Fresenius SE & Co. KGaA
Investor Relations & Sustainability
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As a health care Group, we are not only responsible for the well-being of our patients, but also for the health of our employees. We have implemented numerous management systems and measures throughout the Group to prevent employee accidents and work-related illnesses. Creating a safe and healthy working environment is our top priority. In health protection, prevention is our guiding principle; that is why we offer our employees comprehensive programs that promote their health and prevent occupational diseases.
Ensuring the health and safety of our employees is an essential part of our corporate responsibility. The Fresenius Code of Conduct states that we must take the necessary measures to protect our employees and to prevent work-related accidents. All four business segments focus on preventive measures and on the individual responsibility of employees when it comes to occupational health and safety. The occupational safety concepts are adapted to the specific business models of the four business segments. These focus on occupational health and safety within production, as well as occupational health management for health care facility or administrative employees. The aim of all the measures is not only to protect employees, but also to ensure the health and safety of patients. All Fresenius business segments continually record data on occupational health and safety in line with regulatory requirements.
During the COVID-19 pandemic in 2020, the safety and health of our employees, their families and the communities in which we work were in the focus of our response activities. A major challenge for us in this regard was on developing individual protection concepts, measures and working regulations that allow us to continue all operational and administrative activities. Depending on the evolution of the incidence rates and changes in regulatory requirements, it was necessary to promptly adapt our protection concepts and guidelines and to communicate these to the employees. This also meant equipping our employees with suitable protective materials. In our clinics, we have intensified infection control practices that were already in place in order to protect both our patients and our staff. In the production facilities, we introduced strict hygienic measures, such as disinfection and distancing measures. From March 2020, a large number of our employees in administrative functions worked from home to avoid infection.
Fresenius Medical Care gives top priority to the health and safety of employees. The company's Code of Ethics and Business Conduct includes the commitment to provide a safe and healthy work environment for the company's global team. Fresenius Medical Care expects the same from its business partners. Responsibility for occupational health and safety lies with local management. The respective standards for health and safety are defined in local and regional policies and guidelines. This allows the company to comply with different regulatory and legal requirements and report incidents to authorities based on local specifications. Several of the company's production sites and clinics in the region Europe, Middle East and Africa are certified according to international health and safety standards, including ISO 45001. Fresenius Medical Care is currently working on harmonizing its management concepts for occupational health and safety as part of our Global Sustainability Program. In addition, Fresenius Medical Care is planning to develop a global policy and key performance indicators to reflect its worldwide performance in this area.
Fresenius Medical Care carries out risk assessments on the operational safety of machines and technical equipment as part of the company's work safety program in its production facilities. Internal reviews and external audits by authorities are conducted to monitor compliance with corresponding regulations, policies, and procedures.
The safety of Fresenius Kabi’s employees at their workplace is our central concern. The aim is to avoid all work-related accidents. To achieve this goal, the company has implemented standard operating procedures (SOPs), other regulations, and instructions to provide a global framework for occupational health and safety which are part of Fresenius Kabi’s integrated quality management system. The implemented occupational health and safety guidelines focus on the following principles:
Risk assessment is an important part of the occupational health and safety management. Based on the risk assessment, occupational health and safety measures are derived and performed locally. This is supplemented by a notification system through which work-related accidents are reported, recorded and categorized. Further, training on work-related risks is provided at all sites. To support its occupational health and safety management, Fresenius Kabi has introduced a management system in accordance with the international standard OHSAS 18001. The management handbook and standard operating procedures provide global management requirements for the certified organizations’ local occupational health and safety management. The implementation of the management system is ensured by internal global audits. The global management system is audited on an annual basis and certified by TÜV Rheinland. It covers all employees as well as temporary workers at certified sites. The local management reviews the occupational health and safety management system at least once a year, with regard to its continued suitability, appropriateness, effectiveness, and potential for improvement.
Currently, 21 organizations of Fresenius Kabi are certified according to the standard OHSAS 18001. The company is working on rolling out the certification according to OHSAS 18001/ISO 45001 to all manufacturing plants by 20231. Fresenius Kabi aims to improve occupational health and safety processes there and align them with internationally recognized standards. In 2020, 2 additional manufacturing plants have been included in the OHSAS 18001 certification of Fresenius Kabi. Local targets are set at the certified organizations to enhance the occupational health and safety management.
