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1 Capio Sanidad your health in good hands quality professionals patients Capio Sanidad your health in good hands respect safety trust Mª. de Molina, 54-6ª planta Madrid (España) Tel Fax Annual Report 2009

2 your health in good hands your health in good hands your health in good hands your health in good hands your health in good hands your health in good hands Capio Sanidad Capio Sanidad Mª de Molina, 54-6º planta Madrid (España) Tel Fax your health in good hands

3 Table of contents Letter from the President 1 1 Introduction Health care that makes no distinctions Capio Sanidad 5 3 Looking to the future New Public Hospital in Móstoles Capio Clínica Coreysa Vision, Mission and Values 7 Our figures 9 Organizational structure 10 2 Human Team Professionalism, respect, and trust Our greatest asset Human Resources Training Corporate Nursing Department Electromedical equipment Capio Sanidad in Spain Close to you Present in Madrid Present in Catalonia Present in Extremadura Present in Castile - La Mancha Centers for the elderly and the handicapped Corporate Marketing Department 25 Central Quality Division 29 Workplace risk prevention 33 Capio Sanidad Information systems and technology 37 your health in good hands

4 Letter from the President Letter from the President I would like to open this introduction to the 2009 Annual Report by expressing my gratitude to the more than 6,300 professionals that make up Capio Sanidad and carry out their daily tasks with a commitment to providing quality health care and the finest treatment for all who use our services. Over 30 million euros were invested in 2009 for new facilities, renovation projects to bring added comfort to our centers; thanks to initiatives like these, advanced technology can be used to search for less invasive and safer techniques to be used on patients, such as the new linear accelerator installed in Capio Hospital General de Catalunya. The solid foundation of a Group made up of prestigious hospitals such as the Fundación Jiménez Díaz, Capio Hospital General de Catalunya, or the Hospital Infanta Elena, have consolidated the Capio Sanidad vision. The company's potential for growth can be seen in the new projects that are being undertaken in 2010, like the new Public Hospital in Móstoles (under construction); the new Hospital de Collado Villalba, which Capio Sanidad will build and manage for the Community of Madrid; or the Capio Clínica Coreysa project in Castile-La Mancha. Initiatives like these reinforce the historic partnership between Capio Sanidad and the health-care institutions of the autonomous communities where the company is present. In the past year we performed over 1,400,000 consultations, saw 460,000 ER cases, carried out more than 100,000 surgical operations, and had over 340,000 hospital stays in our 26 care centers. Figures like these for 2009 make us one of the highest capacity health-care firms around. In addition to our care statistics, we have advanced in information systems, developed new applications which facilitate the care-giving process for professionals, increased ease of access for patients and other individuals, and generally devoted ourselves to continuous improvement in care processes, and to offering a clear and personalized relationship with patients as in the "Care and Caring" project. All these are key elements in moving forward in step with our vision for the future. I wish to thank all the institutions and enterprises that place their trust in us and work alongside our organization. In the coming year, Capio Sanidad will continue solidifying its collaborative efforts in order to offer the finest in treatment to all who require our services. We at Capio Sanidad know that the quality health care we provide is made possible by our professionals, cutting-edge technology, a capacity for innovation in management, and personalized treatment for all. Víctor Madera Núñez President and CEO of Capio Sanidad 1 2

5 1 Introduction Health care that makes no distinctions your health in good hands your health in good hands your health in good hands

6 Capio Sanidad Capio Sanidad The origins of Capio Sanidad go back to the firm formerly known as Grupo Sanitario IDC, which became a part of the European network the Capio Group in Capio, a company providing health-care services and management, has operations in 9 European countries: Germany, Sweden, Norway, Finland, Denmark, the United Kingdom, France, Portugal, and Spain. The Capio Group offers a wide range of services both on an appointment basis as well as emergency care. The company covers all medical specialties and its diagnostics program includes laboratory and radiology services. Over 16,000 people work in the company's more than 100 centers. Capio Sanidad is a leading company in provision of health-care services, which are rendered in its 26 centers located in 4 Autonomous Communities: Castile-La Mancha, Catalonia, Extremadura, and Madrid. Our work is done according to an Integrated Management Plan which includes all our centers and allows us to bring the finest in quality care to our patients. Capio Sanidad offers all medical specialties and has earned particular prestige for its work in diagnosis of cardiovascular disease and oncology due to the advanced resources provided by the company. Extremadura Madrid Castile - La Mancha Catalonia Capio Sanidad has earned a superior position for provision of quality health-care services, operating in hospitals, clinics, and centers for the elderly and the handicapped. We are firmly committed to finding partnership opportunities with healthcare authorities in order to improve medical care wherever it may be required. Our firm works with the primary mutual benefit and insurance companies. 5 6

