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    Media Hub To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor SEPARATE GROUP NON-FINANCIAL REPORT 107 Strategy and management 151 Diversity 151 Diversity and equal opportunities 111 Well-being of the patient 111 Access to health care and medicine 154 Compliance & Integrity 115 Patient and product safety 154 Compliance 160 Data Protection 164 Human Rights 126 Digital transformation and innovation 167 Supply Chain 126 Digitalization and innovation 129 Cybersecurity 169 Environment 171 Water management 133 Employees 173 Waste and recycling management 133 Working conditions, recruitment and employee participation 175 Climate protection – Energy and emissions 140 Employee development 178 Environment – Progress and measures 2020 146 Occupational health and safety 181 Report profile 182 Limited assurance report of the Fresenius | Annual Report 2020 independent auditor 3 106


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor SEPARATE GROUP NON-FINANCIAL REPORT. We are committed to responsible and sustainable management as part of our corporate culture and day-to-day business practice. We place great importance on fulfilling our legal and ethical responsibility as a company. Only by doing so can we be perceived as a trustworthy and reliable partner in the health care sector. STRATEGY AND MANAGEMENT of intensive care beds and ventilation stations. In addition, to enable a growing number of people to have access to the dialysis centers were able to continue to provide safe high-quality, affordable medicine. In conclusion, it is our goal As a health care Group with more than 300,000 employees, treatments, even for kidney patients infected with COVID-19. to contribute to medical progress. Fresenius plays an important role in society. For more than We have consistently ensured the supply of our vital medi- In our Code of Conduct, we commit to integrity in deal- 100 years, our mission has been to preserve life, promote cines, medical devices and services for critically and chron- ing with our business associates as well as to socially health and improve patients’ quality of life – as defined in our ically ill patients. responsible behavior and transparent communication. The company objective – better medicine for more people. The For Fresenius, economic success is not an end in itself, Fresenius Code of Conduct defines basic principles that importance of modern and functional health care for society but a means of continuously investing in medical progress. apply to all employees, executives and the management of Fresenius | Annual Report 2020 became particularly clear in 2020 as a result of the COVID-19 The patient’s well-being always comes first. It is our point the Fresenius Group. It also sets out the framework for pandemic. Our employees worldwide have continued to work of reference for all business decisions. The common goal of the relevant regulations of the individual business segments, tirelessly and under sometimes difficult conditions – in all business segments is to improve health care quality and clinics, dialysis centers, factories and logistics. In acute care, efficiency. In line with our commitment to the future – for- for example, we have significantly increased the number ward thinking health care to improve the lives of patients – we aim to provide innovative solutions and work proactively 107


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor and defines our respective activity areas. Further information align our sustainable actions closely to the United Nations on a quarterly basis at Group level by the corporate functions can be found in the section Compliance and Integrity on Global Compact and the sustainability requirements of Corporate Compliance, Group Controlling and Investor pages 154 f. the capital market. Further information is available on our Relations & Sustainability of Fresenius SE & Co. KGaA and sup- website. plemented if necessary. In the reporting year, we identified ▶ We take responsibility for our patients’ well-being and potentially relevant sustainability risks that we would like to are committed to the highest quality in our products, THE BUSINESS MODEL review regularly in the future, including climate change, treatments and services. Fresenius is a global health care Group and one of the leaders water scarcity, and human rights violations, among other ▶ We want to do the right thing and comply with all appli- in the respective markets. The Fresenius Group comprises risks. In the future, we intend to record and assess sus- cable rules and laws. In addition to legal requirements, four independently operating business segments: Fresenius tainability risks across the Group in a more harmonized we adhere to high ethical standards and rules of good Medical Care is a worldwide leader in the treatment of approach together with financial, legal and compliance risks. corporate governance. chronic kidney failure. Fresenius Helios is Europe’s largest This will enable us to achieve an integrated view of our ▶ We largely owe our success and growth to the commit- private hospital chain with clinics in Germany, Spain, and impact on the issues (inside-out perspective) on the one hand ment of our more than 300,000 employees worldwide. Latin America. Fresenius Kabi provides lifesaving medicines, and the impact of the issues on Fresenius (outside-in) on Our aim is therefore to be perceived as an attractive medical devices, and services for the critically and chron- the other. This allows us to assess their short-, medium- or employer to acquire talent, retain employees and allow ically ill. Fresenius Vamed specializes in health care facilities long-term financial impact as well as their impact on society them to develop their skills further in the long term. projects and service business. They are managed by and the environment. In the area of human rights, we have ▶ We think and act long-term in our business decisions. It Fresenius SE & Co. KGaA. The Group Management Report on already started to do this. Further details are provided on therefore goes without saying that we protect nature as pages 37 ff. contains additional information on the Group’s pages 164 ff. of this Non-financial Report. the basis of life and treat resources with care. business model and ownership structures, on legal and eco- In 2020, we did not identify any material non-financial ▶ We are committed to respecting human rights as defined nomic factors, as well as key sales markets and competitive risks, taking into account risk mitigating measures (net risk by international standards, such as the Declaration of positions. assessment), related to our own business activities, busi- Human Rights of the United Nations. ness relationships, products or services that are very likely SUSTAINABILITY RISKS to have an adverse effect on the non-financial aspects We analyze the impact of our actions with the help of the The identification and assessment of potential sustainability mentioned above or on our business operations. The Group 17 Sustainable Development Goals (SDGs) of the United risks (non-financial risks) initially takes place at both the Management Report on pages 88 ff. contains further infor- Nations. A particular focus is on the goals of good health and Group level and in the four business segments via the exist- mation on opportunities and risks as well as a detailed pre- well-being (SDG 3), high-quality education (SDG 4), and ing risk management system. For this purpose, sustainability sentation of risk management. decent work and economic growth (SDG 8). In addition, we risks are assessed that are already covered by the existing Fresenius | Annual Report 2020 risk catalogs and risk reporting of the Fresenius Group. In an additional step, potential sustainability risks are discussed 108


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor OUR SUSTAINABILITY GOALS FRESENIUS GROUP SUSTAINABILITY ORGANIZATION We pursue specific sustainability approaches at the level of the four business segments and Fresenius SE & Co. KGaA. To this end, the business segments each build their own Group Sustainability Board Group Management Board Supervisory Board (GSB) sustainability programs and regularly review how they can supported by Chair: Stephan Sturm – CEO Stephan Sturm – CEO audit firm further develop and optimize them. Fresenius Medical Care’s Global Sustainability Program Information exchange and progress report Management control Audit reflects the growing requirements for sustainability man- agement and the company’s commitment to continuously Group Sustainability strategy improve its performance. It defines global targets for Investor Relations & facilitates Group-wide eight focus areas in the period from 2020 to 2022. These are collaboration Sustainability Reporting derived from the results of a materiality analysis that coordinates and supports Fresenius Medical Care carries out to identify the most rele- sustainability Officers vant sustainability topics for its business. The eight focus areas are: patients, employees, anti-corruption and bribery, data protection and privacy, labor and human rights, sus- tainable supply, environment, and occupational health and safety. The overall objective of the program is to establish common global standards, goals, responsibilities, and key performance indicators for our sustainability performance. Fresenius Helios, Fresenius Kabi and Fresenius Vamed At Group level, we discussed in 2020 the extent to which Fresenius SE & Co. KGaA. The Group Management Board is are in the process of establishing and planning independent we can integrate sustainability into our Management Board regularly informed about sustainability issues by the Inves- sustainability programs. Helios Germany developed its compensation system. Our approach provides for the tor Relations & Sustainability department of Fresenius own sustainability initiatives in 2020 on the basis of material incorporation of sustainability targets and key performance SE & Co. KGaA. The Management Board and the Supervisory topics and requirements and followed a guiding principles indicators into the short-term variable compensation of Board review the progress and the results of the sustain- process (see also Sustainability Report Helios Kliniken 2019). Management Board members from 2021 onwards. We aim ability management, which are then published in the separate In the reporting year, Fresenius Kabi discussed on Manage- to systematically drive forward the core activity areas Group Non-financial Report. The Supervisory Board is ment Board level how the company’s sustainability efforts across the Group. supported in this process by the auditor’s limited assurance Fresenius | Annual Report 2020 can be further improved. engagement. Investor Relations & Sustainability coordinates OUR SUSTAINABILITY ORGANIZATION the implementation of sustainability guidelines and standards Sustainability at Fresenius is the responsibility of the CEO at operational level and is responsible for the non-financial of Fresenius Management SE, as shown in the overview reporting of the Fresenius Group. Corporate Compliance is above. Fresenius Management SE is the general partner of responsible for our Code of Conduct and manages issues 109


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor MATERIAL CLUSTERS AND TOPICS IN ACCORDANCE WITH GERMAN COMMERCIAL CODE (HGB) SECT. 289C (3) THE GROUP SUSTAINABILITY BOARD In 2020, the first two meetings of the Group Sustainability Board (GSB), which was introduced in 2020, were held Social matters Employee matters Combating corruption Human rights Environmental matters under the leadership of CEO Stephan Sturm. The Group and bribery Sustainability Board is composed of those responsible for sustainability at Group level and in the business segments and is scheduled to meet every two months. Well-being of the patient Employees Compliance & Integrity Diversity Environment The Board discusses the future sustainability strategy Access to health care Working conditions, recruit- Compliance Diversity and Water management of the Fresenius Group. The overall goal of the GSB is and medicine ment & employee participation equal opportunities to identify the most important sustainability issues for the Patient & Product safety Employee Data protection Compliance & Integrity Waste and recycling Group and to strengthen intra-Group cooperation. development management Digital Transformation Occupational health Human Rights Climate protection OUR MATERIALITY ANALYSIS & Innovation and safety We identified our main topics in accordance with the HGB Digitalization in a multi-stage process in the reporting year. Material in this & Innovation respect are those aspects that are relevant for understand- Cybersecurity ing Fresenius’ business performance, results of operations, and position, as well as for understanding the effects of its Supply Chain own business activities on the non-financial aspects. The key topics for the Fresenius Group are explained separately Material aspects according to HGB Material cluster Material topic based on the way they are managed in the individual busi- ness segments. On topics such as data protection, cyber- security, compliance, and human rights, we report Group- wide strategies. relating to human rights, supply chain, and compliance. Data sustainability issues within the business segment. Fresenius protection and cybersecurity are independent areas of Medical Care is itself a stock-listed company and has there- MATERIALITY ANALYSIS RESULTS responsibility. The departments and functions on Fresenius fore established its own sustainability governance structure. As a result, we have identified six main topic clusters and SE & Co. KGaA level support the business segments in the The highest governing body for sustainability issues at 15 individual topics as illustrated on page 110. There are no Fresenius | Annual Report 2020 development of guidelines and management concepts relat- Fresenius Medical Care is the Sustainability Decision Board. major changes compared to the main topics of previous ing to these sustainability topics. The business segments Co-headed by the CEO, it is responsible for integrating sus- years, although they have been defined in more detail. The have also defined departments and responsible persons – tainability into the Company’s strategy and business. often in the form of sustainability officers who coordinate all Together with the Sustainability Decision Board, the Manage- ment Board decides on strategic initiatives. 110


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor structure of the chapters in this report reflect the main topic WELL-BEING OF THE PATIENT the expansion of primary care in emerging and developing clusters. The various individual topics are assigned to the countries. The main focus is on the quality of our products chapters according to their prioritization, and their manage- People’s life expectancy is rising – and the world’s popula- and of the medical care we provide our patients. ment approach is described according to requirements tion is growing.1 These developments make high-quality In 2020, access to health care and medicine was ham- the requirements of GRI and the German Commercial Code medical care increasingly important. Fresenius is committed pered by the COVID-19 pandemic. In these challenging (HGB). The online report provides an expanded view with to providing access to health care and medicine to as many times, we have taken on our special responsibility as part of additional information. people as possible worldwide. the health care system with extensive measures. Further information can be found in the Group Management Report STAKEHOLDERS AND PARTNERSHIPS ACCESS TO HEALTH CARE AND MEDICINE on page 38 in this Annual Report 2020 and on page 114 Fresenius is involved in a diverse network of stakeholder Every year we assume responsibility for the well-being of of this report. groups. We gain valuable insights from this exchange millions of patients. We offer lifesaving and life-sustaining which we use to continuously develop our quality and sustain- products and therapies in more than 90 countries. In devel- OUR APPROACH ability management as well as our reporting procedures. oping and improving these products and therapies, we take Fresenius’ long-term goal is to further develop the company’s In 2019, we reviewed and prioritized our stakeholders: to this into account different social and regulatory requirements position as one of the leading international providers of end, existing corporate communication channels, the and adapt them to different health care systems. This will health care products and services. In recent years, we have requirements of sustainability ratings and rankings, and fre- enable us to meet the growing global demand for innova- expanded our company along our value chain – increasing quent inquiries from investors were evaluated. Our main tive, high-quality therapies. the global availability of our products and services. stakeholders are: Our products are often used to treat people who are suf- The constant development of our products and services fering from serious or chronic diseases. Our task is to allows us to take advantage of growth opportunities. We ▶ Patients ensure the safety and quality of our products and services guarantee our patients high-quality, comprehensive health ▶ Employees and to meet the highest safety and quality standards for care with our products and in our own facilities, allowing ▶ Providers all processes and therapies. them to benefit from medical progress. Our core business ▶ Private shareholders, institutional investors, analysts Our range of products and services includes a compre- focuses on ensuring that as many people as possible world- and rating agencies hensive network of hospitals, the availability of modern wide are able to participate in this progress. This ambition is ▶ Political institutions and external organizations, e.g., dialysis procedures and post-acute care – such as rehabili- also reflected in our commitment with regard to the society. in the fields of health care and patient care tation – and high-quality medical products. Our portfolio ▶ Suppliers or other business partners also includes digital health services, advanced therapies, and Fresenius | Annual Report 2020 In their non-financial reports, Fresenius Medical Care and Fresenius Helios in Germany and Spain also include a precise list of the stakeholder groups that are specific to their respective business activities: for example, Fresenius Medical Care includes science and research, while Fresenius Helios considers trade unions. 1 Source: https://www.un.org/development/desa/publications/world-population-prospects-2019-highlights.html 111


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Medical Care Fresenius Kabi is in regular exchange with the Access to Fresenius Vamed Providing access to health care is an important topic and Medicine Foundation, for example with regard to the Anti- Fresenius Vamed is active worldwide in the planning and covers a broad range of activities. Fresenius Medical Care microbial Resistance (AMR) Benchmark. In this Benchmark construction of health care buildings with the aim of serving supports the development of infrastructure for renal care selected manufacturers of generic drugs are regularly evalu- patient health and improving access to health care services. and cooperates with authorities to offer affordable care to a ated in the categories Appropriate Access, Stewardship Fresenius Vamed also provides worldwide operational man- growing number of patients. Innovative digital services and Responsible Manufacturing. Fresenius Kabi scores con- agement services and technical services with a focus on and products also help improve access to health care services sistently high and achieved third place in the latest AMR building, construction, and medical technology, sterile goods and flexibility for patients. In crisis and emergency situa- Benchmark 2020 among the companies evaluated in the supply, information and communication technology, and tions, the business segment benefits from its vertically inte- category of generic drug manufacturers.1 infrastructure and business services worldwide. This enables grated organization to provide access to health care to us to provide access to high-quality medical care for a patients in need. Fresenius Helios growing number of people. Fresenius Helios’ acute care hospitals offer the full range of Patient safety is directly dependent on the quality of the Fresenius Kabi medical services throughout Germany and Spain. Most treatments or products used and also indirectly on the Fresenius Kabi is committed to improving the quality of life people can reach a Fresenius Helios hospital in Germany provision of operational management services. Fresenius of patients. Fresenius Kabi’s product portfolio comprises within an hour. The hospitals in Spain and South America Vamed’s main goal which also represents an opportunity a comprehensive range of I.V. generic drugs, infusion ther- acquired in recent years also aim to improve and further is to give people around the world access to health care apies and clinical nutrition products as well as the devices expand access to health care in their markets. This interna- services at all levels of care. for administering these products. In the field of biosimilars, tional network enables Fresenius Helios to transfer knowl- Fresenius Kabi focuses on autoimmune diseases and oncol- edge between two European health care systems: the German ogy. Within transfusion medicine and cell therapies, the system provides health care at a high level that remains company offers products for collection of blood components affordable. The Spanish health care sector offers more inte- and extracorporeal therapies. These products and services grated outpatient and inpatient health care, with very high are used to treat and care for critically and chronically ill standards of service and patient experience. Particularly in patients. 2020, this network enabled us to learn from each other. With its comprehensive range of generics and its biosim- For example, an intensive exchange of knowledge took place ilars products, Fresenius Kabi offers affordable alternatives in the treatment of COVID-19 patients in order to improve and contributes to provide access to modern, high-quality treatment outcomes in both countries for the benefit of and affordable therapies for patients. patients. Fresenius | Annual Report 2020 1 Access to Medicine Foundation – Antimicrobial Resistance Benchmark 2020. 112


