This paper explores strategies for emergent quality improvement, which involve managing both efficiency and effectiveness, or the 'quality dilemma'. An empirical investigation is conducted with seventeen quality managers, representing organisations in ten private companies and one organisation in the public sector. The results indicate five distinct themes of importance to manage the quality dilemma: 1) leadership, 2) the quality organisation, 3) prioritisation, 4) knowledge and competence, and 5) the quality profession. While the dilemmas are categorised into five distinct and critical themes, the second part of the results present tactics regarding how to move positions towards emergent quality management: perspectives, processes, and decision support. The conclusions imply that the current method of organising quality improvement must be revised.