Barriers to and facilitators of the implementation of health promoting hospitals in Taiwan: a top- down movement in need of ground support Chiachi Bonnie Lee 1 *, Michael S. Chen 2 and Ying Wei Wang 3 1 Center for General Education, National Chung Cheng University, Chiayi County, Taiwan 2 Department of Social Welfare, National Chung Cheng University, Chiayi County, Taiwan 3 Department of Medical Humanities, Tzu Chi University, Hualien County, Taiwan SUMMARY This study investigates barriers to and facilitators of health promoting hospitals (HPH) in Taiwan. The findings are based on a cross-sectional questionnaire survey involving 55 hospitals commit- ted to health promotion (HP) as of the end of 2009, and 52 of them completed the questionnaire. The five most reported barriers are inadequate national health insurance coverage of HP, staff detachment, incoherence of government policies, weak inter-sectoral link and resistance to change. The five most reported facilitators are support from hospital superintendents, support from unit/department directors, HP-inclusive hospital development mission and goals, funding from the government, founding of HP-related committees, resources and healthy policies. The study also found that organizational capacity building (OCB) had a significantly negative association with the number of barriers and a positive association with the number of facilitators. Stepwise linear regressions further found that OCB in structure was a significant predictor of the fewer number of barriers and that in-staff participation was a significant predictor of the more perceived facilitators. It also confirmed the significant role of organizational capacity building and that of coordinators in the effective implementation of HPH. The transformational factors as well as transactional factors are very much at work as facilitators, but the transactional factors are trapped in a less-than-friendly environment. Comprehensive support from transformational factors as well as transactional factors is essential and further support for daily routine operations and staff participation are required to sustain the implementation of HPH in Taiwan. Copyright © 2012 John Wiley & Sons, Ltd. KEY WORDS: capacity building; health promoting hospitals; Taiwan INTRODUCTION Taiwan’s experience in implementing health promoting hospitals (HPH) may enrich that of other nations for its somewhat particular yet comparable context. The hospital, in a health system with a referral scheme that is more nominal than real, is endowed *Correspondence to: Chiachi Bonnie Lee, Center for General Education, National Chung Cheng University, 168 University Road, Minhsiung Township, Chiayi County 62102, Taiwan. E-mail: bonnie1012@ mail2000.com.tw Copyright © 2012 John Wiley & Sons, Ltd. THE INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT Int J Health Plann Mgmt 2014; 29: 197–213. Published online 10 December 2012 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/hpm.2156