Read the Conversation
EF: What are Netcare’s current priorities as you head towards retirement?
RF: We are on a 10-year strategy to transform healthcare. Healthcare is broken in our country and globally, both in the public and private sectors. Our journey over the past 6 years, with the 7th approaching next year, has been dedicated to completely revolutionizing healthcare delivery. Our strategy focuses on delivering person-centered health and care that is digitally enabled and data-driven.
The first phase of our strategy involved digitizing our entire network, including 49 hospitals, over 60 primary care centers, and other facilities like emergency services and 14 mental health hospitals. Our extensive digitization efforts aim to empower people with their healthcare, improve outcomes, and enhance longevity, focusing on health span rather than just life span. Addressing non-communicable diseases requires a different approach than acute illnesses, where treatment is swift and direct. It’s crucial to provide patients with access to their medical records. Our comprehensive digitization strategy covers all aspects of healthcare delivery.
We have implemented an advanced, mobile-friendly solution allowing doctors to access patient records remotely, whether at a restaurant, community event, or home. This mobility ensures they can promptly respond to emergencies and manage crises effectively, enhancing patient care and safety. This comprehensive digitization effort, completed earlier this April, ensures that doctors can access patient records securely from anywhere, using mobile devices like iPads. We are now the largest single user of iPads in southern Africa, with over 13,000 users, and we collect over 41 gigabytes of clinical data generated daily. We have 29,000 users of our system, and at any one time, there are over 4,100 people accessing records.
Now, we are advancing into the second phase of our strategy, focusing on digital enablement and data-driven healthcare. This phase centers on enhancing clinical efficiency by redesigning pathways, improving patient safety, and achieving superior outcomes. A critical component is implementing a large-scale database to organize and analyze our data. Scheduled for completion in December of this year, this database will serve as the foundation for our ambitions to become a research leader in South Africa.
EF: How are generative AI and other advanced technologies leveraged to transform healthcare delivery and research in South Africa?
RF: Beyond data organization, the database integrates generative AI, natural language processing (NLP), and other advanced technologies. This setup empowers doctors to conduct research using anonymized data while ensuring stringent protection of personalized information. These innovations are poised to transform our approach to healthcare delivery and research, driving advancements in patient care and medical understanding. This positions us to become a research powerhouse in South Africa.
Our final phase over the next three to four years will concentrate on person-centered care. Person-centered healthcare shifts the focus from simply diagnosing and treating medical conditions to understanding and addressing what truly matters to the patient. Instead of solely asking about the medical issue, a person-centered approach prompts healthcare providers to inquire about the patient's broader goals, values, and preferences. It’s not what matters to you, but what matters to you.
In mental health services, we want to understand what matters to our patients. This way, healthcare providers can better tailor treatment plans and interventions to align with patients' priorities and aspirations. This approach acknowledges each patient's unique circumstances and preferences, aiming to improve overall well-being and quality of life beyond medical symptom management alone, monitor their progress throughout their stay, and identify the milestones they need to achieve to reach their personal goals. This holistic method is what defines person-centered health and care. We are committed to this journey, which will span approximately four years.
EF: What findings can you share in terms of how patients got more engaged and improved outcomes through digitization?
RF: In National Renal Care, where we provide dialysis to patients with end-stage renal disease, we gave people their records, and I thought we had hit the jackpot and succeeded. However, less than 5% of patients downloaded their records. We then brought in behavioural experts and asked our patients if it mattered to them to know they only had a 40% chance of living for the next five years due to end-stage renal failure and dialysis. Naturally, it does matter. We also asked if it would be important to them to know that we measure five or six factors every week using a traffic light system (green, amber, red) that could improve their quality of life and longevity. If these metrics improved, so could their quality of life and longevity. Of course, this matters to them. Many people now download our app, which measures these factors weekly.
From 5% of patients who downloaded the app, we went to 95% of patients who downloaded the app. This is the difference between engaging people in what matters and what is the matter with them. The app shows patients their status with end-stage renal failure, but more importantly, it addresses what matters to them: living longer and having a better quality of life. Given the chance to improve these aspects, patients are eager to download and engage with the app, spending between 14-21 minutes on it. For the first time in 20 years of running various initiatives to improve outcomes, we see significant improvements in two critical clinical measurements for our renal patients. We aim to publish this data early next year.
