174 Chapter 9 When completing the questionnaire at T0, prior to participating in the MCD sessions, almost all respondents rated improvement in the areas of ‘open communication among co-workers’ and ‘mutual understanding of reasoning and behaviour’ as ‘important’ or ‘very important’. When they completed the questionnaire at T1, most participants reported having experienced more open communication and mutual understanding during the MCD sessions. Furthermore, most team members experienced an improvement in ‘becoming aware of recurring, ethically difficult situations’ both during the MCD sessions and in their daily work after these sessions. The results from T0 showed that respondents rated the MCD-related outcomes ‘to enhance my own understanding of ethical theories’ and ‘to manage stress related to the cases better’ as ‘not important’ or ‘somewhat important’. In line with these results, the respondents reported at T1 that they had either not experienced these two outcomes, or only experienced them to some extent, during the MCD sessions and afterward in their daily work. A large majority of respondents initially rated an improvement in ‘enabling team members to decide on concrete actions in order to manage ethically difficult situations’ as ‘important’ or ‘very important’. At T1, however, most respondents reported that they had not experienced this outcome in their daily work subsequent to the MCD sessions, or only to some extent. Most participants experienced an increase in mutual respect among team members in their daily work after the sessions. During the individual interviews and focus groups, several participants mentioned that participating in an MCD session enhanced mutual trust on the team. They attributed this to having learned more about the thinking behind their colleagues’ actions at work because the MCD sessions encouraged individuals to express their own opinions rather than team opinions. Furthermore, the results of the Euro-MCD questionnaire revealed that the majority of clinicians experienced an ‘enhancement in mutual respect among the team members’ after participating in the MCD sessions, and that they ‘became more aware of the stakeholders’ different perspectives’ and of ‘recurring, ethically difficult situations’. “I think that moral case deliberation is a very good way of bringing about greater mutual trust. You usually get closer […] during moral case deliberation sessions there are no team opinions, but all individual opinions, that strengthens your sense of connection.” - Focus group with clinicians Some participants stated that mutual trust is especially crucial in transgender care because several treatment steps are deeply interwoven, requiring close cooperation between the various disciplines involved in the transgender care trajectory.