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    Media Hub To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor PROGRESS AND MEASURES 2020 via a screen as to whether the mouth / nose protection is Fresenius Medical Care operates dialysis facilities in many being worn correctly. Moreover, all Helios Spain Hospitals regions of the world with diverse geographic, social and Product portfolio are certified as COVID-Safe by an outside certification entity. economic conditions. The business segment serves a vulner- Demand for affordable health care products is growing in Fresenius Vamed is one of the leading private providers able population of patients who need regular dialysis treat- emerging markets. To facilitate access to dialysis treatment, of post-acute care in Central Europe, thus strengthening ment multiple days a week. To ensure that patients receive Fresenius Medical Care has developed the 4008A dialysis access to the relevant services, especially in the rehabilitation their dialysis treatment, even in extreme conditions, machine which meets high therapy standards while reducing segment. In 2020, the expansion of outpatient rehabilita- Fresenius Medical Care has developed robust emergency costs for health care systems. At the same time, it is tion services was driven forward. The new outpatient offer- response systems. For example, a system of regionally designed to be easy to handle even in challenging infrastruc- ings are easy to access and enable in-service utilization of organized emergency response teams is in place to ensure tures and remote locations. In 2019, the 4008A dialysis medically necessary rehabilitation services. In Germany, a business continuity. In addition to disaster response activi- machine was successfully launched in Asian emerging mar- total of 3 new outpatient rehabilitation clinics were opened in ties, Fresenius Medical Care repeatedly donates funds, dial- kets, including India, Pakistan, Nepal, and Bangladesh. 2020, while in Austria the construction of 5 outpatient ysis machines and medical supplies to organizations that Fresenius Kabi is constantly expanding its product rehabilitation clinics continued despite the Corona crisis; urgently require support. range to provide high-quality and affordable health care to these will open for patient operations in 2021. In Switzer- Fresenius Kabi has a crisis team for emergency situa- more patients. The company continuously expands the land, the Zihlschlacht rehabilitation clinic was expanded with tions. The crisis team is set up at Management Board level availability of its products in established markets as well as the commissioning of a 4-star superior private clinic for immediately after an event that could lead to a crisis in new markets including emerging markets and has international patients and Swiss private patients. becomes known. The crisis team comprises members of the launched new products in 2020. Fresenius Kabi, for example, Management Board, key staff units, and other relevant launched the Exilia infusion pump system in 2020, a system Patient support in crisis and emergency situations functions of the business segment and initiates the necessary in high demand during the COVID-19 pandemic. As a health care Group, we have to be crisis-proof and measures. In 2020, Helios Germany acquired three Malteser hospi- respond flexibly in all areas: it is our task to enable unre- In the hospital sector, there are legal requirements for tals and affiliated medical care centers in the German cities stricted access to our services and seamless care for how care is to be organized in the event of an emergency. At of Bonn, Duisburg and Krefeld, further improving accessi- patients even under difficult conditions. To ensure this, we Fresenius Helios, for example, emergency power genera- bility to its hospitals. Helios Spain acquired hospitals in have established high-performance as well as resilient tors ensure that operations or vital therapies, such as artificial Colombia and in Spain the Hospital Nosa Señora dos Ollos emergency systems and programs in our business segments. respiration, can continue even in the event of a power fail- Grandes in Lugo. A comprehensive safety concept consist- ure. Fresenius Helios has developed contingency plans as ing of ten combined measures ensured that patients, visitors part of its country-specific hospital infrastructure. and employees in the clinics were protected against infec- Fresenius | Annual Report 2020 tion in 2020, which was significantly impacted by COVID-19. To ensure safe access to the clinics, mask scanners were introduced in the entrance areas of all Fresenius Helios hos- pitals and the outpatient centers, which provide feedback 113


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor At Fresenius Vamed, a structured crisis management system while reducing the risk of infection for patients and staff. The measures taken at our Fresenius Helios’ hospitals were takes immediate effect in crisis situations. It comprises Measures included screening all patients and staff entering always carried out in close, continuous consultation with the Management Board, key staff units and the management the clinics and providing them with personal protective the respective crisis team at Group level and the crisis teams teams of the lead companies. The crisis team meets as equipment. Fresenius Medical Care also set up isolation cen- or task forces of the clinics as well as the central and local soon as a crisis becomes known and initiates all necessary ters for infected patients. Under these circumstances, hospital hygiene departments. In several Helios facilities in measures. Fresenius Vamed’s facilities have emergency and the business segment treated more than 29,000 patients with Germany, emergency departments had to be closed briefly outage concepts and crisis communication plans in place, COVID-19 in North America and rolled out an expanded in 2020. There were also temporary admission suspensions which have been drawn up together with the local emergency telehealth platform to support social distancing for both home at entire clinics in the reporting year due to frequent coro- units. These measures have increased the speed of response and in-center patients. Acute kidney injury is common in navirus infections among employees or patients – for exam- to individual COVID-19-related incidents and thus made it critically ill COVID-19 patients. Fresenius Medical Care pro- ple at Helios Klinikum Bad Saarow in October 2020. Apart possible to provide facilities that were particularly affected vided hundreds of acute dialysis devices and other supplies from these exceptions, health care services were maintained. with additional protective equipment. to hospitals for emergency treatment. Despite the increased Scheduled elective procedures were completely suspended safety measures, Fresenius Medical Care was able to con- in the first wave of the pandemic in spring 2020 due to Health care delivery during the tinue producing and delivering life-saving products, even political requirements on hospitals. In the second wave in COVID-19 pandemic when operations and supply chains were hampered by global fall / winter 2020, hospitals made their own decisions The COVID-19 pandemic posed major challenges to the restrictions. about whether to maintain elective procedures, depending global health care system in 2020. For Fresenius as a health Demand for some of Fresenius Kabi’s drugs and medical on utilization. In Spain, the emergency rooms were never care Group and as a company with a very large number of devices has increased significantly due to the COVID-19 closed, but scheduled activities were reduced or even sus- employees as well as patient contact, pandemic protection pandemic. Fresenius Kabi reacted to this demand early and pended as ordered by the authorities. The number of inten- and prevention are essential. Emergency management switched production. This enabled the business segment sive care beds in Germany in spring 2020 was increased from plays a key role in this: it enables us to maintain the care of to use all suitable capacities to expand production volume 900 to 1,500; in the fall, the number was increased again all patients in our health care facilities and ensure the for these products. Despite the significantly higher produc- to a total of 2,300 beds. During the first wave, the Spanish supply of medicines. Based on the legal requirements and tion costs for essential drugs used to treat COVID-19 patients, hospitals temporarily duplicated the number of intensive regulatory recommendations for the COVID-19 pandemic, Fresenius Kabi kept prices for these drugs stable during care beds, and incremented the conventional hospital beds our business units implemented numerous measures in the pandemic. to respond to the elevated number of COVID-19-patients. response to the pandemic: Fresenius Helios also launched a COVID-19-hotline in Ger- The COVID-19 pandemic presented Fresenius Medical many in 2020, offering 24-hour telephone advice from 30 Care with an extraordinary challenge in 2020. The business experts and receiving around 18,000 calls during the first Fresenius | Annual Report 2020 segment established strict safety protocols in its more than peak phase of the pandemic alone. Helios Spain uses its 4000 clinics to maintain the provision of essential treatments 114


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor corporate social media channel in Spanish language to pro- Social commitment We have established sophisticated processes in all business vide written information or videos on most urgent ques- The ambition to provide access to health care for as many segments that are fully geared toward the safety of our tions, like hygiene, vaccines or even the impact on family life, people as possible worldwide and to continuously improve patients and efficient processes. In the area of quality man- as well as information on the impact of appointments in it is also pursued by our business segments through their agement, we focus on monitoring, managing and improving hospitals and the availability of COVID-19 tests in our centers. social commitment. Fresenius Medical Care’s social commit- these processes by means of performance indicators. The Further, two hotlines were created, one for general informa- ment focuses on regional and local initiatives that support individual business segments adapt their quality manage- tion and recommendations on COVID-19 and a second hotline the interests of kidney patients. This includes emergency aid ment systems to their respective business models and set to attend patients with suspected infection. In total, Helios in crisis situations, e.g. through donations of dialysis priorities accordingly. Our quality management systems meet Spain received around 13,000 calls. machines and medical supplies, as well as long-term mea- or are based on various standards. International standards Among other things, Fresenius Vamed created catalogs sures such as Kidney Kid, an initiative to educate children such as ISO (International Organization for Standardization) of measures in which the pandemic experiences of all about kidney health at an early age. Fresenius Kabi and and GMP (Good Manufacturing Practice) are particularly health care facilities in Austria, Germany, the Czech Republic, Fresenius Helios actively support social causes through dona- important for our production facilities. In our hospitals and the UK, and Switzerland were collected; these catalogs tions or employee community engagement, among other health care facilities, we measure the quality of patient are updated regularly. The experience gained will continue things. care using various indicators. to be incorporated into risk management in the future; it will help Fresenius Vamed to continuously improve its pro- PATIENT AND PRODUCT SAFETY Organization and responsibilities cesses and responsible action. Furthermore, a 24 / 7 infor- All Fresenius employees must ensure that the applicable mation hotline as well as comprehensive and continuously OUR APPROACH quality and safety regulations are always observed in their updated information on the Fresenius Vamed intranet At Fresenius, our aspiration is: better medicine for ever areas of responsibility. The employees in the production “Corona Infocenter” are available to Fresenius Vamed staff more people. Our commitment to always strive for the high- facilities, outpatient centers, and hospitals have a special for current questions on the pandemic. est quality in our products, services, and therapies stems obligation to exercise due care. The organizational struc- Please refer to the Notes to the Consolidated Financial from this. The most important non-financial aspect by which tures are adapted to the requirements of the individual busi- Statements on page 251 f. for further information on assis- we measure our success is the well-being of our patients. ness segments. tance programs provided by various governments in the form In order to provide patients with the best possible care, we of reimbursement payments and funding in connection offer them medical treatments and products that meet our Policies and regulations with the COVID-19 pandemic. strict requirements for quality and safety. All four business segments comply with the applicable laws within the framework of quality management. Our operations are subject to extensive governmental Fresenius | Annual Report 2020 regulation in virtually every country in which we operate. This includes, for example, the EU legislation on the Regis- tration, Evaluation, Authorization and Restriction of Chemi- cals (REACH), the Restriction of Hazardous Substances 115


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor (RoHS), the Medical Device Directive, the new Medical Fresenius Medical Care gram (MDSAP) in 10 of its sites as well as for the company’s Device Regulation, and the Code of Federal Regulations Fresenius Medical Care is committed to delivering safe, high- consolidated quality management system. This enabled (CFR) of the U.S. Food and Drug Administration (FDA). quality care for patients with chronic illnesses. To live up the company to reach a higher level of efficiency and reduce In addition, the business segments have developed their to this commitment, the company continuously monitors and the cost per audit. own comprehensive guidelines. Furthermore, the business analyzes the quality performance of its products and ser- segments have voluntarily committed to complying with a vices. The company also measures patient satisfaction and Organization and responsibilities wide range of industry obligations and international stan- takes its patients’ feedback into account to improve its ser- In 2019, Fresenius Medical Care established the Global dards. For example, Fresenius Medical Care respects the vices. Fresenius Medical Care is continuously working to Medical Office to coordinate its efforts to advance medical industry initiative Kidney Disease: Improving Global Out- expand access to high-quality health care for more patients science and patient care. It is part of a network that drives comes (KDIGO) foundation, the Kidney Disease Outcome and further improve the care the company offers. This also scientific and medical progress worldwide. The Global Quality Initiative (KDOQI), the European Renal Best Practice involves investing in innovations and new technologies and Medical Office is led by the company’s Global Chief Medical Guidelines (ERBP) and industry-specific clinical bench- leveraging insights from scientific research and collaboration Officer, who was appointed to the Management Board in marks. Fresenius Kabi’s quality management system also with partners. 2020. Key findings of the Global Medical Office are published takes applicable national and international regulations Fresenius Medical Care produces and delivers a broad on a regular basis. into account, including Good Clinical Practice (GCP), Good range of products for treating kidney disease. With its net- Manufacturing Practice (GMP), Good Distribution Practice work of 44 manufacturing sites in more than 20 countries, Internal rules of conduct and guidelines (GDP), Guideline on Good Pharmacovigilance Practices (GVP), the company takes care of the procurement, production, Two global functions are responsible for Fresenius Medical Medical Device Regulation (MEDDEV; MDR), the Code of distribution, and supply of renal and multi-organ therapy Care’s product business: Global Research and Development Federal Regulations (CFR) of the U.S. Food and Drug Admin- products. The business segment manages the quality and and Global Manufacturing, Quality and Supply. Both func- istration (FDA), and the ISO 13485 quality management safety of its product business over the entire product life tions report directly to the Management Board. They have standard for medical devices. Helios Spain is committed to cycle, from design and development, to operation and jointly developed our Global Quality Policy, which describes patient safety and has 24% of the hospitals certified under application. our commitment to product and service quality. It also the quality standard UNE 179003. Fresenius Vamed’s facilities Fresenius Medical Care’s consolidated quality manage- covers our obligation to comply with relevant regulations and in Germany have joined the Qualitätskliniken.de initiative, ment system is certified according to ISO 9001 and ISO 13485. maintain environmentally sound and efficient operations. and meet the requirements of the quality aspect of patient In addition, the business segment’s plants are subject to The Global Quality Policy is the basis for regional quality safety. regular external quality audits and reviews in accordance with local requirements. Of the production sites managed by the Global Manufacturing, Quality and Supply function, Fresenius | Annual Report 2020 21 sites are certified with ISO 9001 / 13485. Furthermore, 17 sites have been audited according to the Good Manufac- turing Practice (GMP) or the Current Good Manufacturing Practice (cGMP) guidelines. Fresenius Medical Care also suc- cessfully completed the Medical Device Single Audit Pro- 116


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor manuals and further detailed policies that describe aspects INTEGRATED QUALITY MANAGEMENT FRESENIUS KABI Policies and regulations such as responsibilities, training, risk assessments, and Fresenius Kabi has defined the following principles for its audits. The Management Board is regularly informed about quality management: our global quality performance. ▶ Clear assignment of responsibilities Integrated quality management system ISO 9001 Fresenius Kabi ▶ Qualification and continuous training of employees Fresenius Kabi’s corporate philosophy “caring for life” ▶ Monitoring of product and patient safety describes the company’s commitment to improving the qual- ▶ Transparent and documented processes and procedures Product-specific standards and norms, ity of life of its patients. The quality and safety of its prod- ▶ Fulfillment of regulatory compliance Occupational health and safety ucts and services is therefore of paramount importance to ▶ Continuous improvement Environmental management e.g., GxP, ISO 13485, MDD Fresenius Kabi. An important goal of the quality manage- ▶ Checking of quality management effectiveness Applicable legislation Energy management ment at Fresenius Kabi is to monitor the applicability, effi- cacy, and safety of products and services, as well as the Fresenius Helios OHSAS 18001 success of therapies, and their continuous improvement. To Helios Germany has developed a quality management sys- ISO 14001 ISO 50001 ensure this, the company has established an integrated tem based on three pillars: Measure, Publish, Improve. It is quality management system, a monitoring and reporting sys- used in a similar form by around 500 hospitals in Germany Active tem, and product risk management. Pharmaceuticals Nutritionals pharmaceutical Medical devices Others and Switzerland. This quality management system is based ingredients Fresenius Kabi’s quality management system is orga- on administrative data (routine data) from patient treat- nized in accordance with the ISO 9001 standard and is bind- ments: the hospitals document each treatment step precisely ing for all Fresenius Kabi organizations. Compliance with for later billing with the health insurance companies. For the standard is reviewed by TÜV Süd in annual audits at a example, this routine data shows whether the healing pro- global level and covers 115 Fresenius Kabi organizations Organization and responsibilities cess takes longer than expected, and whether complica- through a matrix certification At Fresenius Kabi, the globally responsible quality manag- tions or even a death occurred. It also indicates whether a Fresenius Kabi has a global quality management hand- ers report directly to the respective member of the Manage- treatment took a normal course; if mistakes were made, book including a global quality policy, as well as standard ment Board. The members of the Management Board are they are reviewed in specific audit procedures (peer reviews). operating procedures. They are applicable globally and thus directly responsible for quality management. They are Defined quality indicators (German Inpatient Quality Indi- cover all sites. Fresenius Kabi uses a global electronic quality regularly informed about quality management in quality cators – G-IQI) are used to measure and monitor the quality management system, KabiTrack, based on the Trackwise® oversight meetings and receive quality management reports of medical outcomes. The outcomes are published. This Fresenius | Annual Report 2020 software, for all quality management processes. The system on a regular basis. data allows patients to see, among other things, how often supports the local implementation of centrally defined pro- cesses as well as global oversight. 117