EF: Netcare has always been innovating and improving. Could you elaborate on how you have been positioned as a leader?
RF: Our philosophy follows the INSEAD School of Business's "Blue Ocean Strategy." This strategy, outlined in their published book, suggests that most companies and CEOs focus too much on competitors and similar products, resulting in fierce competition over the same market, which they call a "red ocean." This is akin to sharks feeding off the same limited resources. In contrast, the "blue ocean" represents uncontested markets, fostering innovation and new ideas in a space filled with more opportunities and less competition. At Netcare, we embrace this blue ocean philosophy. Rather than accepting existing market structures, we aim to break them and develop something innovative and different. Much of what you hear from us aligns with this approach.
Before our digitization transformation, we completed a decade of work on environmental sustainability, where we are now the world leader. We've won over 37 awards and are recognized by the Global Green Hospitals Association, which includes over 43,000 hospitals and 1,700 hospital groups. We have been awarded the top spot globally for environmental sustainability. We started our sustainability program in 2013, reducing our energy footprint by 39% and have one of the largest solar footprints in South Africa.
We are now moving towards wind energy, aiming to be completely carbon-free by 2030, achieving zero waste to landfill, including healthcare risk waste, and reducing water usage by at least 20%. With enabling legislation, we could reduce our water usage by 60% by utilizing Blackwater plants. Before terms like ESG became popular, we were leading in environmental sustainability. We are also at the forefront of digitization on the continent, heavily investing in AI, predictive models, and data analytics, which we believe are the future of healthcare.
Our approach has always been to swim into the blue ocean, focusing on innovation and creating uncontested market space rather than competing in the red ocean.
EF: How are you breaking down the digital divide barrier and ensuring that medical professionals are well-trained to use new digital tools?
RF: The project had two major risks. It was the biggest risk we had ever undertaken, as distributing over 10,000 iPads to nurses who had never used computers presented an educational challenge. Additionally, many doctors were resistant to change. We implemented a comprehensive change management program, where nurses would first get familiarized with the iPad through apps, including games such as Candy Crush.
Doctors have been more challenging to convince. We measure our statistics and aim for at least 80% compliance with digital records, including issuing orders and prescriptions. We were the first to design digital prescriptions in South Africa, setting the benchmark in 2020. Doctors have adapted, and we no longer use paper in our hospitals. When a patient comes in again after several months or years, the doctor can instantly access their records without rummaging through storage.
We have a lot of innovation in our group, which is crucial for safety. Sixty percent of drug errors in hospitals are caused by nurses being unable to read doctors' handwriting. Digital prescriptions eliminate this issue. We handle 1.8 million scripts, so there’s a significant safety element. We are swimming in a different ocean, where we don’t have competitors. Our company-wide digital strategy focuses on person-centered health and care, which is digitally enabled and data-driven. We are now in the data-driven phase, leading to truly person-centered care.
EF: What achievements would you be most proud of when you retire?
RF: I have been here since the start when only 18 of us were in management. We now have more than 18,000. We have built this company together. We are on a journey to transform healthcare meaningfully. Never forget to treat people with dignity and respect and uphold the sanctity of life. No matter how advanced our technology is, if we fail in this, we fail as healthcare workers.
During COVID, we treated over 160,000 people and lost 75 of our frontline heroes, our nurses, doctors and paramedics. Our mission is to treat people with dignity and respect at their most fragile moments. We want to partner with our patients in their wellness and healthcare. This journey is a team effort, not a personal achievement. Our team is passionate, and I have no doubt they will carry this forward.
Netcare started with eighteen people in our head office, four hospitals, and one clinic. We are the largest healthcare provider in South Africa, with 49 hospitals, about 10,000 beds, 14 mental hospitals, and 73 renal centers. Our annual report reflects our significant growth. It is not about being the biggest; it is about treating people with dignity and respect and upholding the sanctity of life. We must view everyone with equal rights.
