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Goals and ambitions

In our healthcare facilities, we focus on targets that consider quality of treatment and care, as well as patient satisfaction.

Besides quality of treatment, we also measure and control key performance indicators (KPIs) related to patient safety. Helios Germany has anchored the implementation of measures derived from liability cases in a focus target on patient safety for hospital management as well as chief physicians. This aims to promote the processing of patient-safety-related incidents and the development of preventive measures.

Helios sets company goals to measure the quality of treatment in its hospitals, using the España Inpatient Quality Indicator (E-IQI) methodology in Spain and the G-IQI methodology in Germany. These indicators are collected as metrics and are a quantitative measure that can be used to assess and evaluate medical quality. Each inpatient hospital treatment (inpatient case) is evaluated by making use of comparative measurements, with the benchmark being the German national average as calculated by the Federal Statistical Office or comparable national benchmarks in Spain. The target is in each case to be better than the national average for the respective indication. Further quality targets in our hospitals in Spain relate to patient satisfaction and are measured via the Net Promoter Score (NPS)Net Promoter Score (NPS)The ​Net ​Promoter ​Score ​is ​designed ​to ​ensure ​that ​Fresenius ​Medical ​Care ​maintains ​excellent ​patient ​relationships ​and ​that ​the ​patient ​voice ​is ​used ​to ​provide ​strategic ​insights ​to ​improve ​patient ​relationships. ​Improving ​the ​Net ​Promoter ​Score ​leads ​to ​better ​service, ​higher ​quality ​of ​care, ​improved ​quality ​of ​life ​and ​loyalty ​to ​remain ​with ​Fresenius ​Medical ​Care ​as ​the ​provider ​of ​choice., among other methods.

In the reporting year 2022, Helios Spain updated its patient safety strategy for the period 2023 to 2026, which is fundamental to various objectives and their improvement. It was expanded from seven to eight strategic line topics. It thus covers the most important fields of action of Fresenius Helios in Spain and Latin America to ensure that high-quality care is provided in the hospitals and that patient safety is guaranteed. New targets are: patient safety and digitalization, qualification and safety of specialists, as well as patient safety in specific health processes (pregnancy, birth, and postpartum period; time-dependent pathologies; fragile patients). The objectives add strategic relevance to the measures and processes already established for all the hospitals we manage in Spain.

Organization and responsibilities

The business segment Fresenius Helios is managed by the holding company Helios Health. Due to the different national regulatory frameworks and standards as well as differences in the business models, the responsibility for patient and product safety lies with the management of the individual divisions. The structure of the management approaches of the divisions is regulated within the respective managements, for example via a business allocation plan.

The task of the quality management steering committee in Germany is to coordinate the central steering processes of medical quality management and patient safety measures on a quarterly basis. Also on a quarterly basis, the medical management committees of the hospitals evaluate all reportable key figures together with the medical consultants. Reporting meetings are subsequently held with the steering committee on those facilities which report deviations such as suspicious quality indicators or reported cases relating to patient safety, in order to determine measures that still need to be implemented during the course of the year. These range from peer reviews at the hospital level, for example, to location-wide quality management measures at the corporate level, if necessary.

The leading physicians in their respective fields come together to form the total of 30 Helios specialist groups. They ensure that the knowledge of their medical specialty is anchored in all hospitals and represent this internally and externally. They also advise and decide on the introduction of standard processes, the selection of medical products, sensible innovations, and on campaigns. Furthermore, they discuss results from clinical trials and derive possible changes in treatment approaches from them.

The Chief Medical Officer (CMO) function at Helios Spain is responsible for the coordination of patient care and safety, as well as research. The function is supported by the Corporate Operations department, whose focus is on improving therapies and other healthcare offerings, as well as developing and marketing digital applications in the outpatient sector.

The CMO is also responsible for defining annual targets in the area of quality, as well as patient safety and satisfaction. These targets are included in the contracts both for directly employed doctors as well as contract doctors. As part of the annual performance evaluation, the responsible managers at Helios Spain assess whether and how the targets have been achieved.

