The aim of this paper is to explore the interconnected Six Sigma implementation and quality acceptance with business performance used using the modified Q × A= E formula and questionnaire survey method. The paper begins with a review of literature of Six Sigma and its key factors. The importance factors of Six Sigma being acceptance in the organization is also presented, followed by presentation of a theoretical framework is developed based on Q × A= E formula followed by an empirical application in a multinational enterprise in Taiwan. The results of Six Sigma implementation can achieve business performance, however, it need some improvement activities in order to find out what is significant to the organizations. Organization also need to consider the transformation of Six Sigma culture, integrated management system of Six Sigma for sustain able development.