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Africa Outlook

Netcare

NETCARE

Helping to heal South Africa



Netcare strives for quality patient care, grounded by an unwavering commitment to its values.

Writer Ian Armitage
Project manager Stuart Shirra

As South Africa's largest private hospital group, primary care network and emergency service provider, Netcare strives for quality patient care, grounded by an unwavering commitment to its values.

"Our core value is care," says Kerishnie Naiker, Director Communications at Netcare. "Providing quality care is both a duty and a privilege which we assume seriously.

"In 2011, we launched the Netcare Way, a programme aimed at inculcating five consistent behaviours in our staff. This, together with our values of care, dignity, participation, truth and passion directly and profoundly impact the quality of interpersonal interactions that our patients, colleagues and clinical partners experience within our facilities.

"In practicing these behaviours consistently, we give practical meaning to significantly living our values and create a minimum benchmark of how we treat everyone at Netcare," she asserts. Since its listing on the Johannesburg Stock Exchange (JSE) in December 1996, Netcare has grown into a business with a market capitalisation in excess of R26 billion. The group earned revenues of R25 billion for the financial year ended 30 September 2012, of which 58 percent or almost R15 billion was generated from its South African operations, and the balance from its business in the United Kingdom.

"In 2012, our South African business grew its operating profit by 11 percent to almost R2.5 billion, underpinned by an investment of R875 million in maintaining and expanding our network of world class facilities, hospital beds and technology," says Keith Gibson, Group Chief Financial Officer.

In South Africa, Netcare employs over 20,000 personnel. The Group has also recorded a considerable increase in the number of employees with disabilities – from 245 in 2011 to 410 in 2012, following a concerted awareness and recruitment campaign which is continuing.

Hospital Services
The Netcare group's core business is private hospital care. In South Africa, this is delivered through 55 facilities, including four that are part of private public partnerships (PPPs).

"Our portfolio comprises a mix of technologically advanced hospitals and same day surgical units," explains Jacques du Plessis, Managing Director Hospitals. "In total, we operate 9,262 registered beds, of which 1,543 are intensive or high care beds, as well as 326 theatres, 27 cardiac catheterisation and electrophysiology laboratories, 44 emergency departments, seven transplant units as well as 48 pharmacies serving our hospitals and retailing to the public."

A number of centres of excellence are located in Netcare hospitals. These range from the only dedicated private burns unit in the country at Netcare Milpark Hospital, a specialised paediatric head trauma and drowning unit at Netcare Garden City Hospital, the only intra-operative CT and MRI spinal and neuro surgery units are at Netcare N1 City and Netcare Milpark hospitals, the only level 1 trauma centres accredited by the Trauma Society of SA at Netcare Milpark and Netcare Union hospitals, the largest dedicated private haematology and bone marrow transplant facility at Netcare Pretoria East Hospital, and accredited metabolic medicine and surgery centres at Netcare Waterfall City, Netcare Sunward Park, Netcare St Augustine's, Netcare St Anne's, Netcare Greenacres and Netcare N1 City hospitals – to name a few.

"We are privileged to have highly skilled and experienced specialists and other healthcare professionals working in our facilities," says Du Plessis. "We are well positioned to provide efficient, effective and responsive patient care, supported by our group's ancillary businesses."

Noeleen Phillipson, the Netcare Executive responsible for oncology, concurs: "Netcare's oncology vision is to ensure that every cancer patient receives treatment of excellent quality. Some of the finest medical and academic minds harness groundbreaking technology to optimise outcomes for patients diagnosed with cancer. The radiation oncology centre at Netcare Unitas Hospital in Pretoria is, for example, considered the most technologically advanced facility of its kind in the private sector in South Africa. In Cape Town, the radiation oncology centre at Netcare N1 City Hospital was the first in the world to use iPlan platform software in focused stereotactic irradiation for treating both cancerous and benign lesions. At the University of Cape Town Private Academic Hospital the head of liver surgery performed the first ever procedure using the Accu2i percutaneous microwave tissue ablation system to ablate liver cancers."

Emergency Services
"We are passionate about providing remarkable care and clinical outcomes to as many patients as possible at the lowest possible cost when it comes to pre-hospital emergency medical services and medical evacuations," says Phillipson, who is also Managing Director of Netcare 911, the group's emergency services division.

Netcare 911 has contracts with various medical funders and companies in commerce and industry to provide emergency medical services to their members and employees, approximately six million lives in total. All-round efficiency is a key driver in optimising quality emergency medical treatment. To achieve this, the right infrastructure, technology, fleet and staffing are essential. Our fleet consists of response cars, ambulances, as well as helicopter and fixed wing air ambulances, the latter deployed in long distance evacuations.

"We are, for example, currently in the process of upgrading our tracker system and launching smartphone tracking technology which our emergency medical personnel will use as an aid. It's imperative to ensure that we respond to emergency calls promptly, have resources available in strategic locations and accordingly dispatch the right level of personnel and vehicles," says Phillipson.