Furthermore, the Corporate Risk Unit in Spain has been created to improve risk management within the Spanish clinic group. Measures are implemented and monitored by the Corporate Patient Safety Committee. It is responsible for implementing the central strategy for patient safety, which is supported by the aforementioned targets.

The medical departments of Helios Germany and Helios Spain exchange ideas and information on specific topics. For example, the German hospitals benefit from Helios Spain’s very close networking of outpatient and inpatient care, and can take advantage of this experience.

The CMO of Helios Health also coordinates synergy projects between the divisions in this area, as well as in the fields of medical quality and research.

Guidelines and regulations

In Germany, we had been engaged in the development of a quality management system in recent years with the aim of creating transparency regarding the quality of treatment results in the clinics and making them comparable. In 2008, Helios clinics joined forces with 14 other hospital operators to form the Initiative Qualitätsmedizin (IQM – Initiative for Quality Medicine). IQM is now the largest voluntary quality initiative in the German healthcare system.

Helios Germany applies the IQM management system and the related G-IQI in all German clinics. Newly acquired entities are integrated into this management system from the start of the acquisition. Further certifications encompass acknowledgment as centers of medical expertise, e. g., for oncology, diabetes, endoprosthetics, or other areas.

All hospitals and centers of Helios Spain are certified according to the ISO 9001 standard. They are also certified according to the Spanish Association for Standardization UNEUNEThe ​Spanish ​Association ​for ​Standardization, ​UNE, ​is ​the ​body ​legally ​responsible ​for ​the ​development ​of ​standards ​in ​Spain. ​It ​is ​the ​Spanish ​representative ​in ​ISO., (e. g., for surveillance, prevention, and control of infections as well as for patient safety) or according to other standards recognized in the hospital sector (e. g., according to to the standards of the Joint Commission International (JCI) and the model of the European Foundation for Quality Management (EFQM)).

Moreover, Helios Spain received the Gold Seal of the Joint Commission International Enterprise in 2022. This makes the company the first private hospital group in the world and the first operator of healthcare facilities in Europe to receive this award. In October 2023, Helios Spain’s certification was presented as best practice at the JCI Global Leadership Summit.

Quality standards Fresenius Helios

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  ISO 9001 IQM
Number of certified entities 49 86
Number of certified entities, in %1 94 100
1 % coverage based on entities for which the standard is of relevance. ISO 9001 applies to Spain only. IQM applies to Germany only.
Treatment quality

The quality management system at Helios Germany is based on administrative data (routine data) from patient treatments. The hospitals document each treatment step for later billing with the health insurance companies. This routine data shows whether the healing process took longer than expected, and whether complications or even a death occurred. It also indicates whether a treatment took a normal course or if mistakes were made. Mistakes are then reviewed in peer reviews, for more information, please refer to the following section. In addition, patients can access the publicly available information how often certain treatments are performed, among other things. This gives them important information on the doctors’ experience and routine and helps them to make their own decisions about their treatment.

Each clinic and each department receives a monthly report on the results of medical treatment quality. In this way, key quality parameters can continuously be monitored and, if necessary, countermeasures can be taken at an early stage. This data illustrates how the hospitals perform compared to the national average, to other Helios hospitals, or to IQM member hospitals.

Number of patients

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in millions 2023 2022 2021
Germany 5.5 5.5 5.4
Thereof inpatient 1.2 1.1 1.0
Thereof outpatient 4.3 4.4 4.4
Spain 20.3 19.4 17.1
Thereof inpatient 1.2 1.1 1.0
Thereof outpatient 19.1 18.3 16.1

In 2023, the number of patients in Germany remained at the previous year’s level. In Spain, the number increased by around 5% in the outpatient sector and by more than 5% in the inpatient sector.