1 The certification roll-out is going to be concluded at all manufacturing plants of Fresenius Kabi in 2023. The certification issuance from the individual certification companies may extend into the following year.
Responsibility for occupational health and safety management lies with the divisional and local organizations; global management responsibility lies with the central organization, which reports to the responsible member of Fresenius Kabi’s management board.
Fresenius Kabi has implemented standard operating procedures (SOPs), other regulations, and instructions to provide a global framework for occupational health and safety which are part of Fresenius Kabi’s integrated quality management system. The OHSAS 18001 management handbook and the standard operating procedures of Fresenius Kabi provide a consistent framework for the certified organizations’ local occupational health and safety management.
Fresenius Helios hospitals have risk assessments at their disposal for the individual workplaces and keep lists of dangerous substances. As a preventive measure, Fresenius Helios conducts occupational health and safety inspections of areas of the hospitals to look for potential risks. The main risk areas at our German locations, for example, are identified via accident reports or information from employees and undergo rigorous assessment. As part of a risk assessment, these are then analyzed; in the short term, measures are communicated to decision-makers using the S-T-O-P principle (substitution, technical, organizational and personal measures). Fresenius Helios then reviews the implementation process and effectiveness. The procedure used is the equivalent of a classic PDCA loop, i.e., Plan, Do, Check, Act – for continuous improvement.
In loops for mental health risk assessments, for example, specialized employees work together with managers to develop cross-functional measures. Similar procedures can be found in occupational health management and occupational rehabilitation management, for example. The business segment is currently reviewing whether to introduce an integrated management system for health and safety in Germany.
Helios Spain strives to develop an exemplary culture within health care provision, in order to avoid occupational health risks and promote healthy habits among its workforce. This is also implemented in the company’s policy on workplace safety. The policy is applicable at all company levels and locations. Helios Spain has standardized occupational health and safety across the Group’s hospitals and companies and developed a company-wide training platform for specific workplace-related risks. Various KPIs, including absenteeism and work-related injuries, are consolidated in one standardized system and evaluated. Based on this, measures are then taken to reduce absenteeism or to avoid accidents at work.
As a hospital operator, Fresenius Helios implements occupational safety and occupational medicine measures primarily for its own medical personnel. The company also supplies occupational health services to external companies at numerous locations. For example, our range of services encompasses about 300 institutions in Spain that provide occupational health management. Via these prevention centers, we examine about five million employees annually, working in cooperation with companies.
The senior management team of Fresenius Helios and the Helios Occupational Health business segment have the task of coordinating occupational health and safety in Germany. In terms of organization, the Helios Occupational Safety segment is assigned to the area of Authorized Officers & Environmental Management in the Infrastructure business segment. It was founded in 2019 and currently looks after about two-thirds of all the employees in the business segment, in addition to Fresenius Vamed and Xenios, a Fresenius Medical Care company. Specialists and engineers at Helios Occupational Safety are responsible for almost all Helios clinics and their subsidiaries (e.g., cleaning, logistics or catering). They look after all aspects of health and safety at work for Fresenius Helios employees, as well as the employees of Fresenius Helios internal service providers and subsidiaries, ensuring coordination is done in close collaboration with the German supervisory authorities.
The Helios Occupational Health business segment in Germany also has an Occupational and Organizational Psychology department, which carries out risk assessments for potential to cause mental health problems at numerous Fresenius Helios and Xenios (Fresenius Medical Care) sites.
At local level, the members of the Occupational Health and Safety Committee take a targeted approach to monitoring the various aspects of occupational safety and health promotion. The meetings held by the Occupational Health and Safety Committee meet the legal requirements set for composition and number of participants. In addition, specialist personnel and managers in special steering groups at the hospital sites work on dealing with specific areas, such as occupational health management.