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor certain treatments are performed in Fresenius Helios hospi- in Germany come together in these specialist groups. Fresenius Vamed tals. This gives patients important information on how They ensure that the knowledge of their medical specialty Fresenius Vamed aligns its internal processes to estab- much experience doctors have in this area and helps them is anchored in all hospitals and represent their respective lished quality standards such as ISO 9001, ISO 14001, and make their own decisions about their treatment. Thanks to medical fields internally and externally. They also advise and ISO 13485, as well as the EFQM standards. In addition, its quality and risk management, Helios Germany can con- decide on the introduction of standard processes, sensible Fresenius Vamed has certified several health care facilities tinuously monitor key quality parameters and, if necessary, innovations, campaigns and the introduction of medical prod- according to international standards such as JCI, ISO, and take countermeasures at an early stage. ucts. QMS-REHA®. These certifications form the basis for the con- Helios Spain gears its quality management toward the The specialist groups of Helios Germany and Helios tinuous improvement of the processes at Fresenius Vamed. requirements of recognized international quality standards. Spain exchange ideas and information on specific topics. For All hospitals and centers are certified according to ISO example, the German hospitals benefit from Helios Spain’s Organization and responsibilities Standard 9001. Further, the certification according to the close networking of outpatient and inpatient care – and can In order to raise awareness of quality requirements among most relevant international quality standards (Spanish take advantage of these experiences. employees, Fresenius Vamed employs staff for quality and Association for Standardization, UNE) was continued. In addi- risk management. These employees report directly to the tion, hospitals are certified in accordance with of the Joint Policies and regulations management. Other quality assurance officers carry out train- Commission International (JCI) and the European Foundation In recent years, Helios Germany has introduced numerous ing courses in the various segments, thus integrating all for Quality Management (EFQM) standards. In 2020, two measures to increase patient safety. Checklists are manda- employees in the quality management systems of their facil- further hospitals were awarded the international certifica- tory for all operations in Fresenius Helios’ clinics. The “pre” ities. The quality assurance officers can thus ensure that tion UNE 179003, which means that a total of 12 hospitals checklist assesses the risks associated with the operation the employees comply with their obligation to exercise due in Spain are certified in accordance with this standard. before it takes place. The “peri” checklist helps to avoid treat- care. Fresenius Vamed informs its employees about its Regarding UNE 179006, the standard for infection control, ment errors immediately before, during, and immediately understanding of quality early in the initial training and intro- eight hospitals are already certified. For 2021, we aim to after the operation: this reduces wrong-side errors or surgical ductory events. Guidelines are traceably communicated to include further three health centers in the JCI certification. material left behind in the body to a minimum. the relevant areas and departments in writing (e.g. via work In 2020, Helios Spain appointed new members to the instructions from the respective management). Organization and responsibilities Corporate Safety Committee with the aim of involving further The VAMED International Medical Board (IMB) ensures At Fresenius Helios, the medical director has direct respon- hospitals and generating new ideas. The committee has the exchange of information between Fresenius Vamed sibility for patient and product safety; further, the position of remained active throughout the pandemic, not only advising physicians from Austria, Germany, the Czech Republic, the a Patient Safety Officer was created. Helios Germany’s cen- the hospitals in the COVID-19-management but also devel- United Kingdom, and Switzerland. Within Fresenius Vamed, tral medical services and medical specialist groups help to oping new strategic patient safety protocols. The Patient medical specialist groups and executive conferences coordi- Fresenius | Annual Report 2020 implement the appropriate measures. The leading physi- Safety Strategy developed by this committee was completed nate on quality and safety. cians in a particular field from all Fresenius Helios hospitals in 2020. It is based on the principles of international insti- tutions such as the World Health Organization (WHO) and the JCI. 118


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Policies and regulations Fresenius Medical Care has set itself the goal of implement- than 440 product improvements to its dialysis machines Fresenius Vamed sets ethical standards through its mission ing a global quality management system by 2024. As part of and is planning to extend this KPI to further product groups statement as well as through codes such as the Code of its initiative to harmonize our quality systems and processes in 2021. Conduct, the Clinical Code of Conduct, and the Code of Con- worldwide, the business segment is planning to introduce a Fresenius Medical Care also carries out innovations with duct for Business Partners. Fresenius Vamed’s internal global electronic training system within the next three years. the aim of continuously improving its portfolio. To enable guidelines are based on the regulatory requirements estab- The overarching goals of Fresenius Kabi’s quality man- access to the latest technologies, the business segments lished throughout Europe, e.g. for rehabilitation. In addi- agement are to ensure the well-being of patients as well as invests in research and development and collaborates with tion to the statutory requirements and the requirements of the quality and safety of products, services, and therapies, external partners, including academic institutions. Fresenius the insurers, Fresenius Vamed also adheres to interna- and to fulfill regulatory requirements. Medical Care also invests in startups that develop products, tional standards such as ISO and EFQM, expert standards, Helios sets company goals using the E-IQI methodology technologies and therapies in the health care sector. and medical guidelines. All internal guidelines are regu- in Spain and the G-IQI methodology in Germany, making larly reviewed and updated as necessary. Employees can use of comparative measurements, with the benchmark being Hygiene management in hospitals obtain information on the guidelines via the intranet. the German national average as calculated by the Federal The aim of Fresenius Helios’ hygiene management system is Statistical Office. The aim is to be better than the national to avoid infections within the hospital and, as quickly as Our ambitions average for each target. Further quality objectives in our possible when they do occur, to prevent them from spread- Quality targets are determined and reviewed in each business hospitals in Spain relate to patient satisfaction. ing. The main focus is on adequate personnel with hygiene segment based on the defined quality parameters. Further Fresenius Vamed defines its quality goals annually with specialists and doctors, infection and pathogen monitoring, information is provided on pages 121 ff. the aid of additional key performance indicators. The find- control of antibiotic consumption, and training of physi- In 2020, Fresenius Medical Care developed a global pol- ings from complaint, case, and risk management are also cians to become antibiotic stewardship (ABS) specialists. The icy on patient care, including a chapter dedicated to patient incorporated. The goals are reviewed regularly. planned antibiotic reporting for clinics in Germany was experience surveys and related processes that are harmo- available for the first time at the end of 2020. nized worldwide. The main goal in doing so is to strengthen PROGRESS AND MEASURES 2020 the inclusion of patients’ feedback. To achieve this, the Hygiene management in rehabilitation and nursing care business segment has set itself targets. In 2021, Fresenius Clinical efficiency and hygiene management One of Fresenius Vamed’s tasks with regard to hygiene in Medical Care endeavors to further roll out its harmonized rehabilitation clinics and nursing facilities is to ensure the patient experience survey worldwide and also plans to imple- Improved dialysis treatments highest possible protection for everyone – without restricting ment a globally consistent process for making improvements Continuous improvement is an essential prerequisite for individual rehabilitation. Protecting patients from infec- in all countries in which the patient survey is rolled out. enhancing the quality and safety of Fresenius Medical Care’s tious diseases during their stay is a key topic for Fresenius Fresenius | Annual Report 2020 products. Product improvement is defined as a change Vamed. Newly established health care facilities follow sys- that focuses on at least one of the following: patient safety tematic guidelines from day one to prevent infections break- and quality, product performance, or customer service. ing out or spreading. Clearly defined procedures are fol- Product improvements are evaluated from the patient’s per- lowed and compliance with hygiene regulations is strictly spective. In 2020, the business segment implemented more controlled. 119


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Labeling and product and patient information Helios Germany provides information to its patients within Training It is essential for the safety and well-being of our patients its hospitals about the patient admission process with the Training courses for our employees, which guarantee the that we label our products appropriately, describe our help of the treatment contract, as well as special information safety of our patients and products, are an important compo- services, and provide necessary further patient information. flyers and privacy statements. The therapeutic objective nent of our quality management systems. For example, Each of the four business segments is subject to specific is discussed and evaluated with patients during admission Helios Germany works with simulation centers to provide regulatory requirements and standards – depending on the and discharge discussions with the treating physicians. training for surgical crisis scenarios. By offering regular business activity and the market. Helios Germany communicates via its online magazine, its training on a global, regional, and local level, Fresenius Kabi Listening to patients is also important when it comes to website, and in its communication campaigns. In addition, ensures that employees are aware of those aspects of the their choice of therapy. Fresenius Medical Care treats its patient information events on specific medical topics are held quality management system that are relevant for their daily patients across the full spectrum of chronic kidney disease in all hospitals. work. Helios Spain continuously provides training on with the aim of giving them a more informed choice and Fresenius Vamed provides information to its patients in patient safety, on its quality management systems and on providing treatment options that best fit their life circum- different ways – for example, in the patient information topics which are essential in hospital routine. In 2020, 22 stances. In 2020, for example, Fresenius Medical Care folder or in the treatment contract, via information brochures, sessions were conducted in the hospital network. offered home therapy to more than 44,000 peritoneal and privacy statements, the house rules, and the mission state- Fresenius Vamed’s quality management officers also hemodialysis patients who choose to be treated in a famil- ment. Welcome lectures and training sessions are also regularly conduct legally required training courses and qual- iar environment and whose medical condition allows them offered. The website is available as a source of information ity management training courses. In addition, Fresenius to do so. In the U.S. alone, the company educated more before arrival. The goal of therapy is usually discussed Vamed plans and conducts in-person and online training than 50,000 people living with chronic kidney disease or end- and evaluated with patients during admission and discharge courses on a wide range of topics. stage kidney disease about home dialysis options with the discussions. Further information on employee training can be found help of more than 180 internal kidney care experts. Since Fresenius Vamed is also active as an accredited in the Employee Development chapter on pages 140 ff. Fresenius Kabi’s products are classified, e.g. as pharma- inspection body (ISO 17020) and as a manufacturer of medical ceuticals, nutritional products, active pharmaceutical ingre- gas supply systems (RL93 / 42 EEC), the business segment dients, or medical devices, based on global and national reg- is subject to a labeling obligation and information obligation ulations and standards. The marketing of these products in accordance with RL93 / 42 EEC and MPG and / or ISO 13485. is subject to various laws and regulations to ensure a com- The accreditation authority uses external audits, for example, plete and fact-based product information. Fresenius Kabi to check whether appropriate regulations exist and whether has a global policy and global standard operating procedures regulatory or normative requirements are complied with. for its product information to ensure that they are in accor- Fresenius | Annual Report 2020 dance with applicable laws and regulations and that the product information on correct use is clear, accurate, and not misleading. 120


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Product complaints and recalls Fresenius Kabi’s product risk management In 2020, Fresenius Medical Care aimed to maintain the clin- The global safety officers react promptly and appropriately ical care environment as stable as possible during the Handling product complaints at to potential quality-related issues. They initiate and coordi- worldwide COVID-19 pandemic. The impact of the pandemic Fresenius Medical Care nate necessary actions on a global level, for example product was felt in all regions with the most vulnerable population of Fresenius Medical Care strives to ensure compliance with recalls. With its early-warning system, Fresenius Kabi patients. However, the key clinical quality indicators showed legal requirements related to monitoring the adverse effects evaluates any quality-related information from various risk a consistently high quality of care among Fresenius Medical of drugs – also called pharmacovigilance – and product areas to identify risks at an early stage and take corrective Care’s patients. complaints. To this end, the business segment collects and and preventive actions. Information is obtained from data- reviews adverse events and product complaints. In addition bases for complaints and side effects, internal and external Fresenius Kabi’s vigilance system to compliance with applicable legal requirements, the com- audits, and from key performance indicators used for internal The monitoring of adverse reactions or events (side effects) pany has included the topic of reporting adverse events control and optimization of quality processes. With these associated with the use of medicinal products is referred and product complaints in its Code of Ethics and Business systems, Fresenius Kabi can evaluate the safety profile of any to as pharmacovigilance (drug safety). The statutory pharma- Conduct. of its products at a global level. covigilance commitments relate to our medicinal products Product recalls, for example, are initiated as a risk-mini- for human use. Similar regulations exist for medical devices. Fresenius Kabi’s monitoring and reporting systems mizing measure in cooperation with the responsible regu- Fresenius Kabi has established various standard operating Fresenius Kabi interacts with patients, users, and custom- latory authority. At the same time, the cause of the recall is procedures for the continuous monitoring of the benefit risk ers not only in the delivery of products and services, it analyzed. Where necessary, corrective measures are taken ratio of its own products and assesses their successful imple- also monitors the applicability, effectiveness and safety of to prevent the cause of the recall in the future. mentation on the basis of specific indicators. the products on the market. Fresenius Kabi therefore monitors and evaluates relevant information and feedback EVALUATION ▶ Fresenius Kabi collects and assesses reports about on the products, services, and therapies during their use. individual side effects and reports them to health Fresenius Kabi has set up a monitoring and reporting system Quality evaluation parameters authorities worldwide according to regulatory require- (vigilance system) and a product risk management system ments. Fresenius Kabi claims to submit all safety covering all regions worldwide, in order to be informed about Quality analyses at Fresenius Medical Care reports in accordance with the applicable regulations product quality and patient safety issues in a timely manner Fresenius Medical Care evaluates a set of medical indicators and therefore strives to report 100% of the Individual- and deal with them appropriately. These early-warning sys- on an ongoing basis to measure the quality of care provided ized Case Safety Reports (ICSRs) to the authorities tems are designed in such a way that trained complaints and in its clinics. The company is currently harmonizing the in time. For 2020, the worldwide compliance rate was safety officers worldwide record complaints and side effects quality reporting around kidney care to better understand 99.9% (2019: 99.9%). In Europe, in 2020 99.5% Fresenius | Annual Report 2020 in IT systems and forward messages to experts for review. geographic differences. (2019: 99.6%) of all adverse reactions were reported to the European Medicines Agency (EMA) in due time. 121


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor ▶ In addition, Fresenius Kabi regularly evaluates the FRESENIUS MEDICAL CARE: QUALITY PARAMETERS BY OPERATING SEGMENT 1 benefit-risk ratio of its products based on safety-related Europe, information from various sources (e.g. adverse event Middle East, North America Africa Latin America Asia-Pacific reports, medical literature). The results of these analyses Description Possible impact 2020 2019 2020 2019 2020 2019 2020 2019 are submitted to authorities as periodic safety reports. Effectiveness of dialysis: Fresenius Kabi aims to submit all periodic safety reports measures how well More days spent worldwide to authorities in due time. For 2020, the the body is cleaned of in hospital; Kt / V 2, 3 ≥ 1.2 uremic toxins increased mortality 97% 97% 93% 94% 91% 91% 94% 95% compliance rate was 99.6% (2019: 99.1%). In Europe, Hemoglobin is responsi- 98.6% of all periodic safety reports were submitted in ble for transporting Hemoglobin 4, 5, 6 = 10 – 12 g / dl oxygen around the body Indicator for anemia 71% 71% 82% 82% 48% 50% 52% 56% due time to the European Medicines Agency (EMA) in Calcium 3, 8 = 8.4 – 10.2 mg / dl Measures the patient’s 81% 81% 78% 79% 73% 76% 72% 74% 2020 (2019: 97.5%). Albumin 7, 8 ≥ 3.5 g / dl nutritional status and Marker for increased 80% 81% 90% 89% 89% 91% 91% 87% ▶ According to regulatory requirements, Fresenius Kabi as Phosphate 3, 8, 9 ≤ 5.5 mg / dl mineral balance mortality 59% 60% 80% 80% 76% 76% 64% 63% a pharmaceutical company is obliged to describe its Measures the number of Patients without catheter patients with More days spent vigilance system in a Pharmacovigilance System Master (after 90 days) 10 vascular access in hospital 79% 81% 77% 78% 78% 79% 81% 83% File (PSMF). Fresenius Kabi uses a global database to Days in hospital Result of complications Restrictions in per patient year 11 during dialysis quality of life 9.7 10.3 7.7 7.5 4.0 4.3 3.5 2.6 collect and evaluate vigilance data on a quarterly basis 1 The numbers for 2020 are based on quality parameters of 90% of our dialysis clinics worldwide. This includes 80% of our clinics in EMEA and 46% of our clinics in Asia-Pacific. from all local marketing and sales units. These are 2 Kt / V provides information about the effectiveness and efficiency of dialysis. compiled in the PSMF. The goal is to receive timely data 3 4 Kidney Disease Outcomes Quality Initiative guidelines. The hemoglobin value in patients’ blood should be kept within a defined range. Hemoglobin is the component of red blood cells that transports oxygen within the human body. An insufficient level of from all marketing and sales units worldwide. This is hemoglobin in the blood indicates anemia. 5 Kidney Disease: Improving Global Outcomes and European Renal Best Practice guidelines. documented in the company’s vigilance system. For 2020, 6 EMEA data includes patients with Hb > 12 g / dl without erythropoiesis-stimulating agents (ESA). 7 Certified reference material for human albumin based on specifications from Joint Research Centre of the European Commission (#ERM-DA470k) was obtained to ensure consistent results over time. the compliance rate was 100% (2019: 100%). 8 Calcium, albumin, and phosphate levels in the blood are indicative of a patient’s general nutritional status and point to disorders in the mineral and bone metabolism of patients with chronic kidney disease. 9 Phosphate specified as mg / dL of phosphorus. 10 Catheters are associated with a serious risk of infection and an increase in the number of days spent in hospital. Fresenius Medical Care records the number of patients who do not need to use a Fresenius Kabi’s products are subject to labeling require- catheter as a vascular access for dialysis. Where we as the care provider are directly responsible, the proportion of patients with permanent vascular access serves as an indirect quality indicator. 11 The number of days patients are hospitalized over a 365-day dialysis treatment period per patient. This is relevant for determining the quality of care because more days spent in hospital significantly ments. The labeling of the products is checked as part of the reduce the quality of life for dialysis patients and are particularly cost-intensive for health care systems. regular pharmacovigilance activities and updated if neces- Relating to the fourth quarter of the respective year sary. For example, product labeling is updated if competent authorities, e.g. the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) With the help of its vigilance activities, Fresenius Kabi Fresenius | Annual Report 2020 publish relevant information. Fresenius Kabi uses an elec- ensures that the patients’ safety of its products is always tronic management system for product labeling to manage guaranteed, and that the company is able to identify any the information necessary for labeling and to ensure cor- changes in the benefit-risk ratio at an early stage and react rectness. in a timely manner. 122


