Purpose – Small-scale enterprises are important for sustainable development in Europe and account for a significant proportion of private enterprises and their large contribution to employment. The overall research aim of the study is to explore workplace health management from the perspective of managers in small-scale enterprises (SSEs) in Norway and Sweden. Methodology – In-depth interviews with 18 managers in SSEs were conducted and a stepwise qualitative analysis was used. Findings – The findings are presented as two main patterns 1) Interorganisational dynamics and 2) Participative leadership. Managers iscussed opportunities for workplace health management to foster solidarity and flexibility in the workplace, the potential of employees for self-governance, and a cultural environment at the workplace characterized by safety, trust, care, loyalty and humour. The managers employed a process-oriented communicator style, were all-rounders, and demonstrated dedicated and distinct management. Managers in small-scale enterprises were lonely problem-solvers and experienced high and conflicting work demands and work-family conflicts. Research limitations – The findings should be interpreted with caution concerning representation of small-scale enterprises generally. The enterprises were recruited from an development project focusing on workplace health management and might therefore have a positive attitude. Originality – This study adds important knowledge regarding the preconditions for creating health-promoting workplaces in SSEs, an area for which limited research exists. The findings provide insights and knowledge about managers’ possibilities and obstacles in workplace health management. The findings could be transferrable to management in similar contexts if managers develop more awareness and knowledge. Practical implications – The managers obtain recommended information about what to do and how to address workplace health management in SSEs.