The objective of this chapter is to problematize the strategic management of both efficiency and effectiveness through quality management. First, the chapter describes five cases with lessons learned from the dichotomy of efficiency and effectiveness on how quality management could be turned into either a constructive or a destructive dilemma. Then, the history of the quality movement and how it has developed during the last century is discussed briefly. Quality management will be considered in relation to organization theory regarding exploration, exploitation, and dual organizational capabilities. Finally, the chapter concludes with proposals on ways forward for quality management as a strategy for both short-term efficiency and long-term effectiveness and survival.