Small-scale enterprises (SSEs) are important for ensuring growth, innovation, job creation, in addition to social integration in working life. Research shows that SSEs pay little attention to and have insufficient competence in workplace health management. From the perspective of managers, this study explores how external factors influence the development of this management. The article refers to a case study between eight Norwegian and ten Swedish managers of SSEs in the middle part of Norway and Sweden. We used a stepwise qualitative approach to analyse data, using an interpretive indexing of main categories. Two main categories were found to have an influence on the development of workplace health- management: (1) Restricted leeway and (2) Commitments. Concerning the first main category, areas that managers highlight as important comprise the legal framework and regulations; workforce and market situation, production, finances; and occupational safety and health issues. Areas related to the second main category were advice from the board, guidance from mentors, work-related networks, and family and friends as buffers. One conclusion is that despite limited scope for developing workplace health anagement, managers find supportive guidance and inspiration from environments that are committed to helping them and their enterprise.