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There have been calls for formal quality standards to reduce a so-called \u201cpostcode lottery\u201d of care. The original aim of this study\u2014to examine the nature of quality in long covid care and reduce unwarranted variation in services\u2014evolved to focus on examining the reasons why standardizing care was so challenging in this condition.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In 2021\u20132023, we ran a quality improvement collaborative across 10 UK sites. The dataset reported here was mostly but not entirely qualitative. It included data on the origins and current context of each clinic, interviews with staff and patients, and ethnographic observations at 13 clinics (50 consultations) and 45 multidisciplinary team (MDT) meetings (244 patient cases). Data collection and analysis were informed by relevant lenses from clinical care (e.g. evidence-based guidelines), improvement science (e.g. quality improvement cycles) and philosophy of knowledge.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Participating clinics made progress towards standardizing assessment and management in some topics; some variation remained but this could usually be explained. Clinics had different histories and path dependencies, occupied a different place in their healthcare ecosystem and served a varied caseload including a high proportion of patients with comorbidities. A key mechanism for achieving high-quality long covid care was when local MDTs deliberated on unusual, complex or challenging cases for which evidence-based guidelines provided no easy answers. In such cases, collective learning occurred through <jats:italic>idiographic (case-based) reasoning<\/jats:italic>, in which practitioners build lessons from the particular to the general. This contrasts with the <jats:italic>nomothetic reasoning<\/jats:italic> implicit in evidence-based guidelines, in which reasoning is assumed to go from the general (e.g. findings of clinical trials) to the particular (management of individual patients).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Not all variation in long covid services is unwarranted. Largely because long covid\u2019s manifestations are so varied and comorbidities common, generic \u201cevidence-based\u201d standards require much individual adaptation. In this complex condition, quality improvement resources may be productively spent supporting MDTs to optimise their case-based learning through interdisciplinary discussion. Quality assessment of a long covid service should include review of a sample of individual cases to assess how guidelines have been interpreted and personalized to meet patients\u2019 unique needs.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Study registration<\/jats:title>\n                <jats:p>NCT05057260, ISRCTN15022307.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12916-024-03371-6","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T00:02:05Z","timestamp":1713139325000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["What is quality in long covid care? 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If they consented, the researcher was then invited to sit in. A written record was made in field notes of this verbal consent. It was impractical to seek consent from patients whose cases were discussed (usually with very brief clinical details) in online MDTs. Therefore, clinical case examples from MDTs presented in the paper are fictionalized cases constructed from multiple real cases and with key clinical details changed (for example, comorbidities were replaced with different conditions which would produce similar symptoms). All fictionalized cases were checked by our patient advisory group to check that they were plausible to lived experience experts.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"No direct patient cases are reported in this manuscript. 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