7 Vision, Mission, and Values Vision, Mission, and Values Vision and Mission To offer quality medical and other health services while optimizing the use of resources. This way, we capitalize on the size and knowhow of the Group in order to bring the following added value: Our patients and clients receive the finest care possible, and we prioritize their needs, demands, and expectations at all times. Our staff feels satisfied and proud of the work they do and with a company like ours that allows them to develop personally. Attention focused on patients and clients Respect and empathy Innovation Our values Trust Benefit for society Values Attention focused on patients and clients. We never lose track of why we do what we do. Trust. Only by convincing those around us of our ability and willingness to excel will we attain our goals. Respect and empathy. Our work must be known for its sensitivity, its dedication, and its respect for individual integrity. Innovation. We search for employees with initiative, who find new paths for development and bring improvements to our different activities. Benefit for society. Our aspiration is to develop stable and satisfactory relationships with our clients so that our work may bring greater benefit to society. 7 8

8 Our figures Organizational structure The finest professionals, the most advanced technology, research, and training, and a common management model all back our commitment to quality health care for all citizens. Capio Spain Board of Directors Corporate management Operations management Information systems Professionals Centers Beds Stays 6, , ,944 Consultations ER cases Admissions Surgical procedures MRIs Radiotherapy sessions Hemodynamic monitoring 1,493, , , ,971 57,297 51,405 3,336 Purchasing and general services Nursing management Finance HR Communication Marketing Quality Managers of large and regional hospitals Hospitals - Clinics Polyclinics - Residences 9 10

9 Human Team Professionalism, respect, and trust 2 your health in good hands your health in good hands your health in good hands

10 Our greatest asset Our greatest asset Our professionals We believe that the knowledge and skills of our people are the only kinds of irreplaceable capital that Capio Sanidad has. This is why we gear our training programs to increasing the competencies of our staff with a view to enhancing the quality of the medical and preventive care we provide for our patients and society. Facilitating the development of those who work in our company is a priority, which is why we structure our training policy along two major lines: staff training and training for new professionals who join our organization thanks to our ties with universities such as the Universidad Autónoma de Madrid or the Universidad Internacional de Catalunya. Hospitals like Capio Fundación Jiménez Díaz and Capio Hospital General de Catalunya train medical students so that they will be able to complete their requirements to become doctors, nurses, and technicians

11 Human resources Human resources The competencies and involvement of all professionals are key elements in providing the kind of quality care that allows us to offer the most appropriate treatments for our patients and clients as a whole. This capacity sets down a stable and lasting framework for our relations with staff. The Capio Sanidad human resources policy adheres to the following bases: 1. Knowledge of our surroundings (within the company and beyond) 2. Active role in the company's plans and projects in order to determine human-resources needs, profiles, and competencies. 3. Collaboration among institutions so as to orient training initiatives to the needs of the changing landscape and fast-paced technological advancement of the health-care industry. 4. Support of clinical-management projects from a human-resources perspective: management by competencies, training geared toward covering the needs detected, adaptation of competencies and professional development, and the notion of quality understood as a process of continuous improvement. 5. H u m a n - r e s o u r c e s b e n c h m a r k i n g : knowledge, communication, and incorporation of best practices. 6. Communication as a key element: orientation plans for each center, informational newsletters, work groups, quality, scientific and technical committees, etc. 7. Relationships with entities of civil society that work in conflict mitigation so as to avoid litigation in labor relations. 8. Transparency and non-discrimination in policies regarding employment, promotion, and overall personnel management. 9. Balancing work and personal life. 10. Prevention of work-related risks and health management as a facet of the overall policy of the company and an essential element in the management of all our centers. Objetives: Recruitment of highly qualified professionals. Employee loyalty. Job stability. Providing open-ended contracts. Implementation and development of HR policies that provide equity and motivation for professionals, thereby promoting the ability to learn and to improve. Promote and consolidate the feeling of belonging to the Group. A human-resources strategy that is capable of adding both value and values to people and to the organization. Management geared toward optimum adaptation of human resources to the needs of the company. Reliable and flexible information systems that are integrated in the overall corporate framework. Responsiveness to the needs of the organization. Competency management

