This case study describes the implementation of a ward-based respiratory care unit to improve access to specialised respiratory failure management at an Australian metropolitan health service. Using a case study approach, we describe the conception, development and implementation of a respiratory care unit within a previously inexperienced ward. Key barriers and facilitators are explored and the importance of a safety culture and an aspiration for continuous quality improvement are detailed. Three key aspects of implementation were identified: physical environment, expertise and governance. Continuous review of clinical and quality data was also considered critical to success. Stakeholder engagement was identified as both a barrier and facilitator to successful implementation. Early success was demonstrated through increased utilisation of respiratory interventions but with less utilisation of the intensive care unit and no apparent deterioration in clinical outcomes. Successful implementation of ward-based management of respiratory failure can be undertaken within non-tertiary settings but requires a comprehensive plan. Essential aspects include the support of clinical champions, early and continuous stakeholder engagement and an aspirational culture of safety and continuous quality improvement. What is known about the topic? Non-invasive ventilation and high-flow oxygen therapy are now established as key treatments in the management of acute respiratory failure. Access to these treatments is often limited to critical care locations (emergency department, intensive care unit (ICU) and operating theatre), but ward-based use can be safe and effective when applied with appropriate clinical policies, expertise and staffing. What does this paper add? This report describes the successful and rapid development of a specialised respiratory care unit within an inexperienced ward at an Australian metropolitan health service. Prior to development of the unit, the health service only provided non-invasive ventilation and high-flow oxygen therapy within critical care locations. Successful implementation was associated with increased utilisation of these therapies with significantly less ICU utilisation and no apparent deterioration in outcomes. What are the implications for practitioners? An explanation of a model for implementation is provided that may help health services improve access to complex respiratory failure management outside of critical care locations. Key factors in the success of the model are identified and examined.