Primary Care Services
The Primary Care Division operates a national network of 88 comprehensive primary healthcare facilities, the largest private network of group general practitioner and dental practices.

Medicross' well equipped medical and dental centres provide convenient access to private general practitioners and dentists as well as to pharmacy, optometry, radiology, pathology, day theatre and other services for both medically insured and private self-pay patients.

Prime Cure is an accredited managed care organisation which contracts with medical schemes to deliver managed care to their members. Care is provided through a network of designated service providers.

Prime Cure also contracts with employer groups in commerce and industry to provide occupational health and wellness as well as travel medicine services to their employees. These services are delivered, either on-site at the employers' premises or at Prime Cure clinics.

Dr Charmaine Pailman, Managing Director Primary Care, says the division, which recorded 3.2 million patient visits in 2012, is well positioned to participate in primary care service delivery under the proposed National Health Insurance (NHI).

To this end, all Medicross and Prime Cure facilities have been benchmarked against the 2011 National Core Standards for Health Establishments in SA, which will in future be monitored by the Office of Standards Compliance as part of the development of a new regulatory framework for the health sector.

"We were the first private national network of primary care facilities to undertake this audit voluntarily," says Dr Pailman.

53 Netcare hospitals have also concluded baseline assessments against these core standards, and assessments have now been extended to National Renal Care.

National Renal Care
National Renal Care (NRC), a 50-50 joint venture between Netcare and Adcock Ingram Critical Care, is the largest private dialysis provider in the country. It offers chronic haemodialysis at 58 facilities and peritoneal dialysis at 12 specialised units, with a total of 558 dialysis stations.

"We're committed to improving the quality of life for patients with compromised kidney function," says Robert Souter, Chief Executive Officer NRC. "We also introduced nocturnal dialysis to South Africa some 18 months ago. This service, which offers important clinical and lifestyle benefits to patients, is now established at six NRC units, and we have plans to expand this further."

In addition NRC has 16 specialised acute dialysis teams offering 24-hour acute haemodialysis, continuous renal replacement therapy and plasma therapy services. The Healthy Start programme, a service unique to NRC, focuses on educating patients with early stage kidney disease with the aim of slowing down the progression of the disease to prevent complete kidney failure.

NRC's commitment to contribute to transformation of the South African healthcare environment is evidenced by its 14 public private partnerships to date with public healthcare institutions, widening access to crucial dialysis services.

Quality Leadership
"With our unique portfolio of healthcare services and our commitment to quality leadership, Netcare has the opportunity to play a critical role in promoting high standards of care and creating increasingly greater value in our country's healthcare delivery system," says Dr Dena van den Bergh, Director Quality Leadership and IT.

Quality strategy and goals are aligned across all Netcare divisions. "This has created a platform for system-wide learning which contributes to a culture of performance excellence, continuous improvements against measurable quality outcomes and accountability for results. Our commitment to quality leadership is integral to achieving excellent health outcomes for our patients and a safer working environment for our staff and doctors," explains Dr Van den Bergh. Performance and improvements against our goals are formally tracked, measured and reviewed on an ongoing basis. This is done through a multidimensional quality balance scorecard which covers the group's six strategic focus areas. "The importance we place on quality is evidenced by the fact that results are reviewed across all levels of the organisation through to board level," she adds.

The six strategic areas on which Netcare's quality leadership is focused include:

● A group-wide quality assurance framework and annual audit process to ensure consistent, ongoing measurement of quality programmes and initiatives.

● Patient-centred care including a real-time feedback system driven by the latest technology.

● The prevention and management of adverse events focusing on five identified risk areas, namely falls, medication safety, pressure ulcers, theatre safety and needle stick injuries.

● Improving clinical quality. The focus is on a suite of high-impact clinical improvement areas including the prevention of healthcare associated infections; participation in a national antibiotic stewardship programme to mitigate the risk of multi-drug resistant organisms; and a number of internationally proven best practice clinical interventions to improve patient outcomes such as optimising care in acute myocardial infarction and preventing venous thromboembolism.

● A deepening capability for improvement is aligned to the Institute of Healthcare Improvement (IHI) strategic improvement framework of 'Will, Ideas and Execution', with the goal of achieving organisation-level results in quality.

"By working closely with government and actively supporting national quality improvement programmes such as the Best Care... Always campaign, Netcare is making a meaningful contribution to transformation efforts in the wider South African healthcare landscape." says Dr Van den Bergh.

Training and Development
Another of Netcare's key objectives is the training, education and development of its employees, based on the belief that organised learning and development interventions equip employees to continuously improve service excellence and result in increased job satisfaction and individual growth opportunities, says Peter Warrener, Group Human Resources Director.

The group's education facility, Netcare Education, comprises three faculties that provide training in the fields of nursing and ancillary disciplines, management and leadership, and business generic training. Netcare's skills development spend for the period 1 April 2011 to 31 March 2012, amounted to R42 million.

"Given the shortage of skilled healthcare professionals in South Africa it is essential for private sector companies such as ours to be actively involved in training initiatives aimed at increasing the pool of skilled professionals," says Warrener. Netcare is the largest private trainer of nurses in South Africa. The number of students registered on various nursing programmes in the 2012 financial year was just under 3,300.

