This article analyzes tobacco control policies in hospitals based on the experience of the Catalan Network of Smoke-Free Hospitals, Spain. The objective is to understand through this case study how tobacco policies are designed and implemented in health care organizations. Because tobacco control is a public health issue, governmental, institutional, and professional involvement is necessary. This article identifies and examines the structure and relationships among the different actors involved in the tobacco control policies in health care organizations using Ostrom's Institutional Analysis and Development framework.This theory helps one understand the policy failures and rethink the future challenges. Critical issues should be reviewed to enhance implementation of smoke-free hospitals-such as assuring the compliance of nonsmoking areas and introducing compulsory tobacco cessation activities that are promoted and monitored by the public administration. The author suggests that relying primarily on an organization's interpretation of rules leads to irregular implementation.