Background: Concussion-related guidelines appear to be inconsistently implemented in secondary schools in Aotearoa New Zealand. The purpose of this qualitative Participatory Action Research study was to describe key school stakeholders' perceptions of their current concussion management processes. Methods: Seventeen focus groups, two dyad, and nine individual interviews were conducted with stakeholders (n = 95) from six secondary schools and healthcare clinics, exploring their perceptions of barriers and facilitators to concussion management. We used thematic analysis to analyze data. Results: Our analysis identified five overarching and inter-relating themes: Hit or miss, the need for a clear pathway; the school context; aligning attitudes and enacting values; concussion knowledge and education; and complexity of concussion. The effectiveness of concussion management in secondary school settings is shaped by the dynamic interaction of these five themes. Implications for School Health Policy, Practice, and Equity: These findings highlight the need to develop a context-sensitive framework that can assist schools with real-world implementation of concussion management guidelines, for both sports and non-sports related concussions. Conclusions: The intent to support students was evident among most stakeholders yet appeared to be limited by lack of structured processes to follow, resources, unfavorable attitudes towards concussion management, and lack of knowledge.