12 Human resources Human resources The lines of work addressed in 2009 are as follows: average staff: Nearly 6,000 professionals worked in our Group during the past year. The average number of staff increased by more than 500 as compared to previous year. 1,600 1,400 1,200 1, Doctors Average staff by category Residents Registered nurses Nurses aides Technicians Administrative staff Management Service/Department heads General services Degree-holding care workers Others 2.- Work has been done to attain job stability, and such efforts will continue in the future. In keeping with the principle of employment stability promoted by the Group's Human Resources Department, over 80% of staff works under open-ended contracts. 3.- Transparency and non-discrimination in employment practices, promotion and management of personnel, as well as the balancing of professional and personal life have undergone follow-up initiatives. 74% of the Group's employees are women. Workplace Equality Act 26% 74% % women % men During the past year, the Department worked on and updated the following: Employee orientation plans in each center. Efforts are being made to foster promotion and internal mobility as an incentive for employees and a source of motivation for the professionals that work in the Capio Group. During 2009, work has been done to improve performance assessment through objectives by distinguishing between activity-related and quality-related objectives both in careand non-care services. The Human Resources Department has participated in the implementation of a Shift-Management System (Aida). This program was first rolled out in the Hospital Infanta Elena in June 2009 and was later implemented in the Fundación Jiménez Díaz and in the Hospital Tres Culturas. The system is a tool for managing the shifts of mostly care-related personnel. Working alongside the Nursing and Systems Departments, Human Resources has created an interface between Milena and Aida in such a way that Aida receives all the information on an employee (e.g., personal information, contract, category, date of hire and date of termination of employment, etc.) and provides Milena with information on variable remuneration, such as shifts worked on nights, holidays, duty shifts, etc. Active participation in the implementation of processes to bring quality to the centers, and support provided for the Quality Department. Development and implementation of the Milena program in new centers and associated operations, such as Capio Servicios

13 Training Training We at Capio know that our most valuable asset is our employees. Since staff are a pillar of our operations, we design our continuing training program as a process of constant individual development and a commitment to promoting the excellence of the Group's professionals. Training is another of the pillars which are put into action by means of efficient communication of the initiatives which take place, and appropriate content adapted to the needs of each position within the company. A list is compiled of general areas of training in which concrete proposals are collected according to the needs and deficiencies detected during both overall and individual performance assessment. All these efforts have led to more than 48% of professionals having received training under the Training Plan or the Development and Skills Updating Plan which was implemented in This year, the professionals of Capio Sanidad have been trained to use the tools acquired to continuously improve patient care. In the coming years, this will continue to be one of the top priorities within the corporate training policy

14 Corporate Nursing Department Corporate Nursing Department The Corporate Nursing Committee holds a firm belief in the need to foster the image of nursing professionals as a key element within Capio Sanidad by searching for an overall identity of this group that is able to adapt to the specificities of each center. Medical records Work module: women and infants This was one of the most salient improvement initiatives undertaken in the electronic clinical record system. It is the result of an integrated vision of the needs of all the professionals providing care for mothers and their babies throughout pregnancy, delivery, and in the first hours of motherhood (mothers) and new life (infants). Corporate quality indicators These allow us to identify, name, and differentiate our realm of responsibility within the global care received by patients. Thanks to this initiative, we can also measure, evaluate, and identify areas needing improvement, and perform comparisons of these responsibilities. We have continued in the efforts undertaken in previous years by revising the definition of indicators and improving the way they are used. Updating and training Our team includes supervisors and nursing professionals with expertise in the management of medical records. These individuals lead the training programs held in the centers and manage the updating process of the systems. Continuity between levels of care This is a necessary objective for centers that provide health care within the public health network for an assigned population. It is a strategic coordination initiative between the different providers of care and the possible courses it may take. Implementation of the shift-management program A computerized shift-management program has been introduced which allows for: Design of annual planning schemes by unit and by employee. Creation of hour-by-hour rotation patterns. Replenishment and maintenance of staff (i.e., entry, exit, and movements). Update incident log. Management by competencies Identification and definition of the Positions Catalog: Selection and stratification of the competencies needed, as described in the Dictionary of Competencies. Creation of competency profiles associated to the work positions, called Position Profile Matrix. Finally, the establishment of criteria for performance assessment

