This book is discussing journey of understanding need of SMEs & development of new integrated concept for improving their performance. While doing consultancy work for SMEs in India, I could closely observe that, SME owners are worried about whether their unit performance is improved or otherwise after the implementations of ISO-QMS. Hence, it becomes essential for me to know the effect of ISO-QMS implementation on performance of SMEs. With this view, the problem of SME is selected for the research study & reported in this book. Experience survey method is used to understand the status of different aspects of ISO implementation in SMEs. This survey revealed that; ISO-QMS implementation could only assure the performance change only marginal level. Therefore, a need of developing a new concept, which can make use of existing ISO based company’s QMS for improving performance is sensed and ‘Integrated ISO-QMS + Six Sigma concept' is developed. Validation of this concept for its applicability is done using case studies & accordingly recommendations are made.