IntroductionThe rapid expansion of higher education in sub-Saharan Africa, coupled with the adoption of quality assurance (QA) audit systems modelled on international frameworks, has created significant implementation challenges. While extensive research exists on QA audits in Western and Asian contexts, the African perspective-particularly how institutional leaders interpret and respond to audit pressures-remains underexplored.MethodsThis qualitative multiple-case study applies New Institutional Theory (NIT) to examine how senior leaders in four Ghanaian public universities perceive and respond to institutional audits. Semi-structured interviews were conducted with 20 university leaders (Vice-Chancellors, Registrars, QA Directors, Deans of Academic Affairs). Data were analyzed using hybrid thematic analysis incorporating both deductive coding (NIT concepts) and inductive coding (emergent themes).ResultsFindings reveal a legitimacy paradox wherein leaders balance external compliance demands with internal resource constraints that hinder authentic QA implementation. Leaders simultaneously understand audits as compliance instruments (coercive isomorphism), improvement tools (normative isomorphism), accountability mechanisms, and accreditation pathways. Persistent challenges including inadequate preparedness, inefficient data management, and communication failures produce decoupling-where formal audit structures are adopted but fail to integrate into everyday practice. Universities respond through mimetic strategies including decentralizing quality management, enhancing data systems, engaging in professional networks, and developing internal QA capacity.DiscussionThe study demonstrates that audit challenges reflect deeper institutional legitimacy issues rather than mere operational failures. Decoupling emerges not as organizational failure but as strategic management-a rational response to competing pressures in resource-constrained environments. By positioning Ghana as a critical case for examining isomorphism and decoupling, this research offers a transferable analytical model for understanding QA implementation in developing higher education systems. The findings hold significant implications for policymakers and institutional leaders seeking to align regulatory compliance with authentic quality culture.