Thinking Ahead, Getting Ahead

CHRO Joseph Cabral knows his biggest competition is status quo. His solution? Constant change for constant improvement.

By The Editors

It is somewhat surprising that one of the most successful and influential HR leaders came into the industry by what he describes as a fluke. Joseph Cabral calls himself a numbers guy with a varied career, having stints in the U.S Air Force, as an entrepreneur launching a staffing company, and as an adjunct professor at UMASS Boston. But each of these roles has led him to the place where he has spent the last 10 years as senior vice president of HR and chief HR officer: North Shore-LIJ Health System. 

Cabral says that when he was in the military, it was reinforced that the way you learn is by doing. He recalls their unofficial motto was to learn one, do one, then teach one.

This effectively encourages leadership since it allows for constant development.


“I think leading my success was whatever I did, I tried to become an expert. I am a true believer that if you’re going to do something, do it to the best of your ability, with passion,” he says. “That was how I always approached any of my careers or any of my jobs.”

In fact, at press time, it was announced that Cabral is moving his knowledge, leadership, and passion to Ohio, where he will be Cleveland Clinic’s new CHRO, starting in September. Cabral says he is excited to bring what he has learned to the organization, which is ranked as one of America’s top four hospitals by U.S. News & World Report.

In July, HRO Today visited Cabral in his Long Island office to discuss the importance of leadership, how analytics are changing the workforce, and the potential future of HR as a profit center. 

HRO Today: While you were in Air Force, you learned the true value of process efficiency. How did you bring process redesign to North Shore-LIJ, and what impact has it had?

Joseph Cabral: There were so many, right? And we are even redesigning the process that I redesigned 10 years ago today. You always have to be a little unhappy with where you are or you will fall behind; the biggest competition is status quo.

I think back 10 years and nothing was automated— HR was very, very transactional. I wanted to make a statement about our hiring and onboarding process.

It was so inefficient: The process required more than 100 forms to hire ONE new employee! So I plastered each one of the forms on the conference room wall. Needless to say, it got people’s attention. I wanted to communicate that we really needed to change and evolve. The key issue was not just about automating processes. Because if you have a bad process and you automate it, then it becomes a bad process on steroids. So our goal was to re-engineer the entire processes.

Take, for example, job postings. Fast forward 10 years, and we are no longer using job boards; right now it’s allsocial media. You have to constantly reinvent yourself.

HROT: With your shared services model, do you also rely on external vendors? Or do you literally build it all?

JC: The big question has always been to build or to buy? Can we do it as effectively as a vendor? So let’s use SkillSurvey as an example. This past year we hired 7,700- plus employees to the organization because we were expanding. The idea that our recruiters would have to call three references per hire in order to schedule time for a reference check was ludicrous. And most of the time, said references were not available! SkillSurvey is a platform that allows us to do reference checks via email and tabulates the recorded information on a numerical level. It is so much more efficient and effective—and I couldn’t build that. But we’ve also used the technology to build something that doesn’t exist on the market today, which is a physician credentialing process.

From a shared services perspective, we’re getting into this management services organization (MSO) business group. We now can sell our HR services to other companies and businesses that we don’t own. For example, we can fulfill the service needs of say a nursing home that doesn’t necessarily need a full- blown HR department. As we continue to grow as an organization, it allows us to affiliate in a different way than acquisition.

HROT: Your internal leadership program is strong: It’s trained close to 600 leaders; nearly 80 percent have been promoted; and the overall retention rate is 95 percent. Tell us a little bit about the process and how people respond to it.

JC: Today, every CEO is paying close attention to whether or not they have the right leaders. Do we have the right competencies not only for today, but to get us to tomorrow? So we built our Center for Learning and Innovation, and the key was to really keep it very simple. Employees are vetted and nominated at four different levels: emerging leaders, team leaders, operational leaders, and strategic leaders. Depending on what level the employee is determines how long they spend in a classroom. So an emerging leader might spend 60 to 70 percent in the classroom, versus an operational strategic leader, who might spend 20 percent in the classroom. And their experience would be very different.

