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A system of evidence‐based periodic service review (PSR) was implemented in specialist health services for people with challenging behaviour, to support the adoption of a positive behavioural approach. The extent and accuracy of PSR implementation, its impact on staff knowledge and attitudes, and its value as a practice leadership tool were assessed. The results indicated that PSR was implemented regularly, scoring was based accurately on tangible evidence, and increased scores over time indicated service improvement in line with PSR principles. Staff generally welcomed PSR as a quality monitoring tool, and greater knowledge of the rationale and process for PSR was associated with more positive attitudes. Managers regarded PSR as a valuable aid to practice leadership and had used innovative implementation methods to maximise its acceptance by staff teams. The style of management and need for support from the wider organisational structure are discussed as critical factors in successful implementation.

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