130 Chapter 5 such as MCD with the existing research instruments (Svantesson et al., 2014). By contrast, analyses of various qualitative studies, also conducted in health care, have shown that MCD leads to positive results (Haan et al., 2018; Hem et al., 2015). Because of the different contexts and cultures within Dutch health care and prisons, results of ethics support interventions in health care cannot be extrapolated to the prison setting. The quantitative analyses of our impact study in the prison context of DCIA showed a positive development in some elements of MCS following the series of MCD sessions. The intervention group scored significantly higher on 7 items after participating in MCD. Most of the significant changes found were interpreted as being positive for MCS. There was a large number of items that had not (statistically significantly) changed at postmeasurement. We initially had expected more impact after the intervention of MCD. We will mention some possible explanations for why items did not change. First, in current literature, the concept of MCS is not yet clearly defined and instrumentalized. Therefore, this research has to show whether the used items “catch” the concept of MCS. Despite the existence of questionnaires that measure the outcomes of MCD, there was not yet a questionnaire that looks specifically at the impact on MCS. The innovative questionnaire developed for this study is not yet validated. Further investigation is needed in order to be able to effectively measure the impact of an ESS intervention. Furthermore, it was the first time a series of MCD sessions took place at these prison locations. It was the first time, and therefore unusual for Dutch prison staff, that they looked at their own work in this way. For large parts of the staff (in particular security guards, correctional officers, office staff re-integration services and labour instructors) the work is characterized by routines, regulations and protocols, in addition to a clear hierarchy (Van Houwelingen et al., 2015). On top of that, Dutch prison staff experienced high work pressure at the time of the study (FNV Overheid, 2017). These organizational circumstances probably made achieving a positive impact onMCS particularly challenging. Not finding quantitative changes does not necessarily mean that there are no positive changes in practice after MCD. Many qualitative studies show positive impact of MCD (Haan et al., 2018; Hem et al., 2015; Janssens et al., 2015). Yet, quantitative research in the context of health care has yet to detect impact of MCD. More in general, international evaluation and impact research has shown that quantitative mapping of changes after