Over the last few decades, key account management (KAM) has become a widespread approach to creating value in strategic customer relationships. Research in KAM has often focused on the role of the key account manager, taking a customer interface perspective and adopting cross sectional methods. We contribute to the KAM body of knowledge by presenting a novel longitudinal study of the intraorganizational decisions and dilemmas faced by leaders when implementing KAM programs. Our findings demonstrate that deploying KAM involves the continual balancing and harmonization of strategic and operational practices. In particular, we show that KAM programs become embedded when firms create structural as well as individual support systems and when long-term aims can be reconciled with the need for short term deliverables.