Helios Spain works continuously to ensure the safety and health of its employees. With the implementation of SAP at all our hospitals in Spain, we changed the management of occupational health and safety from local systems to one company-wide system. Based on ISO 45001 (former 18001) as well as Spanish regulatory provisions, all hospitals are required to report occupational health and safety incidents, cause, lost time, illnesses and absenteeism as well as other KPIs in one tool. The local management which is responsible for ensuring that regulatory requirements are met for occupational health and safety, is guided by a handbook as well as standard operating procedures. A central department for corporate health prevention coordinates all activities and the reporting.
In Germany, Fresenius Helios uses the statutory regulations and guidelines of accident insurance institutions as the basis for its work. The business segment also cooperates with authorities at a more local level in Germany, such as the “Unfallkasse Hessen” accident insurance fund. Fresenius Helios Germany is currently planning to develop a corporate policy on workplace safety. This guideline for occupational health and safety will be interdisciplinary, developed together with Helios Occupational Health in the first quarter of 2021. It will then be reviewed and adopted by management.
Helios Spain wants to develop an exemplary culture within health care provision, in order to avoid occupational health risks and promote healthy habits among its workforce. This is also included in Fresenius Helios policy on workplace safety in Spain. The policy is applicable at all levels of work and at all locations in Spain.
In 2020, temporarily admissions were stopped at entire hospitals due to the frequent coronavirus infections affecting employees and patients. Over the course of the COVID-19 pandemic, Fresenius Helios has been adapting the existing risk assessments. In Germany, specific pandemic-related aspects were factored in, while existing aspects were re-evaluated to take protection against the pandemic into account: These include use of personal protective equipment (PPE), establishing isolated COVID-19 stations in the hospitals, specially protected separate access to sensitive areas, protection of mothers while giving birth and taking into account COVID-19, occupational health and safety measures for office work, and creation of storage facilities for PPE and disinfectants.
Based on pandemic-related legal requirements and official recommendations, Fresenius Helios in Germany has adapted and expanded its range of e-learning courses in the area of occupational health and safety. All in-person events were coordinated in close collaboration with the respective hospital hygiene and management teams. Overall, it was possible for most of the training sessions to be held in accordance with local recommendations and protection measures.
In addition, Fresenius Helios in Germany set up a hotline to provide mental health support to its employees; the hotline is also available to employees in other business segments. To help them cope with the pandemic, the business segment also offered online training courses to its employees. Last but not least, Fresenius Helios increased its childcare provision for employees in Germany to cover the pandemic-related closure of kindergartens and schools.
The health and safety of employees is firmly embedded in our company’s culture and the Fresenius Vamed mission statement. All employees, and in most instances patients and customers too, are covered by the company’s holistic approach to occupational health and safety. Due to the diverse range of services and the different responsibilities involved, the implementation process is organized in very different ways throughout the business segment – nationally and internationally. In the context of our business areas, this is particularly the case for the project and service business as well as for the overall management of operations and the technical services provided by the individual Fresenius Vamed locations. In the area of occupational health and safety, all locations are subject to the respective local laws and regulations. Compliance with these regulations is also ensured at local level.
Due to the decentralized organizational structure of Fresenius Vamed, a range of different legal and internal guidelines play a significant role in occupational health and safety. The Code of Conduct covers administration and the area of technical services, while the Clinical Code of Conduct regulates the area of health care and medical personnel.
The requirements for occupational safety and health protection changed very quickly during the pandemic. From the outset, Fresenius Vamed has recorded suspected and quarantined cases in all countries and areas on a daily basis, continuously checking whether further steps are necessary to contain the pandemic. In order to protect employees, patients and customers, the business segment immediately adopted new regulations. These were coordinated with occupational health professionals and adapted specifically to the health care sector as well as to the areas of technical services, construction management and office operations. For the operation of its central office facilities, Fresenius Vamed has developed and implemented numerous COVID-19 safety precautions in collaboration with the Medical University of Vienna and documented them in a COVID-19 prevention concept.
All four business segments have notification systems for accidents at work. Fresenius Helios uses a Critical Incident Reporting System (CIRS) at all its German hospitals, for example. This system is anonymous and can be used in all areas of a hospital site. It is used for the preventive protection of both employees and patients. The reporting system can be used to make preventive corrections in processes and workflows and thus eliminate risks from everyday work.
