Thesis

67 Evaluation of MCD sessions Each team received one introductory session to meet their facilitators and be broadly informed about morality, dialogue, and moral dilemmas. Regulated and responsive research design Since MCD can be facilitated in different settings and with various conversation methods, we assumed a regulated setting would benefit our research design. To gain in-depth and comparable results, we chose the following regulations: set locations with teambased MCD sessions, one conversation method (the dilemma method, see Appendix 2; Stolper et al., 2016), and a fixed set of two facilitators per team. All teams strove for 10 MCD sessions within 12-18 months. Most facilitators were professionally trained by the MCD facilitator training program of the Department of Ethics, Law and Humanities of the Amsterdam UMC (Stolper et al., 2015). We combined the regulated design with a responsive research design. A key in the approach of responsive evaluations is the direct involvement of all stakeholders (Abma, 2005). The implementation of MCD benefits from the possibility of changing circumstances during the process (Weidema et al., 2016). Therefore, the evaluator should create conditions for interactions between stakeholders about possible improvements (Abma, 2005). We created local steering committees at each location, which consisted of members of participating teams, the management team, a coordinator from the Educational Institute, and two researchers. The aim was to facilitate and monitor the research and implementation of MCD; to make adjustments when necessary. With this aim to help improve the implementation, the researchers shared relevant findings based on mid-term interviews and quantitative data from evaluation forms. We intended to stimulate shared ownership: all involved are connected to make MCD successful (as individuals and as a group/team) (Hartman et al., 2016). The steering committees made 2 substantial mid-term changes: 1) to exclude 1 team from the project, based on their needs and explicit request for more general team meetings instead of MCD, and 2) to make some changes in the sets of facilitators for a better fit with the teams. Multiple peer meetings were organized for the facilitators to reflect upon and practice possible improvements in their role, e.g., to avoid using ethical jargon. Data collection Initially, this study included 2 locations; however, the Dutch Ministry of Justice and Security closed 1 during our research. We started a new MCD series at a third location in 2019. Thus, 16 selected teams at 3 locations participated in 148 MCD sessions between September 2017 and February 2020. Overall, our data collection took place until September 2020. We used our single-MCD-evaluation forms immediately after single 3

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