Quality Improvement (QI) has become a central strategy for strengthening primary healthcare systems, particularly in low- and middle-income countries where gaps between clinical guidelines and routine practice persist. This study examined the Quality Improvement initiatives implemented in three primary healthcare facilities in Sunyani, Ghana Seventh Day Adventist Hospital, Rafchik Health Centre, and Nkrankrom Community-Based Health Planning and Services compound and explored how these initiatives influence healthcare providers’ adherence to quality guidelines and protocols. A qualitative case study design was employed, guided by an interpretivist paradigm. Semi-structured interviews were conducted with twenty-one healthcare providers purposively selected for their involvement in clinical care and Quality Improvement activities. Data were analysed thematically to identify recurring patterns and meanings. The findings show that Quality Improvement activities across the facilities were organised around four main initiatives: peer review, community engagement, participation in the SafeCare programme, and the routine use of patient satisfaction surveys and clinical protocols. These initiatives focused on improving patient care, infection prevention and control, preventive health services, and operational efficiency. Healthcare providers reported that Quality Improvement initiatives contributed to better patient outcomes, smoother workflows, increased staff motivation, and improved performance in external assessments. Providers demonstrated a high level of familiarity with quality guidelines and generally strong adherence to protocols. However, full compliance was sometimes constrained by resource shortages, emergency care pressures, and the technical complexity of certain procedures. Internal supervision, peer review processes, and external inspections were identified as critical mechanisms for monitoring practice and reinforcing accountability.