We started with the very basic fundamentals around leadership development and from there, it has really evolved into a succession planning program. So if I need a CFO for a new facility, I can easily look at a group of operational leaders who are ready for a strategic role, and can place one of them quickly. That’s really been the strategy and a main reason why our retention rate and the mobility rate have been so high. We recently did some testimonials from the high potentials and they were phenomenal. In fact, the high potential program was so successful that we created a physician leadership high potential program as well.

HROT: How do metrics and analytics play a role in your decision-making process.

JC: We focus on quality, financial performance, and customer experience because that’s what drives the success of the business. Of course we measure all of the other typical HR metrics like turnover, promotions, and internal movement.

The next level of measurement we are looking into is how much it actually costs for a full-time employee to take care of a particular patient (customer) based on care. We slightly struggle with that today because we get the data after the patient (customer) has left. But it’s crucial we figure this out because there is a big difference between the customer costs and full- time employee costs. And I’m not talking about the bandages, but the patient-staff ratio at any given time.

We also need to take into consideration how many employees are full time, how many are part-time, and how many are per diem. Right now nearly 78 percent of our workforce are full-time employees, about 18 percent is part-time, and the rest are per diem. Having such a high percentage of full-time employees doesn’t allow the organization to flex up and down with the census.

We’ve just started to get into predictive modeling around the number of visits, and we’re trying to do the same thing with our workforce. So the idea is: Do we have enough data today to allow us to predict the percent of full-time workers we need? If that number goes from 78 percent to 50 percent, more than 25 percent of our workforce will no longer need benefits. We’re going to save a lot money and the organization will be able to flex up and down.

Today, employees are considered a fixed cost. Whether I have three patients (customers) or 10 in a unit, I still have all my staff coming in at the same time. We are looking at other industries for best practices on scheduling appropriately. How do we make sure that we’re delivering the services most effectively with the right number of staff?

HROT: How has technology played a role in the healthcare industry?

JC: Today, in most hospitals, you can find an online calculator that can tell you the approximate costs of treatment, like having a knee replaced. Plus appointments can be scheduled online, and medical records can be accessed with the click of a button. So technology really has allowed the healthcare industry to catch up to the same level of technology and services that consumers are accustomed to.

Technology also has advanced treatments. We’re starting to move almost everything that we can outside of our acute care settings into the ambulatory world. Our biggest challenge today is most healthcare professionals are brought up in the acute care world, but we’ve seen a 6 to 8 percent shift into the ambulatory world. This translates into thousands of positions moving into the ambulatory side.

As we move away from the acute care setting, we’re looking for accountability in the ambulatory world, and technology enables us to make sure that the care is effective and efficient, and all details are delivered electronically.

HROT: So given all these trends in the healthcare market, how do you, from the people strategy of the business, stay ahead?

JC: Everybody’s looking for case managers because we’re moving from acute care to ambulatory care, and there are not enough out there. So we have to train our own through our Center for Learning and Innovation. Our challenge is to make sure we continue to pay competitive rates because we’re the ones training them and we don’t need our competitors stealing them away after they are done.

And we’ve discovered another way to fix the problem. For example, there’s a critical care telemedicine combined role that is new. We put a year-long, highly successful training program together, and we’ve actually partnered with a couple of hospitals in the city to offer that training to some of their nurses. That’s another way for us to generate revenue.

HROT: So you’re actually turning HR into a bit of a profit center. Can you share just how much does HR defray its cost model from?

JC: Not a lot because we’re just starting. We recently partnered with an organization—a research institution—that was looking for employee health services. And we’re providing all of their occupational health care similar to a wellness center.

They’ve talked about how many lives this has saved them, because we do a lot of preventative care. It’s the same type of things that we do here, but we’ve now expanded it out to some of these other employers. It also has decreased their health costs for their benefits. That’s a huge success story.

Posted August 19, 2014 in Talent Acquisition