ObjectiveThere is an increased expectation that contemporary hospital design will improve clinical outcomes and patient experiences and support staff well-being. In response, this study examined innovative approaches in the design of in-patient palliative care facilities.MethodsAn ethnographic study comprised the identification and analysis of 30 architectural precedents, 24 qualitative, semistructured interviews with key stakeholders and 11 site visits, during which field notes and photographs were taken. Data were analysed using the framework approach, to identify design solutions that move beyond standard practice, to offer insight into the possibilities and challenges of processes of design or refurbishment in palliative care settings.ResultsThree thematic areas of focus were derived from the analysis: (1) planning solutions that support privacy plus connection; (2) enhancing comfort through the use of non-standard materials—and managing the risks associated with those and (3) shaking off tradition in hospital design.ConclusionsMyriad constraints resist innovation within the contemporary construction of hospital and hospice facilities. Drawing on a series of real-world examples, our findings point to the value of broad consultation and collaboration throughout the design process in achieving design solutions that go beyond standard practice for the benefit for patients, families and staff.