision at the organizational and unit levels is needed to promote use of evidence in practice. Practical approaches that have been effective in promoting development of an evidence-based practice program and project are outlined. An exemplar describing development and adoption of an evidence-based project to improve sedation management led to improvements in patient care processes and outcomes.