Thesis

170 Chapter 7 locations, high work pressure, and strong influences of protocols and hierarchy). In general, quantitatively measuring the impact of a complex intervention, such as MCD, is considered to be very difficult (Schildmann et al., 2019). It proved valuable that our mixed methods design includes qualitatively measured outcomes as perceived by participants after MCD (see Ch.6). This explorative research attempted to provide a starting point for new developments in impact measurement. In this context a Delphi study on the concept of moral craftsmanship and more field-testing and validating our MCSQ would be worthwhile (see Recommendations). Part C Chapter 6 showed many different experienced outcomes by MCD participants and it showed that MCD holds value for prison staff. Experienced outcomes of MCD Our study in Chapter 6 demonstrated that overall prison staff experienced various positive outcomes after the MCD sessions. Parts of our results confirm what was known from current MCD studies with health care professionals, for example, that MCD increases participants’ insight into the discussed cases and a better understanding of colleagues’ perspectives (De Snoo-Trimp et al., 2020; Haan et al., 2018; Hem et al., 2015; Svantesson et al., 2014; Weidema et al., 2013). In addition, Chapter 6 explains that MCD can stimulate a moral learning process of staff. Van Houwelingen et al. (2015, p. 46) stated in their report on Dutch prison staff that moral awareness is the first step in such a learning process. Our study shows that MCD did indeed lead to moral awareness. Furthermore, the MCD studies of Haan et al. (2018) and Van der Dam et al. (2011) indicate that MCD increases feelings of relief and confidence. Our study brings new insights into how participants mentioned to have gained more control over their emotions and improved their self-awareness and self-control. MCD empowered prison staff in that they state to (sooner) address issues and ask questions about what they perceive as unacceptable behavior from others. Moreover, we noticed that MCD participants became aware of their responsibilities and limitations and build on their courage to speak up. The increased awareness of staff’s professional limitations, for example, regarding their level of influence within the organization, emerged strongly in our study.

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