Helios quality indicators

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  2023 2022 2021
Germany, G-IQI targets 2,099 2,223 2,228
Thereof achieved 1,862 1,933 1,935
Targets achieved, in % 88.71 87.0 86.8
Spain, E-IQI targets 453 45 45
Thereof achieved 23 262 282
Targets achieved, in % 76.71,3 60.02 62.22

Considering the individual G-IQI results of the clinics in Germany, 88.7%1 of the targets were achieved (2022: 87.0%). Around 21% of the clinics achieved a rate of 100%, a further 40% achieved a rate of 90% or betterIn Spain, 23 targets were achieved.In Spain, a target rate of 55.1% was achieved, based on the 45 total targets set.

1 The KPIs as part of the short-term variable remuneration (STI) of the Management Board are audited with reasonable assurance, as explained on pages 201 ff. in the independent practitioner´s report in the Group Non-financial Report.

2 Not audited.

3 The calculation of the success rate for the compensation is based on 30 of the overall 45 targets.

Peer reviews

Fresenius Helios analyzes the cases – including treatments and medical routines – in hospitals that fail to meet individual quality targets, in order to identify and implement improvements. Particularly important are the specific audit procedures in the medical and nursing sectors, and the peer reviews – expert discussions of cases. In Germany, trained physicians from the hospitals of Helios Germany and from the IQM network in particular cooperate in the peer review, and question statistical abnormalities. Their insights are translated into concrete recommendations for action in the hospital with the aim of increasing patient safety.

  2023 2022 2021
Germany 22 9 7
Spain 1 4 4
Patient safety and reporting systems

Fresenius Helios uses a reporting and learning system for critical events and near-misses of patients in all hospitals in Germany and Spain (Critical Incident Reporting System – CIRS). This is anonymous, can be used in all areas of a hospital site, and primarily serves the preventive protection of both patients and employees. Based on the information collected via the reporting system, potential errors in processes and workflows can be identified. Measures for improvement can be derived accordingly. In addition, one clinic at a time is subject to a safety inspection every quarter. In this way, risks relevant for the overall division are identified and can be avoided.

Patient safety reports

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  2023 2022 2021
CIRS reports 12,442 12,066 9,055
Thereof Germany 955 767 547
Thereof Spain1 11,487 11,299 8,508
1 All types of incidents are recorded via the Helios Spain reporting system, i. e., both risks and near misses as well as sentinel events.

Furthermore, a dedicated system is used to regularly measure patient safety at its hospitals. Fresenius Helios also has an obligation to report certain incidents of harm, which are categorized using Patient Safety Indicators (PSI). These include both internationally established and Helios’ own patient safety indicators. Examples of such reporting cases are mix-ups during an operation or unintentionally left foreign objects.

An important part of Fresenius Helios error management is the recording of allegations of treatment errors, justified or unjustified. These allegations include, to varying degrees, all specialties and all stages of treatment, from patient information, diagnostics, surgery, and therapy to aftercare. In our hospitals, we actively encourage reporting incidents, including dangerous or unsafe conditions and near misses, as a way of promoting patient safety. Helios Spain uses an online reporting system for all types of incidents, from near misses to sentinel events. Based on the definition from JCI, these are serious patient safety events that result in death, permanent harm, or severe temporary harm. The system is accessible for all healthcare professionals and hospital employees. The reported events are analyzed at least quarterly by each hospital Patient Safety Commission. Trends and causes are identified in order to implement the necessary improvements. This analysis is also recorded in the reporting system, and feedback is provided to the notifier. In 2023, a total of 11,487 incidents1 were reported (2022: 11,299). In addition, there were 17 of what are known as never events in the reporting year, which have a negative impact on the corporate goal of zero never events. These are easily preventable adverse events that can lead to particularly serious harm to patients. They include patient and lateral mix-ups, or foreign bodies left in the body after operations.

Clinical alerts are also an important tool used by the Medical Directorate of Helios Spain to prevent patient safety incidents. These are designed to inform hospitals of important information related to adverse events and the implementation of timely interventions. In 2023, four clinical alerts were sent to hospitals.

