Making empathy measurable: New tool turns empathy from “nice-to-have” trait into a core competency in patient care

A multi-institutional research team* led by GERI and Khoo Teck Puat Hospital have developed and validated a new tool called the Multidimensional Clinical Empathy Scale (M-CES). Unlike existing measurement scales, the M-CES assesses both cognitive and affective empathy in healthcare professionals.

Locally validated among nearly 1,000 doctors, nurses and students, and across healthcare settings in Singapore, the tool can provide domain-specific results that can be used to refine development programmes for healthcare professionals, tailoring their training towards fostering more empathetic patient-provider relationships.

We speak to the core project team about the importance of measuring clinical empathy across the full spectrum, co-creating the M-CES with target end-users, and their plans for bringing the tool into healthcare education and practice.

^{*with collaborators from the Lee Kuan Yew School of Public Policy, Lee Kong Chian School of Medicine at Nanyang Technological University, Nanyang Polytechnic, the Alice Lee Centre for Nursing Studies at the National University of Singapore, Ngee Ann Polytechnic and Tan Tock Seng Hospital.}

GERI: Why is it important to make empathy a core, measurable competency?

Dr Laurence Tan (Principal Investigator and Senior Consultant, Geriatric Medicine, Khoo Teck Puat Hospital (KTPH) and Yishun Community Hospital (YCH)): Empathy has long been recognised as fundamental to quality healthcare, but without measurement, it remains an abstract ideal rather than a tangible skill we can develop and improve. Our research shows that clinical empathy directly impacts patient outcomes, satisfaction, and healthcare professional well-being. By making empathy measurable, we transform it from a “nice-to-have” soft skill into a core clinical competency that can be systematically taught, assessed and enhanced.

The multidimensional nature of empathy – encompassing cognitive, affective and behavioural components – means that different healthcare professionals may excel in different domains. A measurable framework allows for personalised development.

Moreover, measurement enables accountability and quality improvement. Just as we measure clinical indicators, measuring empathy ensures it remains central to healthcare delivery rather than being overlooked under operational pressures.

— Dr Laurence Tan, Principal Investigator

Why do you think empathy matters in healthcare?

Associate Professor James Alvin Low (Lead Scientist & Member, Research Management Committee, GERI and Senior Consultant, Geriatric Medicine and Palliative Care, KTPH and YCH): Empathy should be a natural response or reaction to pain and suffering seen in our fellow humans. We see a lot of the latter in the acute hospitals and hospices. Empathy, which emanates from within the person, subsequently moves the healthcare worker to act in a compassionate manner.

Therefore, empathy is putting oneself in the shoes of the patient while the resultant compassion compels the healthcare worker to act and do something for the comfort and care of the patient. Today’s patient is calling out for a holistic approach to care and management. Empathy should be the driver for compassionate care.

Dr Yu Chou Chuen (Co-Investigator and former Senior Research Fellow, GERI): Understanding patients’ perspectives (cognitive empathy) must be coupled with genuine emotional attunement (affective empathy) to build trust, strengthen communication, and foster compassionate, person-centred care. This dual lens ensures clinicians not only “know” what patients feel, but also “feel with” them in ways that support healing and dignity.

While early life experiences or stressors shape one’s orientation to empathy, what we can work with in training (of healthcare professionals) are the domains that manifest in practice, such as perspective-taking, genuine concern, or empathetic behaviours.

Tapping into your experience as clinicians, why is it important to tailor tools in consultation with the people who use them?

In the area of translational research and implementation science, it is very important that we identify barriers and enablers that impact a programme or service, determining its ultimate success or failure.

— Associate Professor James Alvin Low

Associate Professor Low: This is an iterative process, with process indicators and outcome measures being closely monitored, which ensures that strategic goals are ultimately met. No one could be more appropriate than those at the forefront: administrators, implementers or ground staff, to give feedback on the barriers or facilitators of a service or programme, as they will have deep experience and intimate knowledge of its inner workings. Once these are made known, the tools needed can then be curated, tailored and customised accordingly.

Dr Tan: The biggest barriers to empathy measurement aren't technical, they're human. Healthcare professionals face time constraints, assessment fatigue, and scepticism about measuring “soft skills”.

We overcame these by making healthcare professionals co-creators, not just end-users of the M-CES scale. Through focus groups and validation studies, we addressed their concerns directly: streamlining the scale from 48 to 26 items, eliminating confusing negatively-worded questions, and ensuring the tool provides actionable insights rather than just scores. When professionals feel heard and see their challenges addressed, they become advocates rather than resistors.

The real test now is translation and implementation. The critical next step is working with healthcare institutions to embed the M-CES into existing workflows, training programmes, and quality improvement initiatives. Success depends on continued collaboration with end-users to ensure the tool enhances rather than burdens clinical practice.

Dr Yu (left) and Dr Tan (right) present their findings at the Singapore Health and Biomedical Congress 2024.

One of the potential impacts of the scale is how measurement results can personalise the empathy training of healthcare professionals. How would this look like in practice?

Ideally, we can assess empathy at the individual level and compare scores across the cohort. For example, a trainee who scores lower on perspective-taking could be given role-play exercises to practise seeing situations from the patient’s point of view.

— Dr Yu Chou Chuen

Dr Yu: Someone with lower scores in empathetic behaviours might benefit from communication workshops or simulated patient encounters, such as coaching on how to express empathy verbally during ward rounds or use reflective listening when patients share concerns.

Dr Tan: Or, in another scenario, a healthcare professional who genuinely cares but struggles with emotional boundaries can learn cognitive regulation techniques.

Dr Yu: In this way, the M-CES translates empathy into concrete skills that can be practised, refined and applied directly in clinical care. It not only identifies who may need extra support, but also highlights which specific domains to focus on for more personalised training. Over time, repeating the assessment can also guide ongoing professional development, helping clinicians track their growth and sustain empathy in practice.

What’s next for the M-CES?

Dr Tan: We would like to work with medical and nursing schools to integrate the M-CES into curricula, and we are working with healthcare institutions to embed it in professional development programmes. Our research pipeline includes establishing predictive validity by correlating M-CES scores with patient outcomes, and investigating how different empathy domains relate to healthcare professional burnout. We're also seeking international partnerships for cross-cultural validation.

My ultimate hope is that the M-CES becomes a standard tool that helps healthcare organisations systematically cultivate empathy, ensuring compassionate care remains central to healthcare delivery even as systems become increasingly complex and pressured.

For more, click here to read full paper.

Reference: Tan L, Yu CC, Choo R, et al. Development and validation of the Multidimensional Clinical Empathy Scale for healthcare professionals and students. Sage Open Medicine. 2025;13. doi:10.1177/20503121251365011