We consider quadrature spatial modulation (QSM) schemes, which achieve high spectral efficiency (SE) via the dispersion of a relatively small number P of M -ary modulated symbols over a large number of combinations of nT transmit antennas and T transmit instances. In particular, we design a new space-time block code (STBC)-based scalable QSM scheme combining high SE with maximum diversity and optimum coding gains. Deriving a closed-form expression for the optimum SE, we show that scaling the size T with nT not only is required to achieve SE optimality, but also results in further gains in bit error rate (BER) performance. Building on the latter optimal parameterization, a fully optimized scalable QSM (OS-QSM) transmitter design is then obtained by introducing a new dispersion matrix index selection algorithm that ensures even utilization of spatial-temporal resources. Finally, a new greedy boxed iterative shrinkage thresholding algorithm (GB-ISTA) QSM receiver is proposed, which exploits the inherent sparsity of QSM signals and while detecting spatially and digitally modulated bits in a greedy fashion. The resulting low complexity of the new receiver, which is linear on nT , enables the utilization of OS-QSM in systems of previously prohibitive dimensions.