Fresenius employees receive regular occupational health and safety training in all four business segments. To avoid incidents and increase awareness, we also provide training on health and safety. In our clinics, employee training courses cover topics such as the safe use of sharps and disposables and hand hygiene. Further topics include infection prevention, and emergency control. Training provided in our production sites focuses, for instance, on the safe handling of work equipment, hazardous chemicals, emergency prevention and response. Fresenius Kabi, for instance, holds training sessions on work-related risks at all locations. Fresenius Vamed offers employees a separate e-learning module on employee protection.
Our business segments manage their occupational health and safety measures towards segment-specific ambitions. Fresenius Helios for example pursues one central and overarching ambition when it comes to occupational health and safety in Germany: to maintain and continuously promote employee health, consistently reduce risk in hospitals and reduce numbers of near misses, minor incidents and work accidents on-site to zero. For 2021, Fresenius Helios is planning to put a comprehensive system in place that will record work accidents in all German hospitals, supplementing the local data collection done for facilities in Germany. In the future, key figures such as the downtime LTIF (Lost Time Injury Frequency) are set to be collected, for example, with Fresenius Helios cooperating closely with German accident insurers and internal managers in order to do so. In the future, Fresenius Helios will also collect data for preventive health and safety at work purposes. Fresenius Vamed currently collects relevant key figures locally, that may result from occupational accidents. In the future, changes in occupational health management will also be increasingly evaluated.
In 2020, Fresenius Medical Care started to assess local health and safety policies and goals in all regions. In the region Europe, Middle East and Africa, for example, the health and safety targets relate to incident rates, safety training and incident reporting.
In addition to occupational safety aspects, Fresenius Helios in Germany has also specifically addressed the matter of fire protection at clinics in order to take a holistic approach to avoiding risks. In the year under review, Fresenius Helios Commissioning personnel set up online training and put effective practice grading in place for fire safety assistants. For example, employees learn how to handle fire fighting equipment in their roles as fire safety assistants, and how to respond in the event of a fire and during evacuation from affected areas. This can be introduced at all locations.
Fresenius Medical Care’s commitment to providing a healthy work environment also includes initiatives for flexible working hours and workplaces where this is compatible with operational requirements. Depending on the regional conditions, the business segment implements additional measures to support its employees’ wellbeing. In North America, for example, Fresenius Medical Care offers employees access to a digital platform that provides personal recommendations and activities to help employees stay fit, eat better, manage stress, and improve their sleep. Over 20,000 employees use this platform actively. In 2020, Fresenius Helios in Germany focused on the matter of maternity rights, with the work done in this area then implemented and standardized as one joint Occupational Health and Occupational Safety project across all hospitals. In addition, Helios Germany offers its employees activities to promote good occupational health – this includes offering employees the chance to use the company’s own fitness studios, and running back health courses and team events such as “Rowing against cancer” or company runs. The programs also cover topics such as healthy nutrition, relaxation techniques and healthy sleep. Due to the COVID-19 pandemic, the programs could not run as usual this year. Instead, Helios Germany has been offering employees the option of digital courses. The Helios PlusCard is a comprehensive supplementary insurance policy for all employees working for Fresenius Helios. It is also part of the company's occupational health management system.
Fresenius Vamed offers its employees occupational health care and health examinations at the company on an individual basis. Health management includes, for example, company doctors, occupational psychologists, vaccination programs, preventive examinations, workplace visits and assessment of possible psychological stress.
No Group results are available for occupational health and safety in fiscal year 2020. Although no effects can yet be reported at Group level, we report on the measures initiated in the reporting year and related progress in the business segments.
Fresenius Medical Care's goal is to prevent work-related illnesses and injuries. For this reason, the business segment tracks and analyzes work-related accidents and injuries at local and regional level, identifies their root causes, and implements corrective actions. As part of these activities, Fresenius Medical Care has introduced different performance indicators for occupational health and safety in its production sites and dialysis clinics based on local requirements. These indicators generally focus on work-related accidents, including the incident rate and lost time incident rate.
