Palliative care is a complex environment in which teams of health care professionals are constantly challenged to match the configuration of care delivery to suit the dynamics of the whole of a patient’s bio-medical, social and spiritual situations as they change during the end of life process. In such an environment these teams need to engage in ongoing interaction between different professional disciplines, incremental improvement in care delivery, learning and radical innovation. This is aimed at combining operational effectiveness and strategic flexibility, exploitation and exploration in a way that ensures the best possible end of life experience for the patient. This paper examines previous research on the management competences and the organisational capabilities necessary for continuous innovation, and analyses evidence emerging from a study of palliative care. Work on the relationships between innovation capacities, organisational capabilities and team-based competence is drawn together. Evidence is presented from research into the management of innovation in palliative care.