SHE report

Promoting the well being of all people
In accordance with the Occupational Health and Safety Act, 1993 (Act No. 85 of 1993), as amended, including the regulations, Netcare strives to provide an occupational health and safety service in South Africa that will protect and promote the health and safety of all Netcare employees; and a safety and awareness programme that will protect the safety of our patients and members of the public entering Netcare hospitals.

Clinical governance
Aiming to become a learning organisation that embraces it successes, acknowledges its failures and applies these lessons to improving the healthcare services provided to all patients, Netcare began implementing a broad-based Clinical Governance initiative in May 2005. During this year we began to implement clinical guidelines in the ICUs, trauma and infection control areas and established the Clinical Governance Operational Committee and Medical Advisory Ethics Committee, a body of doctors elected by their peers to assist Netcare on clinical governance issues. Infection control is one of the primary focus areas of clinical governance and a vital measure of the quality of care. Clinical Governance provides the means to achieve several strategic goals. These include:

• Promoting best clinical practice;
• Providing scientific evidence of care through research and development;
• Ensuring professional service is delivered at all times while continually improving quality;
• Ensuring that resources are optimally and effectively utilised, trained and incentivised;
• Eliminating clinical risk; and
• Partnering with physicians and healthcare service providers to enhance patient care.

While most of these aspects were already in place within Netcare, the implementation of a formal Clinical Governance initiative was deemed important, for the benefit of patients and is also in keeping with World Health Organisation (“WHO”) recommendations that healthcare providers pay close attention to and establish science-based systems that ensure patient safety, promote evidence-based policies that include global standards to improve patient care and develop mechanisms through accreditation and other means to recognise excellence in healthcare and patient safety. Our Clinical Governance initiatives take cognisance of the draft Health Charter, which proposes strict measures to ensure quality of patient care, accountability by the healthcare provider for the provision of this care and optimum costefficiencies. A Clinical Governance Operations Committee has also been established, with responsibility for executing all strategic imperatives and establishing national guidelines for Netcare facilities. There are also Clinical Governance Committees within each Netcare hospital or operating division, complemented by a Physicians’ or Medical Practitioners’ Associations and a Regional Nursing Advisory Committee. The activities at each level in the Corporate Governance hierarchy are grouped into four pillars, as illustrated in the accompanying graphic, namely:

• Clinical effectiveness and clinical practice;
• Clinical risk management;
• Patient experience; and
• Professional development management and training.

Leveraging intellectual capital
In keeping with the lifelong learning aspirations of Clinical Governance, Netcare has embarked on an initiative to nurture closer relationships between the Group and South Africa’s universities. Already, five professorships at the University of Pretoria are closely affiliated to Unitas Hospital in Pretoria, while several other universities’ Faculties of Health Science have been approached and are involved in bringing academic medicine within reach of the doctors and specialists practising at Netcare hospitals across the country.

We are working closely with Netcare Education Division on an initiative to encourage participation of Netcare’s doctors and hospitals in clinical research, and to publish their results. We have established a Clinical Research Committee that has a primary mandate to turn the innovative, evidencebased medicine practised at our hospitals into benchmarking research. In addition to stimulating research, the committee also plays a key role in governing the practice of research using international principles, so as to ensure adherence to global best practice.

A number of knowledge dissemination platforms are already being investigated, including a routinely published Netcare-branded research publication; and an electronic, internetbased platform for knowledge management and sharing throughout the Group.

Integral to Clinical Governance is the Physician Advisory Board (“PAB”) infrastructure established at each Netcare hospital. Designed to engage the assistance of resident doctors in setting and maintaining the highest quality standards with regards to the clinical aspects of hospital management, the PABs offer a solid peer review platform that facilitates meaningful Clinical Governance as well as an environment of continuous learning and holistic patient care, governed by an appropriate code of conduct.

The initiative to accredit all Netcare hospitals through Health Quality Service (“HQS”) UK is another way that the goals of Clinical Governance will be realised throughout the Group. Netcare has begun to implement the internationally acclaimed healthcare quality standards laid down by HQS UK. Five of the Group’s flagship hospitals – Unitas in Pretoria; N1 City in Cape Town; St Augustine’s in Durban; and Sunninghill and Milpark in Johannesburg – have all been HQS accredited and have also each acquired ISO 9001:2000 certification for their quality standards. The roll out of HQS to a further five Netcare hospitals – namely Christiaan Barnard Memorial Hospital in Cape Town, Greenacres Hospital in Port Elizabeth, Umhlanga Hospital and Parklands Hospital in Durban, and The Bay Hospital in Richards Bay – is underway.