15 Electromedical equipment Electromedical equipment Optimal control and management of our medical equipment allows us to provide our professionals with the most advanced technology in the industry. In order to optimize diagnostic and therapeutic capabilities, our electromedical equipment and advanced technology is updated constantly. With an average age of 6 years, the technological equipment that is at the disposal of Capio Sanidad includes: By carrying out global management of all our centers, use of equipment is kept at optimal levels, thus helping make Capio Sanidad a leader in the field of electronic equipment. The Electronic Equipment and Advanced Technology Department gives us the ability to raise the bar on quality in terms of the management of our equipment. The finest equipment leading to the best in care. Technological resources Number of machines Magnetic resonance 14 Multi-slice CT scanner 12 Radiotherapy multi-slice CT scanner 2 Digital hemodynamics equipment 4 Digital vascular equipment 4 Digital mammography system 1 Digital remote control x-ray system 6 Lithotripsy machine 1 Gamma camera 4 Linear accelerators 5 Cobalt-therapy units 1 Conventional simulators 1 Radiation therapy planning 3 Brachytherapy 1 TOTAL 59 In 2009, Capio Sanidad made investments in Advanced Technology totalling over 9 million euros. Renovation and investment 1.5 Magnetic resonance system Multi-slice CT scanner Remote control x-ray Ultrasound Gammacamera Digital Vascular Number of machines TOTAL Electromedical equipment plan for new centers Equipment Department Development and implementation of corporate purchasing policies Technological audits in all Centers Improvements have been seen in management, installation, and updating of advanced technology, thereby achieving integrated management of all of the Group's hospitals

16 Corporate marketing department Corporate marketing department The fundamental goals of the Marketing Department are to serve Capio Sanidad hospitals by designing tailored marketing and communication plans and initiatives. These measures support the activities of the centers so as to fully develop the brand and its professionals both within and beyond the organization. Support for Corporate Management and the departments that make up Capio Sanidad to increase brand recognition. Corporate plan for establishing and disseminating the brand Throughout 2009, the Marketing Department has continued in its effort to progressively establish the Capio brand in all our centers. Also, the Corporate Communication strategy has helped to create a single visual identity for the company to represent all our professionals. To this end, a number of communication materials have been developed for specialist publications as well as mass media, including manuals, pamphlets, videos, and advertising campaigns. nuestro trato: respeto y confianza Capio Sanidad tu salud en buenas manos Nuestros Centros Albacete, Capio Clínica Albacete - Capio Residencia Alcábala - Capio Residencia La Manchuela - Residencia El Jardín Residencia Vasco Núñez de Balboa - Residencia Paseo de la Cuba - Badajoz, Capio Clideba - Capio Hospital Santa Justa - Capio Policlínica Clideba - Barcelona, Capio Hospital General de Catalunya - Cáceres, Capio Virgen de Guadalupe - Ciudad Real, Capio Clínica Ciudad Real - Capio Clínica Alcázar - Capio Policlínico Puertollano - Capio Residencia Dulcinea - Residencia Los Jardines - CRDP Guadiana II - Guadalajara, CADP La Chopera - Madrid, Capio Fundación Jiménez Díaz - Hospital Infanta Elena - Capio Hospital Sur - Capio Clínica Alcalá de Henares Toledo, Capio Hospital Tres Culturas - Capio Clínica de Talavera. más de profesionales y 24 centros cerca de ti Capio ghospital General de Catalunya AZINE nº 10 Julio 2009 Ma Andoni Zubizarreta "Cuidar-me i portar una vida sana m'ha permès tenir una llarga carrera esportiva" Capio Fundación Jiménez Díaz ImPULSO nº 17 - Diciembre 2009 La Revista de la Fundación Jiménez Díaz HOMENAJE AL PROFESOR JOSÉ MARÍA SEGOVIA DE ARANA Premio Top 20 IASIST para el Área de Respiratorio El Dr. García Santos-Gallego, Residente de Cardiología de la FJD, recibe el premio Sanitas al MIR del 2009 Éxito en proyectos solicitados y concedidos por el FIS este año a la investigación de la Fundación Jiménez Díaz El Servicio de Transfusión recibe el certificado de calidad AENOR Corporate magazines The design and content of the corporate magazines have been updated: ImPULSO. Magazine of Capio Fundación Jiménez Díaz. Capio Magazine HGC. Magazine of Capio Hospital General de Catalunya. Both publications are a pleasant, personable mechanism for keeping both patients and professionals informed on the developments, renovations, and new services of our hospitals. Local efforts have accompanied new services and facilities during opening and dissemination phases. Public relations Professional conferences and seminars have supported our professionals as they further knowledge on new techniques. These events bring together a sizeable number of top-level specialists. Internal communication Communication initiatives have been strengthened through each center's intranet, thus increasing the number of new items and relevant information that has been made accessible to all employees. Direct marketing initiatives have been carried out in the form of periodic informational newsletters as well as internal bulletins adapted to the different employee profiles working in Capio Sanidad

