Holding the Middle: Program Level Quality Intermediaries in Ontario Polytechnic Health Programs

Quality assurance in health professions education is often framed through policy, accreditation, and institutional systems, with less attention to how quality work is interpreted and enacted by program‑level leaders. This qualitative phenomenological study examined how program coordinators and program managers from one Ontario polytechnic health faculty perceived quality assurance processes, linked them to student success, and navigated implementation challenges in their day-to-day work. Semi-structured interviews were conducted with 10 coordinators and managers responsible for diploma, degree, and graduate certificate programs at that institution, and data were analyzed using Colaizzi-informed phenomenological interpretation and inductive thematic analysis. Participants described quality assurance as accountability and improvement when it informed curriculum sequencing, competency alignment, assessment redesign, and readiness for practice, rather than as a detached compliance exercise. Also, participants defined student success in multidimensional terms, including progression, graduation, licensure or certification outcomes, employment, and affective markers such as confidence, pride, and belonging, reflecting the polytechnic education’s mission. Participants reported role ambiguity, documentation burden, workload intensification, and structural constraints that contributed to quality assurance fatigue when systems emphasized documentation over learning. The findings position those who lead program-level quality work—whether titled program coordinator, program manager, or an equivalent mid-level academic role—as strategic quality intermediaries whose agency, relationships, and working conditions shape whether quality assurance functions as a driver of student-centred innovation and meaningful improvement or remains narrowly focused on meeting external requirements within similar contexts.