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Evaluation of the quality of outcomes at Fresenius Helios HELIOS QUALITY INDICATORS For Fresenius Helios, the quality of medical outcomes is Germany 2020 2019 2018 2017 2016 key. It is measured in Germany using the German Inpatient Key indicators, total > 1,500 > 1,500 > 1,500 > 1,500 > 1,500 Quality Indicators (G-IQI). Data from the Federal Statistical G IQI targets 45 46 46 45 46 Office for all hospitals in Germany serves to provide compar- Targets achieved 89% 96% 89% 98% 93% ative values. Helios Germany has defined specific targets Peer Reviews 8 60 55 69 58 for 45 key G-IQI quality indicators, including, for example, the Further information (German language only):https://www.helios-gesundheit.de/qualitaet/ frequency of interventions and their results. Helios Ger- many’s results are expected to be better than the German average. The year 2020 was exceptional for the hospital landscape and was primarily determined by the pandemic data. The results are also compared with the goals of the Patient grievance processes and the treatment of COVID-19 patients. IQM network. Each hospital publishes its results quarterly in Grievance mechanisms are another way to get patients’ feed- In Germany, Helios achieved a total of 40 of its 45 Group a central IT system. This allows individual hospitals to check back and understand their needs. Fresenius Medical Care targets. This corresponds to a quality target achievement whether they deviate from the standards set. has established patient grievance processes in all regions to of 89% (2019: 96%). In 2020, there were around 13% fewer address topics raised by patients in a timely manner. In patients in the clinics than in the previous year, but some Personalized and individually tailored rehabilitation 2020, the company harmonized the patient grievance process of these had a significantly higher degree in illness compared goals at Fresenius Vamed globally. The harmonization is included in a dedicated with 2019. Many patients stayed at home, first, because Fresenius Vamed uses modern, resource-oriented chapter of the patient care global policy. Fresenius Medical of the nationwide lockdown and the overall stop of surgeries approaches, such as the ICF concept (International Classifica- Care offers patients various channels through which they in hospitals in spring, and second, because people overall tion of Functioning, Disability and Health) or the computer- can express their suggestions and concerns, such as dedi- avoided postponable treatments under the impact of the pan- based evaluation system CHES (Computer Based Health cated hotlines and email addresses, complaint and sugges- demic. Against this background and despite these effects, Evaluation System). This enables patients to achieve the best tion boxes as well as a web form on the company’s website. Helios nevertheless succeeded in achieving high medical possible, evidence-based functional improvement to increase Patients and their representatives have the option to raise quality results. activity and participation in all areas of life, even after severe these suggestions and concerns anonymously. Fresenius Helios Spain has introduced quality indicators that cor- illness. Medical Care’s policies ensure that grievances can be filed respond to Germany’s G-IQI. For this purpose, numerous In addition, the findings on treatment quality are pub- without fear of reprisal or denial of services. indicators have been selected based on the most relevant and lished, for example, by Fresenius Vamed Germany on the Fresenius Helios uses reporting systems for critical common diseases and a cooperation with the Fundación website Qualitätskliniken.de. This allows patients to find events and near-misses in all hospitals. Fresenius Vamed also Fresenius | Annual Report 2020 IDIS (Instituto para el Desarrollo e Integración para la Sani- out about key quality parameters of the various clinics before uses such reporting systems in its health care facilities. dad) was entered into. The aim is to use the Spanish rou- they are admitted there. In addition, Fresenius Vamed uses systems for suggestions tine medical data to determine the E-IQI (Inpatient Quality for improvement, material vigilance (material safety), and Indicators Spain) and to compare it with publicly available pharmacovigilance (drug safety). 123


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Patient satisfaction surveys Satisfaction measurement at Fresenius Helios within 15 days, and the waiting time before the appointment Surveys of patients are a meaningful and important tool for Helios Germany uses the Helios Service Monitor to measure starts must be under 15 minutes. In emergency departments, Fresenius: They enable us to measure, monitor, and improve the satisfaction of inpatients in its hospital locations once a the maximum waiting time should not exceed 30 minutes. the quality of our services and patient care. week. Employees at the hospitals conduct short interviews with patients on care and service. The information is col- Measurement of patient satisfaction Patient surveys at Fresenius Medical Care lected anonymously. The management of the hospital and at Fresenius Vamed Fresenius Medical Care measures patients’ feedback using other authorized persons receive the monthly survey results. Fresenius Vamed measures patient satisfaction in its health patient experience surveys as part of its global patient This makes it possible for necessary improvements to be care facilities in a continuous and structured process. The experience program. Overall responsibility for these surveys introduced quickly. The Service Monitor is used to reach a company collects data for this purpose, evaluates it internally, lies with specialized regional teams in cooperation with total of around 50% of inpatients. The three hospitals and implements appropriate measures. the Global Medical Office, which provides global guidance. acquired in 2020 will introduce the Service Monitor from The company conducts patient experience surveys at least 2021. In addition, Helios Germany publishes the results Audits every other year. The survey results are reviewed to identify ofpatient surveys, further data on medical treatment quality, We use different systems to check our quality management strengths as well as opportunities. Fresenius Medical Care’s and hygiene figures on its corporate website www.helios- systems, depending on the business segment and business aim is to derive measures to enable more personalized care gesundheit.de (German language only). activity. All units are subject to regular external and internal and improve the quality of services. In Spain, Fresenius Helios uses the Net Promoter Score audits. Peer reviews in hospitals are carried out if the inter- Fresenius Medical Care measures patient experience and (NPS) to get specific feedback from patients who have been nal quality targets are not met. customer loyalty using the Net Promoter Score (NPS). In treated as inpatients, outpatients, or in emergencies. In 2020, 2020, the NPS was 67. The NPS reflects the customer’s over- it has been extended to radiology and laboratory. 48 hours Audits at Fresenius Medical Care all satisfaction with the company’s services. In the report- after a hospital stay, an e-mail is sent to patients asking if Fresenius Medical Care has defined key performance indica- ing year, 75% of Fresenius Medical Care’s patients answered they would recommend the hospital and its services. The tors that help monitor its quality objectives and prevent that they would highly recommend the company’s services results are analyzed centrally for Helios Spain and at a hospi- adverse events before they occur. The company discloses the to a friend. By learning about its patients’ willingness to rec- tal level by type of treatment and treatment area. The goal audit score, which measures its performance in certification ommend Fresenius Medical Care, the company can com- is to continuously improve the NPS results. The global NPS audits, and indicates the ratio of major and critical findings pare the services provided by its clinics and turn insights into score has increased over recent years. Due to the COVID-19- to the number of external audits. In 2020, more than 60 action. In addition to the NPS, Fresenius Medical Care tracks pandemic, it was decided to stop the survey process from the certification audits were performed at manufacturing sites survey coverage and response rates. end of March to June 2020. Therefore, the NPS in 2020 remained at the previous year’s level. Fresenius | Annual Report 2020 In 2019, Helios Spain identified waiting times and lack of information as the main causes of dissatisfaction among patients. Therefore, the company has implemented a “15 / 15” target in all hospitals. A patient must get an appointment 124


  • Page 20

    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor that are managed by the Global Manufacturing, Quality and Administration (FDA), the Australian Therapeutic Goods ments. Their insights are translated into concrete recommen- Supply function. The audit score was 0.2 (2019: 0.2). Administration (TGA), European regulatory authorities, and dations for action in the hospital with the aim of increasing Fresenius Medical Care has set the target not to exceed an Quality System audits from TÜV Süd (notifying body for patient safety. In 2020, Helios Germany conducted a total of 8 audit score of 1.0 per audit to ensure the effectiveness of its ISO 9001). peer reviews (2019: 60), due to the impact of the COVID-19 quality management systems and certifications. All findings Based on the respective observations, an audit and pandemic and the resulting restrictions on hospital opera- are documented and escalated depending on how critical inspection score is calculated. The score is calculated by tions. they are. Fresenius Medical Care determines and implements addition of the number of critical and major observations Due to the pandemic, Helios Spain was able to perform appropriate corrective and preventive measures. identified during GMP inspections by the authorities men- only 2 peer reviews online by the end of 2020 (2019: eight). tioned above and the number of non-conformities identified Internally, 23 ISO 9001 audits were conducted at all Helios Audits and inspections at Fresenius Kabi during TÜV Süd ISO 9001 audits divided by the overall num- clinics in Spain. In 2020, Fresenius Helios was the first hos- Fresenius Kabi regularly conducts internal quality audits to ber of inspections and audits; critical observations, if any, pital operator in Spain to certify that the organizational ensure the effectiveness of the quality management system are weighted with a multiplier compared to major observa- measures and protocols it had implemented were used to and compliance with internal and external standards and tions. The audit and inspection score was at 1.3 in 2020 prevent and control COVID-19. requirements. Suppliers of Fresenius Kabi related to manu- (2019: 1.5). 1 Observations have been and will be addressed facturing of products are subject to a qualification process by corrective and preventive actions (CAPAs) and effective- Audits and recertification at Fresenius Vamed based on the relevance of the delivered material or service. ness checks have been and will be defined. The observations To ensure adherence to quality standards, Fresenius Vamed The qualification of suppliers, as well as their recertification, did neither impact the GMP certification nor the ISO 9001 also performs regular internal audits as well as external includes regular audits. Inspections by regulatory authori- certificate. recertifications. This is done in the certified health care com- ties and audits by independent organizations and customers In 2020, no events with a material adverse impact were panies as well as in the other facilities of Fresenius Vamed. are performed along the entire value chain at Fresenius recorded that conflict with our quality management goals. Quality management audits are carried out there once a year Kabi. Whenever these inspections reveal weaknesses or defi- in accordance with the ISO regulations. Internal audits are ciencies, Fresenius Kabi promptly takes steps to deal with Peer reviews at Fresenius Helios carried out systematically and cover all business segments them. Helios Germany analyzes the cases – including treatments and at a minimum those topics that are required by the In 2020, 59 audits and inspections (2019: 64) were per- and medical routines – in hospitals that fail to meet individual certified standards – i.e., all quality management processes. formed at Fresenius Kabi by regulatory authorities or certi- targets, in order to identify and implement improvements. fying bodies, and 42 global internal audits (2019: 60) were Particularly important are the specific audit procedures in the carried out. The external audits and inspections comprised medical and nursing sectors, the peer reviews – expert dis- a total of 21 inspections (2019: 24) regarding Good Manu- cussions of cases. In Germany, specially trained physicians Fresenius | Annual Report 2020 facturing Practices (GMP) by the U.S. Food and Drug from the hospitals of Helios Germany and from the IQM network cooperate in the peer review. They question statis- tical abnormalities and search for ways to identify improve- 1 For the calculation of the audit and inspection score, Fresenius Kabi takes into account all information on findings from audits and inspections received by the company before December 31, 2020. 125


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor DIGITAL TRANSFORMATION Many of our stakeholders, especially our patients and our Fresenius Medical Care manages worldwide R & D activities AND INNOVATION employees, are directly affected by the changes resulting centrally in the Global Research and Development (GRD) from progressive digitalization. Our research and develop- business segment. ment activities are closely linked to digitalization and are Fresenius Medical Care will focus on shaping the future DIGITALIZATION AND INNOVATION an integral part of our growth strategy. Our aim here is to of health care for chronically and critically ill patients Digitalization plays an increasingly important role for improve products and processes as well as to develop across the entire spectrum of kidney disease. In 2020, for Fresenius – whether in health care facilities or in production. innovative therapies and integrated health care services; example, Fresenius Medical Care strengthened its position It is a driving force behind the implementation of innovative however, we do not conduct fundamental research. in acute dialysis. The U.S. Food and Drug Administration technologies and treatment concepts and can help us to All new or improved products and services are subject (FDA) approved Novalung ® a cardiopulmonary support sys- find solutions to many challenges in the health care sector. to our internal quality requirements as well as external reg- tem for the treatment of acute lung and heart-lung failure. For us, the focus is on the opportunities offered by digital ulations and regulatory requirements. In the case of digital Fresenius Medical Care also strives to continuously identify solutions. Through innovative, safe, and user-friendly prod- developments, we pay particular attention to the require- new opportunities in value-creating technologies and ucts and systems, we can further improve the quality and ments of the General Data Protection Regulation (GDPR) of approaches, for example through the Fresenius Medical Care efficiency of treatments. the European Union (EU). We also observe European direc- Ventures Fund. tives such as the EU Medical Devices Directive (MDD) in the OUR APPROACH medical technology sector. We address possible risks, such Fresenius Kabi In order to drive digitalization and innovation at Fresenius, as hacker attacks on sensitive data and systems, by imple- As a global health care company that offers lifesaving medi- we take different approaches in the four business segments – menting comprehensive cybersecurity concepts, as described cines and technologies for infusion, transfusion, and clinical from independent R & D strategies to active innovation man- in the section on Cybersecurity on pages 129 ff. nutrition, digitalization and innovation are of great impor- agement, as described on page 43 in the Group Management tance to Fresenius Kabi. The digitalization of processes is a Report. We also involve external partners such as research Fresenius Medical Care cornerstone in the development of innovations and an institutions and start-up companies in this work. One of our In order to grow continuously in its core business and move important aspect in effective care for critically and chron- priorities is developing innovative products that not only into new business areas, Fresenius Medical Care works ically ill patients, as well as in compliance with regulatory meet stringent quality requirements, but also affordability with a global R & D strategy and a network of external part- requirements on a future-proof basis. Fresenius Kabi devel- requirements. In doing so, we are responding to the grow- ners; in particular, the business segment invests in young ops devices and applications in various medical fields to ing demand worldwide for high-quality yet cost-effective start-up companies. Among other things, Fresenius Medical support its customers’ ongoing digitalization. products and services. In response to the COVID-19 pan- Care is developing new technologies for home therapies Fresenius Kabi’s development expertise includes all demic, we continued to drive the Group’s digital transfor- and is committed to advancing the development of telemed- related components, such as the drug raw material, the phar- Fresenius | Annual Report 2020 mation through new processes and solutions implemented icine applications. These offer great potential for providing maceutical formulation, the primary packaging, the devices at short notice. patients with clinical care between visits to their doctors and avoiding unnecessary hospital stays. Fresenius Medical Care attaches great importance to carefully addressing ethical issues in all its R & D activities. 126