17 Corporate marketing department Corporate marketing department Capio On line During 2009, the on-line employee recruitment channel has been improved within our corporate web platform. The past year also saw the introduction of the on-line appointment service, though which patients can more comfortably choose times to see their doctors. We carried out an active campaign using newsletters and search engine optimization. Such measures have brought the number of visits to 440,000, producing over 1,740,000 page views. As part of the project to support the Capio Sanidad nursing professionals and in conjunction with the Corporate Nursing Department, an individual Web site has been devoted to foster communication, development, and visibility for our nursing professionals. This Web site has been visited over 67,000 times. Patient help center and satisfaction Together with the Patient Help Center, measures have been put in place to establish ongoing satisfaction surveys for our new patients through FBA Consulting, an independent organization that works anonymously. In 2009, over 70,000 surveys were completed under the Satisfaction Improvement Program that was begun in

18 Central Quality Division Central Quality Division Among other responsibilities, the Capio Sanidad corporate quality department, known as the Central Quality Division, is charged with implementing and continually updating the Group Quality Plan. For this, the Division reviews and promotes the implementation of basic common quality indicators and supports the process for obtaining external quality certifications. Featured project Implementation of an integrated quality- and environmentalmanagement system for the Hospital Infanta Elena de Valdemoro: The Central Quality Division introduced the UNE EN ISO 9001:2008 standards (quality-management systems) as well as UNE EN ISO 14001:2004 (environmental-management systems). This project was carried out alongside the company's management team as well as the corporate quality coordinator: Weekly tutorials with process stakeholders. Training initiatives on quality and environmental management. Environmental-awareness campaigns. Full internal audits. Audits on specific aspects upon request of the Health-Care Administration (e.g., medical records, employee identification). Projects initiated in 2009 Development of a quality-management tool: The Central Quality Division, in close collaboration with the Capio Sanidad Systems Department, has begun development of a computerized tool to manage quality. This tool is to simplify document updating and process control, establish objectives, or help in the introduction of preventive, corrective, or improvement measures. Implementation of the quality-management system in Capio Clínica Alcázar (Alcázar de San Juan): In this center, the Capio Sanidad quality-management system has been successfully introduced, thus allowing for the clinic to obtain total certification under UNE EN ISO 9001:2008 standards in

