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 committed 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.