Three of the group's facilities – Netcare Sunninghill, Netcare Unitas and Netcare Pretoria East hospitals – are recognised as satellite academic campuses of the University of Pretoria's medical school.

The School of Emergency and Critical Care (SECC) which is operated by Netcare and accredited by the Health Professions Council of SA, is the largest private EMS training centre in Africa. In 2012, over 4,700 students registered with the SECC for various emergency services progammes, while 533 Netcare 911 emergency services staff members underwent training.

Collaboration and Public Private Partnerships
Extending its special brand of care to the wider South African community lies close to Netcare's heart.

In a country where only 8.6 million people out of a population of some 49 million has medical aid cover, the burden on the state to provide healthcare services is great. "This creates scope for private sector involvement in initiatives to widen access to quality healthcare," says Melanie da Costa, Director Strategy and Health Policy at Netcare.

In 2012, Netcare, along with 22 other private healthcare companies, entered into a groundbreaking Social Compact with the Department of Health. Spearheaded by the Minister of Health, Dr Aaron Motsoaledi, this step symbolises an acceptance that neither the public nor the private sector can individually or successfully confront the immense health challenges facing South Africa. The compact heralds a new standard for collaboration betweenthe two sectors to achieve the national health objectives.

Jointly selected health initiatives aimed at increasing access to quality healthcare and reducing the burden of disease will be executed through the newly established SA Joint Public Health Enhancement Fund. The private sector signatories will make a fixed annual contribution to fund these planned initiatives.

"We look forward to positively impacting healthcare in South Africa through this collaboration," Netcare's Group Chief Executive Officer, Dr Richard Friedland, commented at the occasion.

"We are ready to collaborate with government on NHI," says Da Costa. "The experience we've gained through various PPPs in healthcare delivery will stand us in good stead in our quest to cooperate with government on its planned NHI."

In South Africa, Netcare has already been involved in a few PPPs with government. Partnering with the National Health Service (NHS) in the UK to deliver medical services and hospital care to NHS patients served as an extremely valuable learning experience for the group.

Its latest endeavour, where a Netcare-led private consortium, Tsepong, is involved in an internationally acclaimed healthcare PPP with the Lesotho government, serves as "an excellent model" for achieving significant and sustainable improvements in healthcare delivery while maintaining cost neutrality for consumers. It has the added benefits of providing system-wide gains in efficiency while maintaining predictable government expenditure, as well as technology enhancements, creating job opportunities and the transfer of skills to locally employed staff.

The Lesotho PPP entailed the co-financing, design and construction of the new Queen 'Mamohato Memorial Hospital, three filter clinics and an onsite Gateway clinic and to operate the facilities for a period of 18 years. The consortium is responsible for delivering clinical and non-clinical services as well as staffing, and other activities.

Within its first year of operation, the partnership between the Lesotho government and private consortium clearly demonstrated that quality of care can be transformed in a relatively short period of time. This is evidenced by patient outcomes statistics. Inpatient mortality, for example, reduced from a baseline of 12 percent to just below eight percent and maternal mortality decreased dramatically from 1,115 per 100,000 live births to 495 per 100,000.

Corporate Social Investment
By the very nature of its core business, Netcare is made aware on a daily basis of the needs of less privileged individuals and communities in South Africa. Good corporate citizenship is ingrained in Netcare's fabric and its values of care, dignity, participation, truth and passion are at the heart of many of the group's corporate social investment (CSI) programmes. Netcare commits considerable resources to initiatives that contribute significantly to social and human development.

"The majority of the group's R36 million CSI spend in 2012 was in the healthcare arena. The key focus areas were pro-bono pre-hospital emergency medical services for indigent patients, initiatives to broaden access to healthcare, community health and welfare sponsorships and projects as well as academic sponsorships," says Mande Toubkin, general manager emergency, trauma, transplant and corporate social investment at Netcare.

CSI initiatives are channelled through the Netcare Foundation, a not-for-profit and public benefit company. The foundation undertakes a number of projects in partnership with other organisations, government and communities.

"It is extremely heart-warming that healthcare practitioners working at our facilities, also selflessly contribute their time and expertise to the Netcare Foundation's ongoing programmes which are widening access to specialised healthcare for the indigent population. Such projects include craniofacial surgery to correct facial anomalies mainly in children, cleft lip and palate repair, paediatric cardiac surgery to address congenital and other heart problems in children from across the African continent, and cataract surgery," says Toubkin.

Toubkin and Naiker also have nothing but praise for the passion with which the group's personnel across all levels participate in national and local operations' community outreach initiatives.

"For our members of staff, being of service to others is a way of life," says Naiker. "The manner in which they live the Netcare Way is truly inspirational and for this, we commend and salute them."

Naiker concludes, "Netcare is committed to transformation in the healthcare sector and to the normalisation of South African society."

For more information on the Netcare Group visit www.netcare.co.za.