School heads or principals have various roles in developing school quality, which can often be stressful. In this study we investigated principals' perceptions of quality schools, the practices performed to improve quality, and the stress and support factors involved. We adopted a qualitative inductive content analysis approach to analyse the transcribed data collected from 14 principals of senior high schools in the Volta region of Ghana. The findings show that principals perceive quality schools as having high academic performance, quality teachers, and adequate resources coordinated in a well-organised system. Furthermore, the results reveal practices that principals perform to improve school quality, such as promoting staff professional development, supporting students' intellectual and skills development, supervising teachers, and providing resources. On the other hand, supervision, non-cooperation of some teachers, inadequate resources, and administrative bureaucracy were revealed as causes of stress in improving school quality. Facing these challenges, the principals relied on their academic qualifications and experiences when engaging in practices to improve school quality. We recommend further research on the possibility of principals using technology to monitor the presence of teachers in classrooms from their offices.