Occupational health and safety
Netcare complies with local laws and regulations relating to occupational health and safety and endeavours to minimise, if not eradicate, work-related health hazards. All occupational health and safety risks have been identified and evaluated, allowing the development of appropriate mitigating processes.

The major occupational health risks facing our nursing employees are:

• Exposure to infectious diseases through needlestick injury, infected body fluids and patients with contagious infections;
• Back, shoulder and knee injuries arising from lifting and handling patients – practical training is provided that teaches nurses how to move patients with the minimum stress on the spine and major joints; and
• Exposure to medical waste and other hazardous substances – Netcare complies with statutory healthcare waste management requirements and has been an active participant in the development of the Gauteng Healthcare Risk Waste Regulations.

Appropriate Personal Protective Equipment (“PPE”) is issued to employees, relative to their occupations and duties. This includes surgical gloves, masks, theatre gowns and aprons – all of which also contribute to infection control.

All occupational health-related incidents are recorded and analysed, prompting suitable interventions to prevent similar situations arising. Employees whose health is compromised in any way while on duty receive comprehensive care.

A total of 1 306 occupational health and safety-related incidents were reported during the year ended 30 September 2006, of which contact and collision incidents accounted for 41% and needle stick injuries for 26%. The latter predominantly arose in operating theatre and catheterisation laboratory scenarios, where the utilisation of needles and sharp instruments is high, with commensurate elevated risk of injury. An analysis of injuries by type and hospital has allowed the implementation of improved management of injury risks. No serotype conversion tracking has been undertaken to determine the incidence of disease transmission as a result of these incidents, nor have any cases of HIVtransmission due to needlestick injuries been reported.

We are equally concerned about the safety of the public who visit our facilities to access the healthcare services offered by the medical practitioners, whether as visitors, outpatients or during hospitalisation. In addition to infection control measures, every effort is made to optimise the safety of all public access areas.

	Staff injuries (%) 30 September 2006

HIV and AIDS
Netcare has developed and is in the process of implementing a HIV workplace policy to manage its own employees infected with HIV. This policy includes an assurance that HIV-positive personnel will have access to anti-retroviral therapy (“ART”).

This will be facilitated by the Aid for Aids programme run by the Netcare Medical Scheme or by HIVCare International, an entity within the Netcare portfolio of healthcare investments, which has been mandated to establish clinics to increase access to antiretroviral therapy in partnership with provincial health departments. This initiative has been given a financial boost through the award of a multi-year contract from the US State Department’s Presidential Emergency Programme for Aids Relief (“PEPFAR”) to HIVCare International, for the distribution of ART in the Free State via the Netcare, Medicross and Free State Health Department infrastructure. The contract will also entail the provision of counselling, education and nutrition advice in local communities. Based on the success of this initial phase of the contract, the concept will be rolled out to other parts of South Africa.

An analysis of claim trends on the Netcare funeral policy reveal that the greatest number of deaths among staff is in the 37 to 42 yearold bracket, which is likely to be a direct result of AIDS-related illnesses.

Netcare is also committed to fighting the HIV/ AIDS epidemic through diverse community outreach programmes. These are driven by the Imbizo teams established at every Netcare hospital, which work with community-based organisations to provide HIV/AIDS education and support to HIV-positive individuals.

Protecting the health of our environment
At Netcare, we believe that a healthy environment not only improves the quality of our lives, but also serves as a basis for the sustainable economy on which our business depends. With this in mind, we endeavour at all times to take a leadership role in making environmental protection compatible with economic development by ensuring compliance with the applicable environmental regulations and implementing best practice processes that address the environmental issues relevant to Group operations, in terms of the physical environment in which we functions.

Our environmental management strategy is based primarily on compliance with legislative requirements. Cognisant of the potential impact our operations may have on the natural
environment, we aim to minimise air pollution, minimise water usage/wastage, recycle suitable materials, optimise energy consumption and dispose of medical waste safely.

We also encourage our stakeholders – namely our employees, doctors and specialists, patients, suppliers and contractors – to be proactive in reducing wastage of nonrenewable resources while optimising their usage of raw materials and other resources.