Background The end-of-life framework to improve care efficiency has fuelled the desire to achieve high-quality care, where innovation and evaluation are central components of change. However, implementation of innovations remains challenging, with a lack of understanding regarding the role and attributes of policy champions in the innovation process.

Aim The aim of this study was to explore a local palliative cancer care physiotherapy service provision in the light of best practice recommendations.

Method A single qualitative case study design provided a framework to facilitate the inclusion of multiple perspectives in a complex context within an area of healthcare where little research has been undertaken. Multiple methods of data collection gained a variety of perspectives, which included four data sets: interviews (healthcare professionals [10]); interviews (service users [10]); observations (physiotherapists [2] treating service users [5]); and policy document collection (NICE guidelines; white papers [12]). This was combined with a practice development project, which used a concept analysis approach and improvement framework to enable best practice to be implemented. A thematic approach to data analysis was used within and across the four datasets.

Findings The research and practice development project combined to evidence the metamorphosis of both the physiotherapist profession and service provision where competencies around mentorship, entrepreneurship, leadership, policy championship, integrated teamwork, humanisation and self-reflection embodied within the psycho-social-cultural-spiritual model of healthcare enabled them to meet key policy recommendations of service quality and innovation.

Conclusion Physiotherapists responded to the changing palliative cancer care environment, through the metamorphosis of their service provision and by addressing two out of the three key policy recommendations i) service quality and ii) innovation but not iii) measurement of service quality and innovation. A debate is necessary around the need for profession specific or service specific outcomes in this area and how physiotherapists can ‘prove their worth.’