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor needed for application of drugs and infusions, and the related Helios Spain’s IT and process strategy aims to further business, digital solutions known as virtual Building Infor- production technology. In the field of biosimilars, Fresenius improve patient interaction by digital means, such as video mation Modeling (BIM) concepts are used to simulate and Kabi focuses on autoimmune diseases and oncology. conferencing rounds and chats, at which patients can pres- optimize the entire life cycle (planning, development, con- Fresenius Kabi has standard operating procedures for the ent their medical history, as well as protocols and automated struction and operation) of a health care facility during the development and design of products and for cybersecurity tests for specific diagnoses. To ensure that the IT strategy is planning phase. Additionally, Fresenius Vamed is also under- of its devices. The responsibility for innovation and develop- implemented gradually, the business segment has introduced taking internal digitalization projects in the areas of project ment is anchored in the divisional organizations of the a competence model called “Digital Stars” at Spanish hos- business, high-end services and general operations manage- company. Fresenius Kabi continuously addresses advancing pitals. This model is based on three pillars: Digital Customer ment. The management of the Digitalization strategic busi- technological changes. Employees work together in cross- (patients), Digital Professional (employees) and Digital ness area regularly reports progress to the Management organizational and cross-functional teams to develop inno- Organization (administration). For each of the three pillars, Board. vative solutions for medical needs. key figures have been established to indicate progress in digitalization and acceptance thereof, which, for example, PROGRESS AND MEASURES 2020 Fresenius Helios sees data collected for the number of patients making use The potential of digitalization is key for Fresenius Helios to of digital medical consultations, the number of electronic Digital health care ensure the sustainability of its hospitals and to improve the prescriptions issued by employees, and the number of Connectivity is a key element of Fresenius Medical Care’s quality of health care and the service provided to patients. invoices automatically generated. The business segment eval- development strategy to support the expansion of home In 2020, the business segment introduced a new process uates the data on a monthly basis and can thus compare the therapies. Patients who are in close contact with their clini- for managing digitization projects in Germany and estab- evolution of digitalization in the various hospitals in Spain. cians are less likely to be hospitalized. As more patients lished the Helios Digitization Board to manage and centrally are treated at home, it is essential for to optimize workflows evaluate proposals for digitization projects. To this end, Fresenius Vamed for clinicians and reduce the burden for patients. ideas are being collected in the clinics and outpatient facili- Having established Digitalization as a strategic business area, To this end, Fresenius Medical Care launched ties of Helios Germany and in the Fresenius Group. A clear- Fresenius Vamed is now undertaking numerous initiatives its Kinexus™ Therapy Management Service (“Kinexus”), a ing function and other committees at Fresenius Helios review and projects in this area. For example, patient services for cloud-based home patient management solution, in Chile the proposals. The Digitization Management Board (DIGI digital assistance systems that support ambient assisted and the U.S. in 2020. Its features include remote dialysis Board) then makes the strategic classification of the digiti- living (AAL) and digital rehabilitation services are being devel- monitoring, treatment workflow management, personalized zation projects and, with the help of specialist working oped. To this end, Fresenius Vamed has set up pilot projects prescription programming, and daily treatment reporting to groups, the so-called DIGI-AGs (working groups), decides that are being evaluated on an ongoing basis. In the project clinicians. Kinexus allows Fresenius Medical Care to improve what will be implemented. All digitization projects, includ- patients’ home therapy experience and support those caring Fresenius | Annual Report 2020 ing rejected project ideas, are published in the “Helios.Dig- for them, with the goal of keeping them at home for longer. ital” project database via myHelios. The degree of digitali- zation at hospitals in Germany is measured using the Electronic Medical Record Adoption Model Score (EMRAM Score). 127


  • Page 23

    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Digital product innovations of technical information. In addition, the applications for data Online services for patients For Fresenius Medical Care, modern analytical tools open up management of the networked devices will be expanded to new opportunities for enhancing and automating the end- support customers in their digital transformation initiatives. TheHub, mycompanion and Telehealth to-end delivery of dialysis treatments. They can be used to at Fresenius Medical Care determine the optimal treatment for individual patients and Digital patient files In the United States, Fresenius Medical Care launched its to automate the respective treatment sequence. Moreover, A digital file with doctor’s letters, findings and complete connected health platform TheHub at the end of 2019. This these tools make it possible to not only evaluate the vital clinical imaging is available at almost every workstation in improves collaboration between patients, care teams, and parameters of patients but also to monitor and optimize the the clinics and creates added value for treatment providers providers via an app. In 2020, more than 1.7 million sessions functional state of machines or related services. Fresenius and patients. As one of the pioneers in the German health in the app were documented. In various countries in Europe, Medical Care Data Solutions Care GmbH is working on these care market, Fresenius Helios has set up a patient portal Africa, Asia-Pacific and Latin America, Fresenius Medical approaches and solutions with the aim of allowing physicians that now enables patients in around 50% of clinics to access Care is using the mycompanion app as a new channel to to focus even more on patients and the course of the disease treatment documents, book appointments online, and have reach our patients. During the COVID-19 pandemic in 2020, itself. video consultations from home. By 2022, other medical data telehealth also played a critical role in reducing the expo- In 2020, Fresenius Kabi introduced radio frequency iden- such as nursing documentation and medication will also be sure risk for patients and health care workers. By enabling tification technology (RFID) smart labels for drugs in the available in the digital patient file. virtual contact, Fresenius Medical Care minimized the United States. Since the fourth quarter of 2020, these RFID The digital patient file will make many processes more risk of infection on both sides. At the same time, digitization smart labels have been used on the market. The smart label efficient and improve medical quality. One example here is raises the bar when it comes to protecting patient data. enables hospitals to automatically identify, locate, and man- e-medication: electronic prescriptions can be uniquely age their inventory. assigned and tracked by all parties involved – e.g., medical The Helios patient portal In the area of device products, the company works on practices and pharmacies – and can also be sent digitally, 2019 saw the Helios Patient Portal introduced at Helios solutions for interoperability between pump devices, infusion- such that they are not easily lost. Integrated software solu- Germany hospitals for the first time. It is currently available specific systems and hospital IT systems in order to improve tions issue warnings when there are possible interactions in 38 of the 86 hospitals and will be available at all sites by efficiency and effectiveness in the treatment of patients. with other drugs, which increases patient safety. Patients can the end of 2022. The portal enables patients to view medical Furthermore, devices are constantly being improved with make their own decisions on the distribution of information, letters and reports (among other things) outside of hospital regards to new cybersecurity requirements and insights. since they receive key parts of the patient record themselves and outpatient department opening hours. There is also the Also, in the area of transfusion medicine and cell thera- and can thus maintain an overview. option to go online to book appointments at hospitals and pies, Fresenius Kabi is constantly developing its systems medical centers. Patients can reach the portal via the hospital for collecting blood components and using new technologies websites. Fresenius | Annual Report 2020 to increase the efficiency and effectiveness of the systems. Almost three million users already access Helios Spain’s They are continuously optimized to support the processing patient portal. All Spanish hospitals are connected, with the exception of Hospital Miguel Dominguez, Hospital Costa de la Luz and Son Veri. The connected hospitals benefit from a central data repository and from improved data transmission and coordination. Via the digital portal, patients of Helios 128


  • Page 24

    Media Hub To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient Digital transformation and innovation | Employees | Diversity Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Spain can track the progress of their own clinical treat- sessions are held online within the network of all Helios EVALUATION ments and view recommended therapeutic measures. They Spain hospitals, including Colombia and Perú. In 2020, a total Each Fresenius business segment has its own approach to have direct access to radiological 3D images and can con- of 22 sessions were held. digitalization and innovation. We are currently developing tact their responsible specialists on this basis and interact Fresenius Vamed is making rehabilitation and after-care key performance indicators (KPIs) for digitalization. At Helios via web forms. In addition, it is possible to digitally request services widely accessible to patients with its digital solu- Germany, for example, the DIGI Board will carry out testing an appointment for most available examinations as well as tions. Telemedical services allow more flexibility, including and assessment using the degree of digitalization measured to read up on the risks associated with an examination. in terms of location. Fresenius Vamed is making a contribu- via EMRAM in the future. Fresenius Vamed, as another Before a procedure, patients can also sign a consent form tion to improving health care, especially in regions with weak example, regularly reviews its management approach using electronically via the portal. structures, for example. The company has developed digital standard controlling processes. In addition, the Digitalization treatment pathways, evaluated technical solutions and strategic business area collects data and reports regularly Digital support for treatments launched pilot projects in the area of digital tele-post-acute on the status of the respective initiatives and projects in the All Fresenius Helios health care facilities have the necessary aftercare services. business segment. technical set-up to conduct video consultations, with some Overall, the digitization of processes was driven forward hospitals already offering these kinds of appointments on a Online boards for digital exchange throughout the Fresenius Group in 2020. regular basis, e.g., policlinic Berlin-Buch, where around 70 Experts at Helios Germany have been using online confer- Fresenius Helios doctors routinely check in with patients ences, referred to as tumor boards, to review oncological CYBERSECURITY online. 1,800 video consultations have already taken place in findings collectively across locations and disciplines and Germany. In Spain, Helios has conducted 4,500 video con- thus improve medical quality during cancer treatment. This OUR APPROACH sultations and answered 15,000 chat inquiries. Fresenius exchange allows them to discuss treatment for cancer At the Fresenius Group, we pursue a holistic concept for Helios has also started online consultations in the pre-out- patients. Experts from Helios Germany also discuss patho- the management of cybersecurity. We bring decision-makers patient sector. The business segment also plans to introduce logical findings in the context of digital pathology. of the Group, i.e., the persons responsible for cybersecurity digital measures to shorten waiting times and ensure conti- in the respective departments or business segments, together nuity in follow-up care. These will enable specialists from to develop a common approach, aligned with our strategic Fresenius Helios to accompany patients digitally through- goals. We align our strategy with the security requirements out their treatment path – regardless of whether they are at of our four business segments and the analysis of cyber the hospital or being treated at an outpatient center. Clinical risks. This approach is reflected in all security guidelines that are applicable throughout the Group. In 2017, the Manage- ment Board of Fresenius Management SE initiated the Cyber- Fresenius | Annual Report 2020 security Approach, Roadmap and Execution (CARE). Starting in 2018, CARE has served as a holistic cybersecurity pro- gram that exists alongside the organization and bundles ini- tiatives. The focus is on strengthening our resilience to 129


  • Page 25

    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor prevent and defend against cyber attacks. In addition, with CYBERSECURITY ORGANIZATION CARE, we ensure a consistent level of security throughout the Group. At the beginning of the reporting year, the Man- agement Board of Fresenius Management SE, as a part of Fresenius Management Board CARE, enacted a Group-wide cybersecurity policy. With this policy, we define the structural and operational organiza- Cybersecurity Board Fresenius Group Head of Cybersecurity tion for global cybersecurity governance in the Fresenius Group, which, among other things, forms the framework of CARE. In this way, our cybersecurity policy ensures that cybersecurity is organizationally anchored throughout the Group. The Opportunities and Risk Report contains further infor- Corporate Head of Business Segment Business Segment Business Segment Business Segment Cybersecurity Head of Cybersecurity Head of Cybersecurity Head of Cybersecurity Head of Cybersecurity mation on cybersecurity and cyber incidents at Fresenius in 2020, on pages 101 ff. Risk Domain Managers Risk Domain Managers Risk Domain Managers Risk Domain Managers Risk Domain Managers Organization and responsibilities Steering of Risk Domains Group Cybersecurity Office (GCSO) The organizational structure Lead by Group Head of Cybersecurity In 2020, we reorganized numerous roles and responsibilities Governance & Cyber Defense & Cyber Risks & Product Security & Cyber Cultur & Cyber Program Assurance Analytics Economics Architecture Training Management for cybersecurity as part of the implementation of the new Cybersecurity Policy. Since May 2020, the Group Cybersecu- rity Office (GCSO) is the central organization for managing cybersecurity within the Fresenius Group. It ensures that it analyzes cyber threats and defends cyberattacks. It also functions. The Group Head of Cybersecurity defines the relevant cybersecurity activities are organized and imple- investigates incidents and develops recommendations for Group-wide cybersecurity strategy and coordinates this mented with individual approaches at the business segment preventive measures to avoid potential cyber incidents in line strategy with respective cybersecurity heads in order to level, monitored and coordinated from a Group perspective. with risk management. ensure a common approach across all business units. If necessary, the divisions are advised and supported in their The Group Head of Cybersecurity leads the GCSO. He Fresenius has identified five cybersecurity risk domains activities. has overall responsibility for the governance of cybersecurity throughout the Group: Enterprise IT, Manufacturing IT, Fresenius | Annual Report 2020 The GCSO is divided into six functions: Cyber Gover- within the Fresenius Group. In the business segments, Medical Devices, Health Facilities, and People. The risks nance & Assurance, Cyber Risk & Economics, Products Secu- the respective Business Segment Heads of Cybersecurity are identified include, for example, interruption to manufactur- rity & Architecture, Cyber Defense & Analytics, Cyber Cul- responsible for the activities in their area of responsibility. ing or quality management systems, the unauthorized ture & Training and Cyber Program Management. The Cyber At the level of Fresenius SE & Co. KGaA, the Corporate Head disclosure or manipulation of patients’ health data, and the Defense & Analytics function is of particular importance: of Cybersecurity is responsible for the individual corporate interruption or integrity loss of core enterprise IT systems. 130


  • Page 26

    Media Hub To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient Digital transformation and innovation | Employees | Diversity Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Each risk area is managed by its own Risk Domain Manager – Those responsible for cybersecurity usually have many years The new cybersecurity guideline is based on the Fresenius both at Group level and in the four business segments. of experience in cybersecurity management. They have Code of Conduct and follows internationally recognized Among other things, they define cybersecurity requirements extensive knowledge and appropriate professional certifica- standards and best practices. It defines the overarching pol- and coordinate risk management activities. The Risk Domain tions. icy structure for cybersecurity in the Fresenius Group. In Managers are in contact with each other and promote the use addition, the GCSO, in cooperation with the four business of best practices and the exchange of expertise and knowl- The reporting structures segments, defines further guidelines for the five cyber risk edge across all cybersecurity risk-domains. The Group Head of Cybersecurity reports directly to Rachel domains Enterprise IT, Manufacturing IT, Medical Devices, At the operational level, the four business segments are Empey, Management Board member of Fresenius Manage- Health Facilities, and People. They establish Group-wide responsible for their cybersecurity management. The busi- ment SE. She is informed about cybersecurity-related topics minimum security standards for these risk areas. The four ness segments establish and report on strategic objectives on a weekly basis and as required. The Chief Financial business segments also have specific minimum security and appropriate strategies for addressing risks. The objec- Officers of the business segments, for Fresenius Vamed the standards for cybersecurity management, which take into tives are based on the Group-wide cybersecurity strategy and member of the Management Board responsible for the account specific regulatory requirements or local legisla- are defined independently by the Business Segment Heads service business, meet quarterly in the CARE Steering Com- tion. Minimum security standards already established in the of Cybersecurity. They are responsible for implementation in mittee to organize regular reporting across the business four business segments are leveraged as Group-wide stan- the business segments. segments. The Risk Domain Managers report to their respec- dards where appropriate. In addition, the cross-divisional Cybersecurity Board tive Head of Cybersecurity. The Business Segment Heads meets at least once a month. It consists of the Group Head of of Cybersecurity submit technical reports to the respective Our ambitions Cybersecurity, the Corporate Head of Cybersecurity, and member of the CARE Steering Committee. In the future, the The objective of our cybersecurity program CARE, which all Business Segment Heads of Cybersecurity. It ensures the Business Segment Heads of Cybersecurity will additionally covers all risk domains, is to increase the maturity level of exchange of information on the Group-wide cybersecurity report to their business segment Management Board on a our cybersecurity capabilities, strengthen our resilience to strategy between the business segments and Group func- quarterly basis; the reporting processes are currently being cyber attacks and continuously reduce our cyber risks. We tions, defines criteria for evaluating and monitoring the established. In addition, the Data Protection, Enterprise evaluate the ever-changing threat landscape, define mini- development of cybersecurity across the Group, and reviews Risk Management and Compliance Departments regularly mum security standards for our cyber risk domains, and the progress and results of cybersecurity measures and ini- exchange information on cybersecurity issues. implement appropriate security measures in a targeted, risk- tiatives. In addition, the Cybersecurity Board monitors the based, and cost-effective manner. The Cybersecurity Board adoption and implementation of the Group-wide cyber- Guidelines and regulations annually develops Group-wide and business-unit-specific security policy. Our Cybersecurity Policy Framework consists of a set of operational objectives and measures to safeguard the confi- policies, requirements and procedures. It forms the founda- dentiality, integrity and availability of our data – and to con- Fresenius | Annual Report 2020 tion for cybersecurity in all business segments and Group tinuously enhance the cybersecurity of our IT infrastructures, functions. Within this framework, we define confidentiality, integrity, and availability as our central objectives for pro- tecting data, technologies, and systems. It was approved by the Management Board of Fresenius Management SE and the management committees of the four business segments. 131


