The Health Promoting Hospitals (HPH) initiative, as a setting approach, was launched by the World Health Organisation in 1988, and widespread expansion and development throughout the world ensued. This paper elaborates on and clarifies the concept of HPH and highlights the development of health-promoting settings in hospitals. This review also examines the enabling and hindering roles of organisational factors in reorienting hospitals towards health-promoting settings. This paper reaffirms the significance of organisational change in building capacity for health promotion during the development of HPH and notes that hospitals require systematic organisational support to fulfil their roles in promoting population health. Nevertheless, this review suggests that many of the identified barriers are related to insufficient organisational support. In particular, the low prioritisation of health promotion in hospital missions, shortages of resources, ineffective project management, lack of communication, poor coordination and integration and inappropriate job-person matches were six major reported barriers. Organisational capacity building for health promotion must be considered if hospitals are to adopt the HPH initiative.