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Chapter 6168DiscussionThis study examined modifications to the MDET method that care organisations made during the implementation process and tested whether these modified versions were effective in reducing involuntary care in intellectual disability care. As expected, all four participating organisations adapted MDET to their specific contexts. Adaptations varied in scale, ranging from minor adjustments such as reducing the number of participants in meetings aimed at consensus building on involuntary care, to major modifications, such as decreased attention to monitoring the recordings of involuntary care. Two care organisations did not appoint an independent MDET expert-team, which was a major adaptation. In these organisations the method was executed by process-supervisors or care professionals already involved in the care home. The reasons for adapting MDET often concerned feasibility and resources, such as time- and personnel restraints during the COVID-19 pandemic. Also, some organisations mentioned that not all phases of the MDET were executed due to time constraints. Care homes that implemented MDET in the four organisations did not significantly differ in the number of weekly recorded involuntary care over time, compared to care homes providing care as usual. A possible explanation for the difference in the effectiveness of the MDET method between the study by Schippers (2019) and the current study could be that the previous study was highly controlled by the researcher, which resulted in low plasticity of the MDET method which ensured fidelity to the protocol. Moreover, the researcher made sure that the organisation was supported to change their work routines to fit in MDET, which resulted in a high elasticity of the organisation (May et al., 2016). In the current study, the four organisations had the freedom to adapt MDET to their needs (high plasticity) which could have been detrimental to the method%u2019s fidelity (Moore et al., 2015). Moreover, when organisation are free to adapt methods, this may result in less need for organisations to adjust routines and work structures that are needed to implement new methods. While adapting methods could sometimes be beneficial in implementation processes (Chambers & Norton, 2016), actual changes in clinical outcomes may require sustained changes in organisational structures, daily practices and routines (Nilsen et al., 2012).