19 Central Quality Division Central Quality Division Introduction of the quality-management system in the Capio Hospital General de Catalunya pharmacy service: This center, which previously obtained certification by the Catalonian local government according to its proprietary standards based on the European EFQM model, has begun preparing for ISO 9001:2008 certification. Due to the success of this process, the service will have the opportunity to undergo a certification audit by AENOR to assess its adaptation to the ISO standards in Projects continuing in 2009: 5th annual Quality Conference: For the fifth straight year, the Central Quality Division held a Quality Conference in order to share experiences among centers. Congress of the Spanish Society of Care Quality: In the 27th installment of this conference organized by the Spanish Society of Care Quality, the Capio Sanidad Central Quality Division made the following presentation: "Follow-up and assessment of a quality-management system in a healthcare group." The multi-center nursing group also made a presentation focused on Capio Hospital General de Catalunya and the Fundación Jiménez Díaz-Capio. UNE-EN ISO 9001:2008 Quality Certifications: In 2009, a total of 12 Capio Sanidad medical or socio-health care centers underwent AENOR follow-up or renewal audits. These audits gauged the centers' adaptation to the ISO 9001:2008 standards, and the processes were successful. Also of note is the newly certified transfusion servicehematopoietic transplantation laboratory, providing blooddonation services, apheresis, and hematopoietic stem cell storage (Fundación Jiménez Díaz-Capio Immunohematology Laboratory). Others: Internal audits of all centers (acute and socio-health care). Revision and update of basic indicators in acute-care centers. Beginning of the process of designing protocols for the Fundación Jiménez Díaz-Capio Genetics Laboratory with a view to ISO certification in quality management for the laboratory

20 Workplace risk prevention Workplace risk prevention All the prevention work done at Capio Sanidad is guided by the WORKPLACE RISK AND PREVENTION PLAN, a tool which integrates all preventive processes and establishes a policy for this area. New centers Implementation of the Workplace Risk Prevention Plan in all new centers: CADP La Chopera, Residencia Paseo de La Cuba, and Residencia Vasco Núñez de Balboa in Albacete. Employee interviews and participation This was carried out through the Safety Delegates and the Safety and Health Committees of each center, which served as representatives of all the employees. Ensure proper representation and participate in the meetings of the Safety and Health Committees at least quarterly. Initial or periodic assessments of workplace risks All new centers have undergone primary assessment. All newly created posts in a number of Capio Sanidad centers have also been assessed for workplace risks. Periodic review of positions due to a change in the position's responsibilities. Periodic review of pregnant employees as communicated in pregnancy reports. Periodic review of positions due to other causes. Reporting, logging, and investigating workplace accidents All workplace accidents are reported, logged, and investigated: Causing a leave of absence, no leave of absence, in the workplace, on the way to and from work, during the performance of work. Summary of workplace accidents occurring in 2009 and comparison with 2008 figures 2008 average staff: 2, average staff: 2,554 Staff increase: 439 Accidents causing a leave of absence in 2008: 121 Accidents causing a leave of absence in 2009: 113 Decrease in accidents:

21 Workplace risk prevention Workplace risk prevention Implementation of emergency and/or self-protection plans in Capio centers: 2009 Some of the objectives set for the Department in 2009 included ensuring that an updated Emergency and/or Self- Protection Plan was in place, and advising centers on implementation programs such as the following: a) Designating emergency-response teams. b) Providing hands-on training. c) Making the plan known through information on general and/or specific emergency measures. d) Emergency drills. Information and training in prevention: INFORMATION FOR EMPLOYEES ON PREVENTION: Each employee is given a list of risks for his or her specific post, which informs workers on what to look out for as well as ways of preventing and/or protecting themselves from such risks. Creation of informative publications for each group of employees: 2009 Prevention signs for handling of chemical products. 2. EMPLOYEE PREVENTION TRAINING: All centers held courses on workplace risks according to the needs detected by the Prevention Service and/or the center itself. These courses handled such topics as accidents, legal requirements, untrained employee groups, specific risks, etc. Center Number of courses Number of training initiatives Capio Hospital Sur 6 Capio Clínica Alcalá Hospital Infanta Elena Capio Clínica Ciudad Real / Policlínico Puertollano CRDP Guadiana II Residencia Los Jardines, Manzanares Capio Hospital Alcázar Capio Residencia Dulcinea Capio Hospital Tres Culturas Capio Clínica Talavera Capio Clínica Albacete Capio Residencia Alcabala Capio Residencia La Manchuela Residencia El Jardín Higueruela Capio Clínica Clideba Capio Clínica Virgen de Guadalupe Capio Hospital de Santa Justa Residencia de Mayores Nuñez de Balboa Number of participants

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