Purpose: The purpose of this paper is to describe the perception of real teamwork and sustainable quality culture as well as success factors for achieving a sustainable quality culture within an organisation, focusing on top management teams (TMTs). An additional purpose is to explore the relationship between real teamwork and sustainable quality culture. Design/methodology/approach: A mixed-methods design focusing on TMTs was used. Four TMTs were open-sampled and located in different parts of Sweden. The data were collected through questionnaires and focus group discussions between April 2022 and December 2022. Follow-up meetings were thereafter held with the participants. A meta-analysis was conducted of the data from the four TMTs. Findings: Two overarching conclusions of this study were: to follow the developed methodology can be one way to increase TMTs' abilities for real teamwork alongside a sustainable quality culture, and the results also showed the importance of a systems view, emotional commitment and continuous improvement for improving real teamwork and creating a sustainable quality culture. Practical implications: Practical implications were suggestions on how to increase the TMTs' abilities for real teamwork alongside a sustainable quality culture. A deepened understanding of real teamwork and a sustainable quality culture was also achieved by the participants. Originality/value: The novelty of this paper is the use of a new methodology for assessing teamwork and sustainable quality culture. To the authors' knowledge, no similar research has previously been performed to investigate teamwork alongside a sustainable quality culture, focusing on TMTs.