More hospitals have been urged to consider using wardens to move smokers off their sites after a successful trial helped reduce numbers in one part of Scotland.
Following the introduction of enforcement staff in Glasgow, the number of smokers outside hospital entrances has halved.
Other health boards are beginning to take on their own staff, or train security workers to tackle those who ignore no-smoking signs.
Public health minister Michael Matheson has now urged other areas to consider bringing in wardens to help implement the smoke-free policy.
Under plans announced by the Scottish Government earlier this year, NHS boards will be required to implement and enforce smoke-free policies across their grounds by March 2015.
While many already have such policies, these are rarelyenforced.
Staff at Edinburgh Royal Infirmary have reportedly been warned that they face the sack if caught smoking on site.
Anecdotal evidence suggests staff have been verbally abused when asking smokers to move away from hospital entrances.
In the Glasgow pilot project, three wardens, who also handed out advice to smokers on how to quit, left within days of starting work because of the aggression they faced.
But despite this, those behind the project said it had been a success, with smoker numbers falling and levels of verbal abuse towards wardens reducing. Fiona Dunlop, of NHS Greater Glasgow and Clyde, said: “It is about a permanent culture change. The culture at the moment is that it is OK to smoke at hospital entrances.
“We were getting a lot of complaints from the public, staff and patients saying this is ridiculous – this is a health organisation and yet there are hordes of people smoking at the entrances.”
The trial, which has also included high-visibility posters and markings on the floor around hospital entrances, has been running for four months.
In February, staff counted the smokers outside hospitals during a one-hour period. This was repeated again in July, after wardens were brought in. Numbers dropped from 404 to 208.
Mr Matheson said: “Boards should consider all options for tackling smoking in their grounds, including the use of wardens, and share learning between boards.”
NHS Forth Valley said it was in the process of recruiting a “control officer” who will cover Forth Valley Royal Hospital in Larbert and three community hospitals, after signs askingpeople not to smoke “have been largely ignored”.
NHS Grampian said it had not employed wardens but was training security staff to implement the smoking policy, while NHS Lothian said it was currently considering wardens.
Sheila Duffy, chief executive of Action on Smoking and Health Scotland, welcomed the use of wardens by Glasgow.
She said: “We hope other NHS boards will have similar success.”