Recovery‐oriented practice has become the dominant paradigm of practice in mental health services internationally. The exception is hospital‐based mental health services where the biomedical model continues to prevail, in this context defined by high acuity and safety concerns. This review aims to identify the approaches to, and feasibility of, implementing recovery‐oriented practice in hospital‐based mental health services. A systematic review of the literature (2010–2019) identified seventeen studies of recovery‐oriented practice implementation in hospital‐based mental health services. One study was excluded based on quality assessment. Of the remaining studies, seven reported on staff training initiatives, four reported service user programmes facilitated by staff, and five were implementations of models of care. The findings indicate that it is feasible, albeit challenging, to implement recovery‐oriented practice in hospital‐based mental health services. More successful approaches are multimodal, applied over several years and have organizational support. The main barriers to implementation include resistance to change from the embedded, biomedical model, staff attitudes towards recovery, and an absence of consumer involvement in the implementation of recovery‐oriented practice.