Growth and growth facilitation among SME’s and entrepreneurs have attracted attention from both academics and practitioners for decades. However, the existing literature of growth models tends to oversimplify the different stages, and the inherent determinism in these models does not reflect reality, where firms may have individual choices and not pre-destined evolutionary paths. In addition, firm performance is often seen as the outcome or success criteria in the majority of the SME and entrepreneurial management literature, where performance is primarily measured in innovation, financial performance, and growth. The objective of this paper and the research project behind has been to compensate for these shortcomings and to achieve application-oriented knowledge of what creates growth in SME’s small and medium enterprises and within a specific low growth region in Denmark. This paper aims at identifying and describing the key internal business processes that contribute to growth in a longitudinal study of eleven SME case companies located in a low-growth region. The findings of the study reveal seven key growth facilitating themes and activities, which are critical in active support of firm growth in a low-growth region. These findings are to be examined in a larger quantitative cross-national study.