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Background: Hospitals are a work environment with a high risk of occupational accidents and occupational diseases, including infections. The implementation of the Occupational Health and Safety Management System (OHSMS) is crucial to mitigate this risk. However, the effectiveness of SMK3 implementation in Type B hospitals in Aceh, Indonesia, still faces various challenges that require in-depth evaluation. Objective: This study aims to evaluate the factors that affect the successful implementation of SMK3 in Type B hospitals in Aceh. The factors analyzed included policies, planning, implementation practices, monitoring and evaluation, and performance improvement. Methods: This study used a descriptive quantitative design with an evaluative approach. The study sample was the entire population (census) of 9 Type B hospitals in Aceh, with 356 respondents consisting of safety managers, section heads, and related staff. Data collection was carried out through structured questionnaires, interviews, and observations. Data analysis was conducted using Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS 3.0 software. Results: The results of the analysis showed that policies (t=3.49), implementation practices (t=2.10), monitoring and evaluation (t=4.00), and performance improvement (t=2.39) had a positive and significant influence on the success of SMK3 implementation. Planning factors showed no significant effect (t=1.95; p=0.052). The research model showed high predictive power (R² = 0.88). Conclusion: The successful implementation of SMK3 in Type B hospitals does not depend only on written policies, but is significantly influenced by implementation practices in the field, a strong monitoring and evaluation system, and a commitment to continuous performance improvement. Reinforcement on these aspects is essential to create a safe and healthy work environment.