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor manufacturing, health facilities and medical devices. These Security concept languages. Participation is currently voluntary. The success are coordinated via the Group Head of Cybersecurity and To minimize cyber risks, we have implemented security of the CTAP measures is measured using predefined suc- submitted to the CARE Steering Committee established at architectures and concepts that include preventive and cess criteria. management board level, and are reported on regularly. detective measures. We are able to detect cyber threats at The phishing tests carried out in the reporting year 2020 an early stage by monitoring our networks as well as our have shown that the intensive training activities have raised PROGRESS AND MEASURES IN 2020 endpoints such as desktops, servers, and mobile devices. The security awareness of employees and resulted in a significant security of applications that handle sensitive patient or increase in the number of reported phishing cases. Risk analysis personal data is regularly reviewed by what are known as In addition, we continuously inform our employees In 2020, the GCSO conducted a cyber risk analysis of our penetration tests, which simulate targeted attacks. Critical through various channels about current cyber risks and new business processes. Each business segment identified spe- systems, such as central communication or clinical infor- types of cyber threats. We also organize a Cybersecurity cific cyber risks. The cyber risks of Fresenius Medical Care mation systems, are subject to dedicated protection concepts, Awareness Month in October each year. and Fresenius Kabi are closely related to production: this which can, for example, deal with the failure of a system. includes possible failures of and disruption to central sys- We continuously monitor existing and potential threats Reporting paths tems, e.g. of manufacturing and quality management sys- using the latest security technologies. Recurring analysis If Fresenius employees suspect cyber threats, they can con- tems. Another key risk is the theft of intellectual property, and defense processes are automated in order to be able to tact CERT@Fresenius.com, CyberAware@Fresenius.com, trade secrets, and strategic documents. At Fresenius Helios react even more efficiently to incidents. and any cybersecurity employee. Early warnings and alarms and Fresenius Vamed, the focus is on patients and medical via the monitoring mechanisms are automated. In addition, devices: risks include the potential failure of systems to pro- Training our internal Cyber Emergency Response Team (CERT) inves- tect patients and their health information. Other risks In 2020, we launched the Cybersecurity Training & Aware- tigates possible attacks on our IT infrastructure, manufac- include the disclosure or manipulation of patient data, fail- ness Program (CTAP). The goal is to raise the awareness of turing, and health facilities, suspected violations, as well as ures in patient treatment due to business disruptions, and all Fresenius employees on cyber threats and attacks. In reports from affected persons and regulatory authorities. the interruption of systems that store and process health data. addition to mandatory training on data protection and infor- Based on this cyber risk analysis, we continuously develop mation security, CTAP offers various courses, games, vid- our security measures. Our Risk Report contains extensive eos, and other cybersecurity learning content. For example, information on the effects of cyber risks on risk manage- we use the digital CTAP learning platform to provide infor- ment, see page 101 ff. in our Annual Report 2020. mation about cyber threats. We regularly simulate phishing attacks to check the effectiveness of the training and to provide users with information on an appropriate response Fresenius | Annual Report 2020 if phishing is suspected. With phishing attackers use web- sites or e-mails, e.g., to gain access to user data. We calculate a personal risk score for employees based on their behavior in phishing tests and the number of cybersecurity training sessions they have completed. All CTAP activities are tailored toward Fresenius’ specific risks and are available in several 132


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor EVALUATION EMPLOYEES WORKING CONDITIONS, RECRUITMENT, AND Audits and monitoring The commitment of our more than 300,000 employees world- EMPLOYEE PARTICIPATION Our cybersecurity management is subject to random checks wide forms the basis of our success. Their achievements, at regular intervals by the Internal Audit department. We skills, and dedication help our business segments to hold OUR APPROACH continuously monitor and improve the effectiveness of our leading positions in their respective markets. measures. Our networks, systems, and devices are regularly Working conditions and comprehensively checked for weaknesses by indepen- Reporting in this chapter encompasses three categories that As an international health care Group, we create various dent auditors in the course of penetration tests. In addition, we deem essential: incentives for employees, depending on the country and loca- various certification authorities such as the U.S. Food and tion. These include flexible working time models or the Drug Administration (FDA) or German TÜV, as well as vari- ▶ Working conditions, recruitment, and employee chance to participate in the company’s success via variable ous auditing companies, are involved in the review processes participation compensation models. Particularly in the case of working of our cybersecurity management. For security reasons, we ▶ Employee development time models, challenges remain with regard to an employee’s cannot make any statements about specific review processes. ▶ Occupational health and safety function or the local markets. Further information is included in the business segments’ reporting. Further, diversity has been identified as material to our com- In recent years, we have established various dialog for- pany as well, and is therefore presented on pages 151 ff. of mats to strengthen communication between management this report. and employees – both at Group level and in the individual The importance we attach to personnel issues is also business segments. This allows the Management Board to expressed in our structure: the Group Management Board provide employees with information on important issues member responsible for law, compliance, insurance, and personally. In addition, we promote our feedback culture and personnel is responsible for the interests of employees. This constructive exchange of ideas. We describe our variable Management Board member also holds the position of compensation models in detail on pages 305 ff. of the Notes. Labor Relations Director. The business models of each of our four business segments set different operational require- Recruitment and candidate communication ments for the management of key matters. In the following In order to meet our future demand for qualified specialists, section, we will therefore report on Group-wide as well as we use a variety of different tools to recruit staff. We moni- segment-specific personnel concepts and measures. tor our working environment and competitive surroundings Fresenius | Annual Report 2020 closely to identify potential. Furthermore, we are increas- ingly using digital personnel marketing, organizing our own recruitment events, and presenting the company at career 133


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor fairs. In recent years, we have significantly broadened our which we are affiliated. If this is not the case, country-specific its anticipated growth, employment situation, investments, range of personnel marketing activities and expanded our collective bargaining agreements can be negotiated with local organizational changes, and the introduction of new work global careers website. In 2020, the market research institute trade unions or comparable social partners. and production processes. The EWC meets once a year, Potentialpark named Fresenius the German company with In European countries, workplace representation bodies while its executive committee convenes three times a year, the best online offering for applicants for the ninth consec- are organized according to national law. The business in 2020 in hybrid form due to the COVID-19 pandemic. The utive year. segments have overall responsibility for dealing with local European trade union federations IndustriALL and the Euro- employee representatives and trade unions at country or pean Federation of Public Service Unions (EPSU) attend Employee participation site level. Our discussions with these representatives focus the meetings at the invitation of the EWC. The focus topics of on local and regional circumstances. Together with the the EWC in the past fiscal year were projects in the Group’s Exchange with employee representatives employee representatives, we aim to find tailored solutions business segments for reorganization, e.g. in the area of Trust and cooperation between management, employees, and to the challenges in the different locations. global human resources management, the digital transforma- employee representatives is well-established at Fresenius Fresenius has also reached an agreement with the Euro- tion, and compliance matters relating to the Group’s human and an integral part of our corporate culture. An open and pean Works Council, making provisions for a structured rights declaration. Another focus was on the impact of the ongoing dialog between management and employee repre- dialog with the international trade union associations; collec- COVID-19 pandemic on Fresenius’ employees. To this end, sentatives, as well as unions, is important to us. tive meetings are subsequently held once a year between an exchange of information took place on the situation in the Fresenius acts responsibly toward its employees. This representatives of the business segments and representatives individual countries. Against the backdrop of the COVID-19 includes the commitment to comply with international labor of the international trade union associations. pandemic, and for a limited period of time, an agreement and social standards, which are contained in our Code of was reached with the EWC on the digital performance of Conduct and in the Human Rights Statement. For more infor- Dialog at European level its tasks. mation, see pages 164 ff. Fresenius SE & Co. KGaA has a European Works Council (EWC) The EWC elects six employee representatives to the Employees liaise with their supervisors, but they can also comprising 20 employee representatives from 13 countries Supervisory Board of Fresenius SE & Co. KGaA, to include at turn to their human resources or compliance officers, as as of December 31, 2020. These individuals come from the least one representative of the trade unions. In order to well as to the works council, their union representatives, or EU and EEA (European Economic Area) member states in ensure equal terms of office for all members of the Super- other employee representatives, for assistance. In Europe, which Fresenius employs personnel. visory Board of Fresenius SE & Co. KGaA, the EWC resolved about 77% of our employees are covered by a collective bar- The EWC is responsible for the participation of Fresenius on a corresponding agreement. gaining agreement. In some European countries, Fresenius employees in cross-border measures, insofar as these have is subject to industry-related collective agreements, e.g., in a significant impact on the interests of Fresenius personnel France, which are binding by law due to the industry to and affect at least two countries within their area of respon- Fresenius | Annual Report 2020 sibility, such as the relocation or closure of companies or collective redundancies. For example, the management informs and consults with the EWC on the following: the structure and economic and financial situation of the Group, 134


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Medical Care Policies and regulations The company continuously works to offer its employees a Fresenius Medical Care’s worldwide team is key to its suc- Fresenius Medical Care acts responsibly towards its employ- modern working environment. The COVID-19 pandemic has cess as the world’s leading dialysis company. In line with ees. It is also part of the company’s commitment to comply accelerated the changes that have already been initiated its business objectives, the business segment updated its with applicable social and labor standards. Fresenius Medical regarding mobile working and the use of digital communica- Global People Strategy in 2020. Fresenius Medical Care’s Care has defined this commitment in its Code of Ethics tion methods. aim is to provide an engaging, fair, and trusting work envi- and Business Conduct and in our global statement on Human ronment for all employees to support their growth and con- Rights, Workplace Rights and Labor and Employment Prin- Organization and responsibilities tribution to the company’s success. With this background, the ciples. A Center of Expertise Leadership & Talent, Talent Acquisi- Global People Strategy has four priorities: (1) Engage tion & Employer Branding, Organizational Development, employees; (2) ensure that the right capabilities are available Fresenius Kabi Diversity & Inclusion (CoE TLO) was set up in 2020 in the to support our business goals; (3) continuous advancement Fresenius Kabi aims to be perceived as an attractive employer global human resources department, which reports directly to of the organization; and (4) excellent global human resources around the world in order to attract qualified and motivated the head of global human resources. The Center of Exper- (HR) management practices. talent to the company. It is particularly important to under- tise aims to further develop talent acquisition, personnel and Fresenius Medical Care continuously develops its employ- stand regional and local characteristics of the markets and organizational development, and talent management, and ment standards and HR policies to achieve consistency to take these into account when addressing talents on the to strengthen a company-wide learning culture and corre- and transparency in working conditions and provide equal basis of job profiles. Fresenius Kabi is continuously develop- sponding structures and offers for promoting talent at opportunities for its employees. One key element for this is ing its processes for recruiting employees further and fos- Fresenius Kabi. a unified global HR system that supports the business seg- ters the collaboration between the human resources depart- ment’s global and local business needs and new ways of ments and the divisions. In 2020, Fresenius Kabi adapted Policies and regulations working. its recruiting processes to the particularities of the COVID-19 As the basis for the shared understanding of collaboration, pandemic and increasingly carried out application and Fresenius Kabi has defined company values that have been Organization and responsibilities selection processes virtually. In addition, Fresenius Kabi uses introduced worldwide. The company values are anchored in Fresenius Medical Care’s global HR function is responsible social networks to address potential candidates with the both the Code of Conduct and the Quality Management for the People Strategy and reports directly to Fresenius close involvement of the communications department. In the Handbook. They are embodied in the corporate environment Medical Care’s CEO. The function manages the further devel- past fiscal year, we were able to fill our vacancies as planned. and employees maintain a culture of cooperation across opment of human resources policies and processes and national borders, as well as functions and hierarchies. drives the alignment of HR across all regions and functions. Fresenius | Annual Report 2020 135


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Helios Helios Spain aims to further expand its position as a leading TVöD), or company-specific collective agreements. In Ger- Helios offers its employees in Germany and Spain the private provider of health care services. To do so, it needs many, all Fresenius Helios clinics are subject to the current opportunity to work part-time. Unlike many other industries, to attract new employees, retain them, and develop them Working Time Act, which in some cases provides for wage hospitals need to work around the clock, 365 days a year further. In its human resources policy, Fresenius Spain reopener clauses for supplementary tariff regulations. The to ensure patients are cared for. Against this background, states that the company’s success depends to a large extent Works Constitution Act, which grants the works councils flexible working hours do therefore pose certain challenges on its employees. The guideline also defines the objectives co-determination rights and control, also has a regulatory and require, among other things, that shift systems be of human resources work: these include transparent internal effect. The situation with regard to working hours for the redesigned. In addition, Helios Germany offers employees communication and the development of a program for the individual companies is regularly agreed by the respective other incentives: e.g. the Helios Plus Card, a private sup- ongoing training of employees. company parties on-site. plementary health insurance for Fresenius Helios employees In Spain, we apply the statutory rate for hospital employ- in the event of inpatient treatment at a Helios clinic, in- Organization and responsibilities ees. This ensures attractive working conditions and fair house and external training courses, development programs At Helios Germany, the Central Service for Personnel remuneration for employees in line with the market. To tailor for managers, health prevention programs, access to the Recruitment and Development is responsible for recruiting our personnel management more efficiently to the needs Helios Central Library, and employee discounts at fitness employees. The Central Personnel Management and Collec- of our people, we started a company-wide employee survey studios, among other benefits. tive Bargaining Service is responsible for structuring working and expect first results in 2021. Further information can Helios Germany also has to deal with a specific challenge conditions under collective agreements and improving the be found on page 138 of this report. posed by Germany’s Ordinance on the Minimum Require- service for employees. Affiliated with this is the Helios sup- ments for Nursing Personnel in Hospitals (Personalunter- plementary pension fund, which enables Fresenius Helios Fresenius Vamed grenzen-Verordnung – PpUGV), which has increased the employees in Germany to invest some of their remuneration Fair working conditions are part of Fresenius Vamed’s mis- need for nursing personnel, of whom there is a shortage on in their company pension plan via deferred compensation. sion statement. Fresenius Vamed’s corporate culture is char- the labor market, in some areas. The focus of the search The Helios supplementary pension fund is a company-owned acterized by the diversity of unique people, open dialog, for employees is on three areas of action: training of qualified pension institution. mutual appreciation, respect, caring, clear goals and decisive personnel internally, advertising to skilled workers who leadership. The company values, strategies and goals are not actively looking for a new employer, searching the Policies and regulations should manifest themselves through open, intensive, and international labor market. Helios Germany participates All Fresenius Helios hospitals are bound by collective agree- direct communication. The Fresenius Vamed business in government-led campaigns to recruit personnel on the ments, including those in Germany, which are linked to the model is very broad in nature, which places special demands international labor market, as well as supporting people Helios Group collective agreement, the collective agreement on the recruitment of personnel. The recruiting process who have qualified as nurses abroad in their applications or for public service (Tarifvertrag für den öffentlichen Dienst is tailored to the individual requirements of the individual Fresenius | Annual Report 2020 in their searches for language schools. positions. 136


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Organization and responsibilities In choosing the Loga system, Helios Germany has opted for boarding process, all new employees receive a digital infor- Human resources work at Fresenius Vamed’s entities is integrated HR management software that standardizes and mation booklet about the company. In 2021, new standards managed by the business segments’ Human Resources divi- digitalizes many HR processes in Fresenius Helios hospitals, will be established, such as an onboarding mentor, struc- sion. Since the general conditions in the individual coun- be it recruiting, personnel management, payroll account- tured familiarization concepts, and feedback discussions tries in which Fresenius Vamed is active are very different, ing, or other processes. All employees have access to this during the probationary period. Since 2019, new managers the division ensures those responsible in the local countries system via an employer self-service portal. This enables have undergone a three-stage program within two years of are actively involved. them to view digital paychecks and also to plan business trips taking up their posts to analyze and deploy their leadership or similar activities in the future. potential. Another key component of this process is the Policies and regulations Introduction of a uniform scheduling system has already integration of employees from abroad. This includes lan- Fresenius Vamed has put detailed guidelines and standards begun in all units. In addition to important improvements to guage courses and programs to familiarize them quickly in place regarding working conditions and working hours. planning and reporting options for Helios Germany, employ- with the day-to-day work processes in German hospitals, as Compliance with these requirements is continually checked. ees gain more transparency on their care schedules, and well as supporting measures for social integration together In 2020, new regulations were adopted because of the approval processes have also been simplified, e.g., vacation with local employees. COVID-19 pandemic, for example, for working from home, approval. for hygiene at the workplace, and for business trips. Helios Spain currently develops a company-wide dash- Dialog and feedback formats board to manage, evaluate and improve the most important PROGRESS AND MEASURES 2020 personnel KPIs. The dashboard is available to all clinics and Fresenius Medical Care enables them to conduct benchmark comparisons. The goal Fresenius Medical Care values the contribution of its employ- Flexible working conditions and digitalization is to provide transparency for all clinics on the most rele- ees and are adapts its processes to include their feedback In 2020, Fresenius Kabi expanded the options for flexible vant KPIs and enable best-practice sharing on how to improve on a continuous basis. The company’s global employee working and promoted digital collaboration with the com- personnel management in our Spanish hospitals. engagement surveys are tools to identify strengths as well pany-wide implementation of additional IT applications. In as opportunities to improve its work environment. Fresenius addition, at its Bad Homburg location, for example, the Induction of new employees Medical Care conducts one full employee engagement company began to introduce a new office concept in selected In our business segments, the induction processes for new survey every two years and pulse checks in the years in-be- areas that supports flexible and digital work. The work employees are in some cases standardized centrally, and tween. The company uses the survey results to define environment of around 100 employees will be redesigned are supplemented at the sites by locally relevant measures. and intiate global and local measures, with the aim of further for this purpose. The German Fresenius Kabi subsidiaries In 2020, Helios Germany further standardized the pro- improving engagement levels in the long-term. Based on developed flexible working time models at the company level cess used for induction of new employees, and further devel- the results of the 2019 global engagement survey, Fresenius Fresenius | Annual Report 2020 and created extended parental leave schemes for which an oped the process for new managers. The aim is to reduce Medical Care initiated various follow-up measures on a employer / works council agreement “New Ways of Working” early turnover to a minimum. In what is known as the pre- has been concluded in 2020. 137


