The success of quality assurance initiatives in online education is dependent on the successful implementation of the processes, resources, and tools created to ensure quality. There is scant research, however, on the factors that most enable quality assurance implementation at higher education institutions. This research examined a specific population of institutions who were assessed as engaging in high levels of online course quality assurance efforts, as measured by their activity level of using the Quality Matters (QM) framework. The specific people, policies, and processes that enabled and supported institutional course design quality assurance are examined using a mixed-methods approach. Forty-three implementation coordinators from high-activity institutions completed a survey on institutional quality assurance efforts specific to course design and development. Seventeen of those coordinators also engaged in an individual interview to provide greater depth and insight into the institutional journey of quality assurance implementation for online course quality. Key takeaways showed an impact for focused, institutionally-supported goals for course design; choosing an experienced person who was passionate about quality assurance as the implementation lead; and utilizing an inclusive, flexible, collaborative implementation approach, rather than a top-down approach or mandates. The respondents also indicated that adapting the implementation to the institutional context was a key success factor, as was focusing on creating buy-in and shared goals for quality learning as a pathway toward creating an institutional culture shift.