In Spain, we also worked intensively on the implementation of measures resulting from liability cases and reported incidents where there was room for improvement from a clinical practice and safety perspective. The aim is to promote the introduction of preventive measures in all hospitals in order to avoid the recurrence of such incidents. In this context, the Medical Directorate of Helios Spain organized sevenmeetings on patient safety and risk management in 2023 to share experiences. There is also a Corporate Medical Claims Committee that meets quarterly to analyze high-impact claims together with the medical directors of the hospitals involved.

1 Data excluding public hospitals in Spain, which are legally required to report to the respective district authority.

Hygiene management in hospitals

Hygiene management focuses on close monitoring of infections and pathogens, regular hygiene training for hospital staff, for example on correct hand disinfection, monitoring antibiotic consumption, and training physicians as antibiotic stewardship (ABS) specialists. The implementation of and compliance with hospital hygiene measures in the clinics is accompanied and monitored by our specially trained staff – e. g., hygiene specialist nurses, hospital hygienists, and hygiene officers.


Helios Germany has three simulation and emergency facilities in Erfurt, Krefeld, and Hildesheim. Among other things, surgical procedures or crisis scenarios in the operating room are trained there. In addition, such training courses take place in the clinics directly. In the fields of emergency medicine, anesthesia, intensive care medicine, and obstetrics, decisions on the content and number of participants in the mandatory training courses are based on resolutions of the respective specialist groups.

In Spain, training is provided on patient safety, quality management, and on topics that are essential in hospital routine. In 2023, various patient safety and risk management sessions were conducted in the hospital network of Helios Spain, over 1,500 people were trained. Furthermore, Helios Spain offers several online training courses on patient safety. They are mandatory for new employees and for those whose work is directly related to care. The exchange of knowledge amongthe hospital network should be promoted through interhospital clinical training and meetings, which cover the field of gynecology and obstetrics.

Patient information

Fresenius Helios provides information within its hospitals to its patients and their relatives about the patient admission process, if needed, with the help of the treatment contract, as well as special information documents and privacy statements. The therapeutic objective is discussed during admission and discharge discussions with the treating physicians. Throughout a hospital stay, nurses are an important point of contact and mediator for patients, their relatives, and medical staff.

Fresenius Helios communicates general focus topics via an online magazine, social media, its website, and in its communication campaigns for interested parties. In addition, information events on specific medical topics are held in all hospitals (known as patient academies). Further details on transparency in healthcare can be found in the Strategy and management chapter.

Patient satisfaction measurement and grievance processes

The business segment uses the Helios Service Monitor to measure the satisfaction of inpatients in its German hospital locations once a week. Employees on-site conduct short interviews on care and service. The anonymized results can currently be viewed individually by each clinic in a daily, weekly, or monthly cycle. The respective management of the hospital and other authorized persons receive the monthly survey results to obtain a general picture of satisfaction and to be able to identify areas of criticism. In addition, Helios Germany publishes the results of patient surveys, further data on medical treatment quality, and hygiene figures on its corporate website, see the menu item “Qualität bei Helios” (German language only).

Service Monitor Germany

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  2023 20221 20211
Number of patients surveyed 719,025 739,660 713,382
Share of all patients treated, in % 64 70 70
Satisfaction, in % 96 96 96
1 Not audited.

Typical points of criticism relate, for example, to food supply and cleaning, but also to issues such as communication between individual professional groups or departments. Statistically conspicuous results are examined by local management and measures are taken if necessary.

In Spain, Fresenius Helios uses the NPS to get specific feedback from patients who have been treated as inpatients, outpatients, or in emergencies. 48 hours after a hospital stay, an email is sent to patients asking if they would recommend the hospital and its services. The results are analyzed centrally and at a hospital level by type of treatment and treatment area. The goal is to continuously improve the NPS results.

Net Promoter Score (NPS) Spain

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  2023 2022 2021
Global NPS 60.1 56.3 49.9
Total reports 818,485 652,269 534,930

At the end of 2023, the growth of the NPS compared to the previous year was more than 5%, influenced by increases in the emergency departments.