Experts in the global Environmental and Occupational Management department analyze and evaluate working procedures, risks, objectives, and occupational health and safety programs, and enable exchange about occupational health and safety throughout the company. Fresenius Kabi performs global internal audits at its organizations to identify potential for improvement. If necessary, the company develops measures to tap this potential together with local responsible persons. Due to the COVID-19 pandemic, audits have been conducted virtually in 2020. Quarterly telephone conferences with representatives from the certified organizations are held to foster exchange about work-related accidents and their prevention.
Qualified occupational health and safety specialists as well as occupational physicians check whether or not the requirements for occupational health and safety are met at Fresenius Helios in Germany. In addition, the requirements are regularly reviewed by supervisors from the German Institution for Statutory Accident Insurance and Prevention in Health and Welfare Services (BGW). In 2020, this was carried out, among other locations, at the Helios clinic Leipzig. Various audits, sometimes internal, of Fresenius Helios in Germany enable us to consistently analyze existing procedures, review processes and effectively improve the management of occupational health and safety. Working together with experts from the field of occupational health and hygiene, specific project groups monitor the management of occupational health and safety, coordinating continuously across segments and developing improvement processes. In addition, various audits of Fresenius, sometimes internal, enable a consistent analysis of existing procedures, process validation and effective optimization of the occupational health and safety management already in place.
All Fresenius Vamed locations are subject to regular occupational health and safety inspections. At Fresenius Vamed, work-related incidents must not only be reported, but they also trigger an audit of existing work processes as well as any proposed changes and implementation thereof. Corresponding internal guidelines are available.
Fresenius Kabi documents all accidents that lead to lost working time – worldwide and for all employees, including temporary workers. All reported cases are categorized according to their impact on an employee’s health and their severity. Furthermore, the local management assesses the documented cases to decide whether technical improvements, other working equipment or instructions, or further training are required to avoid future work-related accidents and improve occupational health and safety for employees. Occupational health and safety reports are submitted to the management board as well as other relevant functions of Fresenius Kabi on a quarterly basis.
Fresenius Kabi calculates the lost time injury frequency rate (LTIFR)1 from the data it collects and uses it as an indicator for occupational health and safety; the LTIFR improved by 12% compared to the previous year. Fresenius Kabi also considers the lost time injury severity rate (LTISR) in its analysis. No work-related fatalities were recorded at Fresenius Kabi in 2020; the company recorded 3 serious work-related accidents, which were mainly caused by employee behavior, for example not following work instructions. This has prompted additional preventive measures at the respective sites, e.g. training. In the reporting period, Fresenius Kabi saw only a limited number of COVID-19 cases at its facilities with no significant impact on production output.
|1 LTIFR: Number of work-related accidents with at least one day’s absence from work in relation to hours worked multiplied by 1,000,000.|
Fresenius Helios documents accidents locally and assesses the potential for risk associated with them, with a specific assessment carried out on-site, which is then discussed and assessed together with the relevant supervisory authorities. In Germany, hospitals use time management reports internally; these include downtime or absence periods and how these develop at the location. Various KPIs, including absenteeism and work-related injuries, are consolidated in a standardized system. Local accident figures are evaluated at every meeting held by the Health and Safety Committee. Based on this, a Helios clinic then implements measures to reduce absenteeism or to avoid accidents at work. The figures resulting from accident reporting aside, the main aim of coordination on-site is to monitor the effectiveness of risk assessments and to monitor the effectiveness of local occupational health and safety management systems.
Helios Spain collects data for preventive occupational safety on a monthly basis. The division has defined key figures to document absenteeism and accident rates as well as the status of compliance with important legal requirements at employee level. Each hospital in Spain reports monthly on the development of the key figures.
Fresenius Vamed documents locally all occupational accidents as well as all events that almost led to an accident. In addition, the human resources department reports all accidents with lost days (i.e. also accidents with less than 3 days) to the accident insurance. When incidents occur, it is essential to assess the existing hazards accordingly in order to prevent a recurrence. Risks must be minimized accordingly, which is why all incidents are subject to a structured evaluation by means of a root cause analysis including the corresponding improvement measures. These are prioritized in terms of technical, organizational and personnel criteria. The effectiveness of the measures is validated on site by the responsible local safety specialist. To ensure a holistically structured approach, a standard operating procedure has been implemented.
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