The ‘care factor’ is seldom accounted for when recruiting, employing and retaining health care professionals.

One hot evening after picking oranges in a friend’s orchard we went to the only eating place open in the small country town to be greeted by a waitress who told us that the cook hadn’t shown up. When we said how tired and hungry we were she promptly replied in a sing-song voice reminiscent of a school yard snicker: “There’s a care factor!” and held up her right hand with index finger and thumb joined to indicate a big fat 0.

This incident stuck with me and over the years has been my personal joke when faced with poor service. It wasn’t until I was recently hospitalised that it stopped being a joke.

An astounding number of people are employed in health care in Australia. The 2006 Census reveals nationwide 35,452 medical practitioners, 9071 dental practitioners and 219,788 nurses. There are also many other health care professionals: physiotherapists, occupational therapists, dieticians and so forth.

How then do we account for the care factor of health care people? Can we place a dollar value on it? Is it included in job advertisements? Do we consider it when writing job descriptions? How is it included in selection criteria or interview questions?

In a 2011 article titled ‘Measuring caring: the next frontier in understanding workforce performance and patient outcomes’, the author JW Nelson writes “caring likely has a return on investment that surpasses all other.” If there is merit in that perspective, then you might think HR professionals would be interested.

An overview of the research shows caring is difficult to define and measure. The main issue for researchers is the incorporation of the word ‘care’ in the phrase ‘health care’. You can be involved in health care without really ‘caring’ in the sense of the word when it connotes concern or solicitude. A further issue for HR professionals is that literature specifically dealing with how to capture caring in HR practice cannot readily be found.

There is hard evidence that the need for caring impacts health outcomes. One set of researchers found that “… patients experienced themselves as an ‘indivisible unit’ that contained … caring needs where human desire for life and love and meaningfulness may express itself as bodily, physically and existential/spiritual needs”. Put more simply, holistic caring takes into account the whole person and all his or her needs. Care for one component of a person at the neglect of other components will eventually lead to dysfunction.

Different disciplines focus on different aspects of caring. Social psychology, for example, has researched personality traits, such as extraversion, emotional stability, agreeableness, conscientiousness and openness to experience. It examines how personality traits link with job performance (contentiousness, for example, showed “consistent relationship with all job performance criteria for all occupations”) or factors such as attrition and retention (extraverted nurses were found to “require more work-related peer support than did introverts to avoid emotional exhaustion”). They say little about a composite concept such as caring. Tools, such as personality questionnaires and life-review interviews, are much more the domain of social psychology than HR.

Nursing research has looked at capturing individual components of caring (empathy, altruism and nurturing, for example). It seems that nursing has gone a very long way towards a reliable and valid definition of the holistic notion but the focus has not been to translate that into HR practice.

Management theorists and sociologists find caring can be influenced by situations. One person may find it easy to be caring in one situation whereas in another situation the caring is impeded.

Some education institutions purport to teach and measure caring. They do, however, admit as one researcher put it that “evaluation of caring competencies is not well developed”.

When caring is one component of multiple performance measures, the validity of selection tests for predicting complex performance criteria decreases. What are HR professionals to do with many different measurements?

We could consider the measurement of caring as a three-way process, which uses different tools: employer assessment (as would happen in performance reviews, selection criteria or job interviews), patient–client assessment (as would happen in quality and risk assessments, which may influence recruitment and retention decisions) and self assessments (as would happen in performance reviews or for professional development).

If “measuring caring is the next frontier in understanding workforce performance and patient outcomes”, it makes no sense to continue to ignore the matter. Should the final question be: “Will HR competencies in this dimension of human behaviour be measured when HR practitioners are involved in the business of hiring health care professionals?”