A Framework of Knowledge Creation Processes in Participatory Simulation of Hospital Work SystemsParticipatory simulation (PS) is a method to involve workers in simulating and designing their own future work system. Existing PS studies have focused on analysing the outcome, and minimal attention has been devoted to the process of creating this outcome. In order to study this process, we suggest applying a knowledge creation perspective. The aim of this study was to develop a framework describing the process of how ergonomics knowledge is created in PS. Video recordings from three projects applying PS of hospital work systems constituted the foundation of process mining analysis. The analysis resulted in a framework revealing the sources of ergonomics knowledge creation as sequential relationships between the activities of simulation participants sharing work experiences; experimenting with scenarios; and reflecting on ergonomics consequences. We argue that this framework reveals the hidden steps of PS that are essential when planning and facilitating PS that aims at designing work systems.Keywords: participative ergonomics; health care ergonomics; process mining; knowledge creation; work systems Practitioner summary: When facilitating participatory simulation (PS) in work system design, achieving an understanding of the PS process is essential. By applying a knowledge creation perspective and process mining, we investigated the knowledge creating activities constituting the PS process. The analysis resulted in a framework of the knowledge creating process in PS.