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor global and regional level. The company intensified global CEO and employees. In 2020, numerous articles on current Fresenius Helios communication on this topic and worked out dedicated topics appeared on this blog and reactions from employees Helios Germany generally offers appraisal interviews to all action plans, among others. have been received. For example, in 2020 a blog post about employees. From these employee discussions, as well as In 2020, the company conducted a pulse survey with integrity, respect and diversity was published. Reactions from other dialog formats, it became evident how important more than 16,000 employees worldwide, which revealed that to this were taken as an opportunity to continuously address it is for employees in the nursing division for well-function- 64% of the participating employees are actively engaged. these topics in the United States. An initiative is being ing, integrated teams to be maintained. This aspect should The employee engagement score is based on three aspects: launched to further raise awareness for these topics among be taken into account in cases of internal restructuring in say (speak positively about Fresenius Medical Care), stay the workforce in the United States. particular. Fresenius Spain, meanwhile, conducts employee (intend to stay at Fresenius Medical Care), and strive (make To gain valuable insights into business processes, and satisfaction surveys. In 2020, a project was initiated in an extra effort to promote Fresenius Medical Care). Com- to increase employee loyalty to the company, Fresenius Spain to conduct a company-wide survey. The aim is to use pared to 2019, the engagement rate improved by eight per- Kabi uses regional employee surveys to sustainably increase a standardized questionnaire to monitor employee satis- centage points. Fresenius Medical Care is planning to employee satisfaction. On-site employee surveys are an faction at all sites in a structured manner. The survey will conduct the next full global engagement survey in 2021 to integral part of local human resources work, and the results take place anonymously. Due to the impact of COVID-19, further facilitate and build on this feedback. of these surveys are important for the company, as they the schedule has been delayed. The survey has now been provide it with valuable information that helps to develop a launched in January 2021. Fresenius Kabi stable and appreciative work environment for employees Dialog across hierarchical levels is fostered, for example, and to promote their engagement. In the reporting year 2020, Fresenius Vamed with the Global Town Hall Meeting. Hosted by Fresenius the company conducted an employee survey in the United Appraisal interviews are an essential part of Fresenius Kabi’s CEO, the event, which is broadcast to the locations States; the analysis with regards to resulting measures has Vamed’s management culture. In addition to essential around the world, is regularly used to provide information not yet been completed. Furthermore, in 2020, Fresenius insights and measures for further successful cooperation, the about current company-related developments. As part of the Kabi started preparing a global employee survey, which is necessary training and further education requirements also event, employees have the opportunity to address their envisaged to be carried out in 2021. result from the detailed discussions. These are summarized questions directly to the CEO. A Global Town Hall Meeting in a training plan, on the basis of which the corresponding was held in 2020. An event planned for the second half of training and continuing education program is drawn up. This the year could not take place due to the COVID-19 pandemic ranges from specialist training in the health care sector and was replaced by a video message from the CEO and and personality-building seminars to customized language the invitation to dialog. In addition, a CEO blog that was set training and IT seminars. up in fiscal year 2020, supports the exchange between the Fresenius | Annual Report 2020 138


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor EVALUATION EMPLOYEES (FTE) BY BUSINESS SEGMENT At the end of the 2020 fiscal year, the Fresenius Group had 2020 2019 2018 2017 2016 311,269 employees. That was 17,135 or 6% more than in Fresenius Medical Care 125,364 120,659 112,658 114,000 109,319 the previous year (December 31, 2019: 294,134). In terms of Fresenius Kabi 39,032 38,264 36,423 34,923 33,476 Helios Germany 1 57,143 53,423 51,429 57,719 56,596 FTE (full-time equivalents), this also represented a 6% Helios Spanien 39,753 34,634 31,094 29,087 n. a. increase at the Fresenius Group. Fresenius Vamed 15,364 14,770 13,665 7,215 6,909 The regional distribution is as follows: About 31% of Corporate / Other 1,166 1,154 1,060 969 889 employees are employed in Germany, 25% in the rest of Total (FTE) as of Dec. 31 277,822 262,904 246,329 243,913 207,189 Europe and 24% in North America. 1 FTE: Number of employees converted to the full collectively agreed working time on monthly average (Vollkräfte) Our distribution of employees by function remained largely unchanged in 2020: about 14% of the workforce was employed in the production sector, and 71% in the services EMPLOYEES (HEADCOUNT) BY REGION sector. Our personnel structure was thus stable in terms of 2020 2019 2018 2017 2016 development. The high proportion of service personnel is Europe 174,835 165,862 158,939 154,172 119,434 mainly due to the large number of nurses in our health care thereof Germany 96,915 91,014 88,086 86,613 84,165 Europe excl. Germany 77,920 74,848 70,853 67,559 35,269 facilities. North America 75,837 74,894 72,672 75,083 72,803 The rate of new hires 1, 2 in relation to the overall number Asia-Pacific 27,805 27,457 25,575 24,381 22,441 of employees in each business segment is evidence of our Latin America 30,871 23,998 17,610 17,709 16,283 efforts within recruitment. Africa 1,921 1,923 1,954 1,904 1,912 The length of service within the Group can vary with Total as at Dec. 31 311,269 294,134 276,750 273,249 232,873 acquisitions in the business segments. In 2020, the average was 8.2 years and remained close to the previous year´s level of 8.1 years on average. NEW HIRES 1, 2 In 2020, the proportion of employees who voluntarily left in % 2020 2019 2018 2017 2016 the company 1, 3 was 9.8% (2019: 11.0%) Contributing to Fresenius Medical Care 23.1 24.7 21.7 n. a. n. a. this development were, on the one hand, the uncertainty in Fresenius Kabi 13.5 17.1 16.9 19.8 19.0 the labor market associated with the COVID-19 pandemic, Helios Germany 14.3 15.4 16.0 19.8 14.2 but also the measures taken in recent years to retain employ- Helios Spain 25.5 20.1 27.6 n. a. n. a. Fresenius | Annual Report 2020 ees. Further information can be found on page 135 ff. of Fresenius Vamed 18.4 17.8 22.5 11.0 n. a. the Group Non-financial Report. Corporate / Other 6.1 11.2 12.5 9.7 9.6 1 Fresenius Medical Care’s 2017 data reflects country data representing 96% of all employees. Helios Germany’s data for 2016 and 2017 includes the post- acute care business in Germany. Fresenius Vamed’s data for 2017 also includes temporary staff and, as of 2018, the German post-acute care business transferred from Fresenius Helios to Fresenius Vamed. The data from Helios Spain does not yet contain the recently acquired hospitals in Latin America. 2 Calculated as the number of external hires in a business segment within the reporting period, relative to the number of employees at year-end. 3 Calculated as the number of employees who left the organization voluntarily in relation to the number of employees at the end of the year. 139


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor The proportion of female employees in the Fresenius Group AVERAGE LENGTH OF SERVICE 1 remained unchanged at 68% as at December 31, 2020. The in years 2020 2019 2018 2017 2016 proportion of females in services or care is higher than in Fresenius Medical Care 7.3 6.8 7.1 7.0 n. a. the area of production. This is reflected in the proportion of Fresenius Kabi 7.9 8.6 7.5 7.4 7.6 female employees in our business segments. The number Helios Germany 10.3 10.6 10.8 10.5 10.8 of female participants in the Group-wide Long Term Incentive Helios Spain 8.2 8.4 8.2 n. a. n. a. Plan (LTIP 2018) is a good indication for the share of women Fresenius Vamed 7.7 6.9 7.8 6.1 6.0 in management positions worldwide. According to this, the Corporate / Other 7.5 7.3 7.3 7.6 7.6 Total 8.2 8.1 8.2 8.1 8.4 ratio of women among the 1,700 top executives was 32% as at December 31, 2020. The average age 1 of Group employees was 41.6 years (2019: 41.0 years). The majority (55%) of our employees are VOLUNTARY TURNOVER 1, 2 between 30 and 50 years of age. We aim to maintain a well- in % 2020 2019 2018 2017 2016 balanced age structure within our Group. The distribution Fresenius Medical Care 11.9 14.3 13.2 12.2 n. a. reflects the demand for a high proportion of skilled and expe- Fresenius Kabi 7.1 9.2 9.4 11.3 10.7 rienced employees in our business segments. Helios Germany 8.3 9.1 6.9 6.0 5.3 Helios Spain 9.8 7.6 3.8 n. a. n. a. Fresenius Vamed 7.8 7.6 9.5 8.0 n. a. EMPLOYEE DEVELOPMENT Corporate / Other 1.7 3.5 3.8 2.7 2.5 Total 9.8 11.0 9.8 9.9 10.4 OUR APPROACH We offer our employees the opportunity to develop profes- sionally in a dynamic international environment. Our four FEMALE EMPLOYEES business segments use different concepts and measures for Dec. 31 2020 2019 2018 2017 2016 personnel development – depending on their own customer Fresenius Medical Care 69% 69% 69% 69% 69% and market structure. They constantly adapt their approach Fresenius Kabi 50% 50% 50% 51% 51% to current trends and requirements. In addition to Group- Fresenius Helios 75% 75% 75% 76% 76% wide mandatory training courses on the respective Codes of Fresenius Vamed 62% 63% 64% 56% 56% Fresenius | Annual Report 2020 Conduct, there are mandatory training courses on quality Corporate / Other 38% 39% 39% 39% 39% management, environmental management and occupational Total 68% 68% 68% 68% 68% health and safety in the business segments. Digitalization is also playing an increasingly important role in the daily work done by our employees, which we explain on pages 126 ff. 1 Fresenius Medical Care’s 2017 data reflects country data representing 96% of all employees. Helios Germany’s data for 2016 and 2017 includes the post-acute care business in Germany. Fresenius Vamed’s data for 2017 also includes temporary staff and, as of 2018, the German post-acute care business transferred from Fresenius Helios to Fresenius Vamed. The data from Helios Spain does not yet contain the recently acquired hospitals in Latin America. 2 Calculated as the number of employees who left the organization voluntarily in relation to the number of employees at the end of the year. 140


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Segment-specific talent management and individual further TRAINEES AND TRAINING RATIO training offerings for employees and managers are our other FOR GERMANY personnel development measures. 2020 2019 2018 2017 2016 Trainees 1 5,985 4,952 4,354 4,019 3,743 Vocational training Training ratio 6.18 5.44 4.94 4.64 4.45 Vocational training is very important to us. That is why we 1 Includes vocational training and university students offer applicants many opportunities to start their career pathway in our company. In 2020, more than 5,900 young people were doing dual vocational training and / or dual AVERAGE AGE 1 study at our locations in Germany. Across the Group, we 2020 2019 2018 2017 2016 offered more than 46 posts requiring formal training and 25 Fresenius Medical Care 41.7 40.8 40.8 41.7 n. a. dual degree programs. For the first time, the study programs Fresenius Kabi 39.9 38.7 38.4 38.5 38.7 or majors Management in Medicine, medical Technology Helios Germany 42.2 42.5 42.6 42.7 42.6 Helios Spain 41.0 41.0 40.0 n. a. n. a. Management and Business Informatics, Data Science were Fresenius Vamed 44.0 41.2 43.6 43.0 43.5 offered in cooperation with the Technical University of Corporate / Other 39.3 39.1 38.9 39.2 39.2 Central Hesse and Duale Hochschule Baden-Württemberg Total 41.6 41.0 41.0 41.5 41.5 (Baden-Wuerttemberg Cooperative State University), respec- tively. The classic direct entry route aside, Fresenius also offers graduates trainee programs for further professional orientation. AGE STRUCTURE 1 2020 2019 2018 2017 2016 Between Between Between Between Between Dec. 31 Below 30 30 und 50 Above 50 Below 30 30 and 50 Above 50 Below 30 30 and 50 Above 50 Below 30 30 and 50 Above 50 Below 30 30 and 50 Above 50 Fresenius Medical Care 17% 58% 25% 18% 56% 26% 16% 57% 27% 18% 56% 26% n. a. n. a. n. a. Fresenius | Annual Report 2020 Fresenius Kabi 22% 61% 17% 23% 60% 17% 23% 60% 17% 25% 59% 16% 24% 60% 16% Helios Germany 20% 48% 32% 19% 48% 33% 18% 49% 33% 19% 49% 32% 19% 50% 31% Helios Spain 18% 60% 22% 17% 61% 22% 18% 62% 20% n. a. n. a. n. a. n. a. n. a. n. a. Fresenius Vamed 15% 49% 36% 16% 50% 34% 15% 50% 35% 18% 54% 28% 18% 53% 29% Corporate / Other 25% 53% 22% 24% 54% 22% 25% 54% 21% 24% 55% 21% 23% 57% 20% Total 19% 55% 26% 19% 55% 26% 18% 55% 27% 19% 55% 26% 20% 53% 27% 1 Fresenius Medical Care’s 2017 data reflects country data representing 96% of all employees. Helios Germany’s data for 2016 and 2017 includes the post- acute care business in Germany. Fresenius Vamed’s data for 2017 also includes temporary staff and, as of 2018, the German post-acute care business transferred from Fresenius Helios to Fresenius Vamed. The data from Helios Spain does not yet contain the recently acquired hospitals in Latin America. 141


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Training Catalog Fresenius Medical Care Fresenius Kabi The Fresenius Training Catalog lists all of the training oppor- Fresenius Medical Care attaches great importance to its Fresenius Kabi has global, regional, and local structures for tunities available to our employees. This includes programs employees’ development. The company’s goal is to support training and developing employees. Employees are trained for communication and presentation, self-management and its managers’ and employees’ personal growth and their and qualified according to their functions and tasks. Manda- project management, as well as specific learning content efforts to help others grow. Fresenius Medical Care ap- tory global trainings for employees are carried out inter- depending on the job profile of the target group of employ- proaches learning and development from three angles: (1) nally. This includes, among other areas, training on the Code ees. Provide the digital and non-digital infrastructure to foster of Conduct. learning and development. All employees around the world All employees who are directly involved in manufacturing, Fresenius Learning Center participate in formalized or mandatory training via existing testing and distribution of our products, as well as employ- In addition to the training catalog, we offer training courses learning platforms that support offline and online learning. ees who work in a supporting role (e.g., technical mainte- in the Fresenius Learning Center (FLC) learning manage- (2) Enhance the attractiveness of learning and development nance, IT) receive mandatory training on job-related good ment system. Depending on the subject, these training pro- by increasing the opportunities to learn and improving the manufacturing, control, and distribution practice as well as grams consist of one or more modules. Most of these learning experience. In addition to existing platforms, occupational health and safety and environmental protection. involve some e-learning – for example webinars – as well as around 25,000 employees started using the company’s new In addition, occupational health and safety and environ- classroom training; reading materials are also offered to digital platforms with knowledge and training resources in mental and energy management training is conducted at all different target groups. Employees in Germany who do not 2020. (3) Ensure that the company’s executives are prepared certified sites. Further training supplements this and serves have their own computer or laptop, or who do not have a and equipped to provide ongoing development support. to support the introduction, further development and quiet work environment, can take the training courses they In 2020, Fresenius Medical Care also introduced a digi- improvement of the corresponding management systems and need at specially set up learning locations. The Fresenius tal platform to foster the dialog between managers and measures. Helios and Fresenius Vamed business segments also offer their teams on the topics of development and performance As part of talent management, postings to other countries needs-based e-learning and document the training activi- management. More than 1,500 managers have already are also used to promote professional and personal devel- ties in their own learning management systems. In 2020, new started using this platform. opment. Postings include both, long- and short-term post- or iterative training modules on compliance-specific topics, Fresenius Medical Care identifies and promotes out- ings, which also contribute to meeting specific staffing basic data protection regulations and information security standing talent on an ongoing basis and invests in building needs. In addition, Fresenius Kabi supports the development also became available worldwide in the FLC (with the excep- a sustainable talent pipeline for the company’s top 400 of digital competencies, for example, in connection with mak- tion of the United States). positions and beyond. The different programs for leadership ing work more flexible, such as mobile work by its employ- development are based on regional requirements but with ees, through new training programs. a focus on principles that apply globally. For example, since Fresenius | Annual Report 2020 2014, over 5,000 managers have completed the regional leadership development program in North America. 142


