Institutions and institutional change are mentioned often but rarely specified in discussions of climate adaptation. Policy change is proposed, but the detail of policy processes less often discussed. Adaptation to increased climate change and variability will require policy interventions to change behaviors across multiple sectors, requiring policy processes constrained or enabled by institutional settings. Detailed discussion of how to redesign policy processes and institutions are especially rare at the crucial jurisdictional scales of national and sub-national policy and planning. We review coverage of policy and institutions in the adaptation literature and clarify key issues by drawing on the domains of public policy, institutional change, and sustainable development. The distinction between, but close dependencies among, institutions, institutional systems, organizations, policy processes, policy instruments, and management are emphasized. We propose that the climate policy literature has rapidly become large enough that a tendency of self-referencing has developed, and that insights can be gained from other areas. Within existing parameters of law, politics, and governance, options are identified that could embed considerations of climate adaptation into policy processes and institutional systems, with focus on enabling cross-sectoral policy integration ('mainstreaming'), decision making under conditions of uncertainty, vertical ('cross-scale') policy coordination, issues of capacity and devolution, and policy evaluation and learning. The value of seeking lessons from past policy interventions and from cognate policy sectors is explored .