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Organization and responsibilities nel through in-company training at its 32 training centers in Organization and responsibilities Due to the decentralized structure of Fresenius Kabi, training the future. The business segment is also tackling the con- In 2020, Fresenius Helios merged the two departments is mainly managed decentrally, which enables Fresenius tinuing challenge that the shortage of skilled workers in the Digital Knowledge Media and Academy / Talent Management Kabi to provide training opportunities quickly and according medical sector represents. One example is the structured under the new Central Service Recruitment and Develop- to the respective requirements. The personnel development talent pools of senior doctors that we are building. ment. measures are evaluated by the responsible organizations All professional groups at the hospital can learn, train within Fresenius Kabi. Feedback from employees and exec- and further develop their expertise at the Helios Academy Policies and regulations utives is also taken into account for continuous improve- and at the Fresenius Helios training centers in Germany, to In 2019 and 2020, Fresenius Helios in Germany developed a ment of professional development measures. develop professional and personal competencies or learn new vision / mission. Due to the COVID-19-pandemic, the about their own health and prevention in this area. In addi- roll out was postponed to the first quarter of 2021, instead of Fresenius Helios tion, Fresenius Helios offers its employees trainee and late 2020. The Fresenius Helios Leadership Code also con- Imparting knowledge and developing its employees both assistant programs and builds up competence profiles for tains important guidelines for the management of employees. form part of Fresenius Helios’ self-image. All human hospital management. In Spain, Fresenius Helios is using Company and Group agreements contain specifications for resources training and development activities help the busi- development plans in its work to provide targeted support to the training of employees and / or managers. ness segment achieve its four strategic business objectives: its employees. Furthermore, the training program Talent to offer the best service, to be a leader in medicine, to do Beats was designed to help nursing students make the tran- Fresenius Vamed sustainable business and to expand on its market position. sition from university to the professional environment. The expertise and project experience of its employees plays These will enable Fresenius Helios to further improve with Fresenius Helios now uses digital work tools across the an important role in the success of Fresenius Vamed due regard to medical quality and to position itself as an attractive board in all areas of education, training and further educa- to the heterogeneous nature of its activities in the high-end employer at the same time. Training budgets as well as tion. Learning content is organized using what is known as service business, overall operations management, and proj- regular employee and development discussions are therefore the Helios knowledge account – a digital education man- ect management. It is therefore extremely important for the firmly anchored in Fresenius Helios’ corporate culture. agement system – as well as earning scenarios implemented business segment to promote their further development However, Fresenius Helios has also been faced with via e-learning and online seminars. Throughout the COVID-19 in a targeted manner. Key for Fresenius Vamed’s personnel increased competition in the human resources sector, partly pandemic, Fresenius Helios has been promoting the devel- management are individually adapted personnel develop- due to new regulatory requirements in line with the lower opment of digital formats more than ever before. ment measures and a comprehensive, needs-oriented train- thresholds for nursing. In the last two years, the demand for In 2020, Fresenius Helios managed to implement all ing offering, which is very diverse in nature due to the skilled workers has continued to increase, especially in the development programs as planned. Due to the COVID-19 pan- complex structure of the business segment. As part of its nursing sector. For this reason, Fresenius Helios intends to demic, more digital events took place, e.g., virtual selection strategic personnel planning, Fresenius Vamed identifies Fresenius | Annual Report 2020 acquire a large proportion of the necessary nursing person- of personnel and development procedures in the Assessment young employees with particular potential and promotes their or Development Center. individual development. This is done via trainee programs and in the VAMED Human Capital Management Program (HCM Program). It prepares employees with potential to take on leadership and specialist roles. 143


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Vamed is increasingly using digital elements such PROGRESS AND MEASURES 2020 Fresenius Helios as e-learning to design new training offerings. Employees Development of training programs and digital During the COVID-19 pandemic, digital learning scenarios can access a pool of knowledge via various knowledge plat- training opportunities have become more significant than ever before. The Helios forms. In addition, Fresenius Vamed also has the option The COVID-19 pandemic has also impacted development and knowledge account, the Helios Lernbar, and digital learning of developing and rolling out micro learnings independently. training offerings at Fresenius, requiring us to move numer- media have been of benefit to Fresenius Helios. These short training modules are preferably used online, ous training activities into the digital space. In 2020, Fresenius Helios’ professional training courses and have enabled fast and up-to-date precise training and and further education focused on patient-centered communi- education on applicable COVID-19 regulations, particularly cation as well as on in-classroom, simulation and online Fresenius Medical Care in the area of hygiene. Fresenius Vamed has also digitalized training on COVID-19. The aim in early 2020 was to prepare In 2020, Fresenius Medical Care introduced a digital platform essential and mandatory training and further education hospital staff for an expected pandemic and to train spe- to foster the dialog between managers and their teams activities. The same applies for the monitoring of success. cialist staff who had not worked in intensive care units before, on the topics of development and performance management. All employees are free to use their own Fresenius Vamed for possible deployment there. Online courses on basic, Academy. Their courses and training not only cover specific advanced and expert knowledge of the Corona virus were Fresenius Kabi professional issues, but also topics such as personal devel- developed, among other things. In addition, there was psy- The Code of Conduct learning module was supplemented by opment and leadership, interpersonal skills and method- chological training, such as awareness and self-protection a chapter on human rights in 2020. This training module ological expertise. Various knowledge platforms, such as the in a crisis, as well as courses and communication training for is expected to be rolled out at the beginning of 2021. Com- International Medical Board (IMB), also pool the know-how of crisis situations. pulsory data protection and information security training about 1,200 health care professionals working for Fresenius In 2020, Helios Germany continued its trainer education introduced at the end of 2018, was repeated in 2020. Further- Vamed. Over the course of the COVID-19 pandemic, the con- for the Patient-Centered Communication project on a lim- more, anti-corruption training was created and rolled- tent of the program has not changed significantly, with only ited scale. The aim of the project is to train employees in the out in 2020. In 2020, mandatory online modules were also a number of courses and events being digitalized and some clinics on communication in difficult situations, e.g., with expanded in the industrial area. Fresenius Kabi documented classroom seminars postponed to later dates. patients and relatives. training activities in more than 50 countries with more than In the reporting year, Helios Germany’s digital infra- 27,000 people trained in 2020 in internal learning manage- Organization and responsibilities structure in the human resources area enabled it to rapidly ment systems. Fresenius Vamed’s Human Resources management team, roll out its training as digital educational offerings. This Due to the COVID-19 pandemic, the global quality man- together with the responsible business segments and the included, among other things, the training of nursing staff agement department in cooperation with the occupational Management Board, develop and implement measures to and medical staff for pandemic-related deployment in the safety and environmental protection department, created promote and train employees and new talents. intensive care units. Fresenius | Annual Report 2020 online training on the background, behavior and preventive In 2020, Helios Spain introduced a Corporate Talent Plan measures related to the pandemic in various languages for talented employees. This plan encompasses a talent in 2020. pool for internal exchange, as well as training activities. The 144


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor aim is to identify future leaders as well as key talents in Fresenius Helios: Knowledge target and Fresenius Kabi the company, tailor an individual talent plan to their needs, knowledge account For training of employees in production 1 on quality man- career aspirations and the company’s strategy, and thus The Helios knowledge account is a digital education man- agement an average of 20 hours was spent per employee in strengthen the individual’s commitment to their work. The agement system. It enables Fresenius Helios to respond 2020. In 2019, a strong basis concerning our training of first step is to conduct 360-degree feedback interviews accordingly if the demand for digital learning, further edu- employees on quality management was set. In 2020, we con- with the selected individuals, after which the individual devel- cation and training formats increases. tinued with our training measures and ensured training opment plan is determined based on the evaluations. One Thanks to the annual Helios knowledge goal, all employ- of all respective employees. focus of the training activities in this program is on emotional ees of Fresenius Helios in Germany are able to continue intelligence, which we value as an important attribute for their training on specific health topics via online training. In AVERAGE HOURS OF TRAINING PER YEAR PER EMPLOYEE our talents, especially in the hospital environment. Training the year under review, two areas provided the main focus. IN PRODUCTION 1 REGARDING QUALITY is conducted both internally and in collaboration with such The first area – Strong for the future – saw employees learn- 2020 2019 institutions as IESE, Business School of the Spanish Univer- ing how Fresenius Helios can offer the best medical quality Production (training hours / average) 20.06 25.07 sity of Navarra. in the long term – for example by means of an improved care Number of employees included structure or by setting up centers. The business segment in the calculation (FTE) 21,800 22,000 Fresenius Vamed relied on comparable data from its clinics to do this. The sec- 1 The production area comprises the following employee groups: operations / manufacturing, quality control, quality assurance, maintenance / technical support and warehouse. In 2020, the business segment introduced the new VAMED ond area – Focus on patients – saw employees of Fresenius Leadership Program for the targeted development of execu- Helios seeing things from a patients’ perspective. They found tives. This is made up of different components that are out what the business segment has already done to improve The company uses an annual talent review for a dialogue offered on a needs-based and tailor-made basis. The program the quality of patient contact – and what other plans are in on performance, competencies, and development potential is designed in close cooperation with representatives of place. for upper management levels. This talent review is the university training institutes, such as the Vienna University basis for identifying, evaluating, and developing executives of Economics and Business Administration. Furthermore, EVALUATION and talents in all of Fresenius Kabi’s regions, divisions, individual e-learning modules (e.g. labor law) and micro and central functions worldwide. Due to the COVID-19 pan- learning units were developed and rolled out independently Fresenius Medical Care demic, the talent review process was suspended in 2020. as digital training options. More than 25,000 employees used the new digital platform Further, the process has been conceptually revised in 2020. with knowledge and training resources in 2020. In 2020, The adapted talent review is intended for roll out in 2021 Development program: Fresenius Medical Care also introduced a digital platform to to strengthen the dialog between employees and their supe- nursing department assistants foster the dialog between managers and their teams on riors and the individual development planning. The global Fresenius | Annual Report 2020 In order to be able to fill vacancies in the nursing depart- the topics of development and performance management. process shall be IT-based for a better user experience. ment segment independently of the external labor market, Fresenius Helios introduced the nursing department assis- tant development program in Germany in 2020. It is struc- tured in the same way as the Hospital Management assis- tant program. 145


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Helios OCCUPATIONAL HEALTH AND SAFETY This also meant equipping our employees with suitable pro- Fresenius Helios utilizes annual feedback meetings to dis- tective materials. In our clinics, we have intensified infection cuss topics relating to training and education. Additionally, OUR APPROACH control practices that were already in place in order to pro- the central service for the German locations, analyzes how Ensuring the health and safety of our employees is an essen- tect both our patients and our staff. In the production facili- effective its digital offerings and programs are for employees. tial part of our corporate responsibility. The Fresenius Code ties, we introduced strict hygienic measures, such as disin- It carries out qualitative evaluations and reviews the usage of Conduct states that we must take the necessary measures fection and distancing measures. From March 2020, a large statistics collected, results of outcome measurements (e.g., to protect our employees and to prevent work-related acci- number of our employees in administrative functions filling vacancies after development programs) and partici- dents. All four business segments focus on preventive mea- worked from home to avoid infection. pation rates. sures and on the individual responsibility of employees when In 2020, Fresenius Helios recorded significantly higher it comes to occupational health and safety. The occupational Fresenius Medical Care use of online conference tools and digital learning platforms safety concepts are adapted to the specific business models Fresenius Medical Care gives top priority to the health and in both Germany and Spain. Fresenius Helios is currently of the four business segments. These focus on occupational safety of employees. The company’s Code of Ethics and developing a training portfolio management in Germany, the health and safety within production, as well as occupational Business Conduct includes the commitment to provide a safe aim of which is to evaluate and market employee training health management for health care facility or administrative and healthy work environment for the company’s global and further education options and services more effectively – employees. The aim of all the measures is not only to protect team. Fresenius Medical Care expects the same from its busi- internally and externally. At the same time, it needs to objec- employees, but also to ensure the health and safety of ness partners. Responsibility for occupational health and tively evaluate the performance of the respective offerings. patients. All Fresenius business segments continually record safety lies with local management. The respective standards data on occupational health and safety in line with regula- for health and safety are defined in local and regional poli- Fresenius Vamed tory requirements. cies and guidelines. This allows the company to comply with Fresenius Vamed continually assesses its own vocational During the COVID-19 pandemic in 2020, the safety and different regulatory and legal requirements and report training and development programs; if necessary, the busi- health of our employees, their families and the communities incidents to authorities based on local specifications. Sev- ness segment develops and implements adaptation or in which we work were in the focus of our response activi- eral of the company’s production sites and clinics in the improvement measures. ties. A major challenge for us in this regard was on develop- region Europe, Middle East and Africa are certified according The following data is evidence of the long-term success ing individual protection concepts, measures and working to international health and safety standards, including of the programs: Fresenius Vamed’s HCM program, which regulations that allow us to continue all operational and ISO 45001. Fresenius Medical Care is currently working on has been in place since 2004, has produced about 130 grad- administrative activities. Depending on the evolution of the harmonizing its management concepts for occupational uates to date. More than 70% of them have now taken incidence rates and changes in regulatory requirements, health and safety as part of our Global Sustainability Pro- their next career steps. it was necessary to promptly adapt our protection concepts gram. In addition, Fresenius Medical Care is planning to Fresenius | Annual Report 2020 In addition, Fresenius Vamed’s Human Resources Divi- and guidelines and to communicate these to the employees. develop a global policy and key performance indicators to sion evaluates the utilization rate of digital programs and reflect its worldwide performance in this area. services – for example, from within e-learning or webinars. Further, Fresenius Vamed continually optimizes its human resources development processes in the direction of digita- lization. 146


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Medical Care carries out risk assessments on the ▶ providing and ensuring the continuous safe operation of 2023 1. Fresenius Kabi aims to improve occupational health operational safety of machines and technical equipment as facilities, machinery, and equipment, and safety processes there and align them with internation- part of the company’s work safety program in its production ▶ safe handling, use, storage, and proper disposal of haz- ally recognized standards. In 2020, 2 additional manufac- facilities. Internal reviews and external audits by authorities ardous substances. turing plants have been included in the OHSAS 18001 certi- are conducted to monitor compliance with corresponding fication of Fresenius Kabi. Local targets are set at the regulations, policies, and procedures. Risk assessment is an important part of the occupational certified organizations to enhance the occupational health health and safety management. Based on the risk assess- and safety management. Fresenius Kabi ment, occupational health and safety measures are derived The safety of Fresenius Kabi’s employees at their workplace and performed locally. This is supplemented by a notification Organization and responsibilities is our central concern. The aim is to avoid all work-related system through which work-related accidents are reported, Responsibility for occupational health and safety manage- accidents. To achieve this goal, the company has imple- recorded and categorized. Further, training on work-related ment lies with the divisional and local organizations; global mented standard operating procedures (SOPs), other regula- risks is provided at all sites. To support its occupational management responsibility lies with the central organiza- tions, and instructions to provide a global framework for health and safety management, Fresenius Kabi has intro- tion, which reports to the responsible member of Fresenius occupational health and safety which are part of Fresenius duced a management system in accordance with the interna- Kabi’s management board. Kabi’s integrated quality management system. The imple- tional standard OHSAS 18001. The management handbook mented occupational health and safety guidelines focus on and standard operating procedures provide global manage- Policies and regulations the following principles: ment requirements for the certified organizations’ local Fresenius Kabi has implemented standard operating proce- occupational health and safety management. The implemen- dures (SOPs), other regulations, and instructions to provide ▶ implementing the necessary measures to ensure the tation of the management system is ensured by internal a global framework for occupational health and safety which health and safety of employees, global audits. The global management system is audited on are part of Fresenius Kabi’s integrated quality management ▶ ensuring and supporting continuous improvement, an annual basis and certified by TÜV Rheinland. It covers system. The OHSAS 18001 management handbook and the ▶ avoiding work-related injuries, illnesses, and other all employees as well as temporary workers at certified sites. standard operating procedures of Fresenius Kabi provide incidents, e.g., implementing technical protection The local management reviews the occupational health a consistent framework for the certified organizations’ local measures, and safety management system at least once a year, with occupational health and safety management. ▶ performing hazard and risk assessments for all routine regard to its continued suitability, appropriateness, effec- and non-routine activities, tiveness, and potential for improvement. ▶ complying with applicable legal requirements and other Currently, 21 organizations of Fresenius Kabi are certi- occupational health and safety requirements, fied according to the standard OHSAS 18001. The company Fresenius | Annual Report 2020 is working on rolling out the certification according to OHSAS 18001 / ISO 45001 to all manufacturing plants by 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. 147


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Helios workplace safety. The policy is applicable at all company ing). They look after all aspects of health and safety at work Fresenius Helios hospitals have risk assessments at their levels and locations. Helios Spain has standardized occupa- for Fresenius Helios employees, as well as the employees of disposal for the individual workplaces and keep lists of dan- tional health and safety across the Group’s hospitals and Fresenius Helios internal service providers and subsidiaries, gerous substances. As a preventive measure, Fresenius companies and developed a company-wide training platform ensuring coordination is done in close collaboration with Helios conducts occupational health and safety inspections for specific workplace-related risks. Various KPIs, including the German supervisory authorities. of areas of the hospitals to look for potential risks. The absenteeism and work-related injuries, are consolidated in The Helios Occupational Health business segment in main risk areas at our German locations, for example, are one standardized system and evaluated. Based on this, Germany also has an Occupational and Organizational Psy- identified via accident reports or information from employ- measures are then taken to reduce absenteeism or to avoid chology department, which carries out risk assessments ees and undergo rigorous assessment. As part of a risk accidents at work. for potential to cause mental health problems at numerous assessment, these are then analyzed; in the short term, mea- As a hospital operator, Fresenius Helios implements occu- Fresenius Helios and Xenios (Fresenius Medical Care) sites. sures are communicated to decision-makers using the pational safety and occupational medicine measures primar- At local level, the members of the Occupational Health S-T-O-P principle (substitution, technical, organizational and ily for its own medical personnel. The company also supplies and Safety Committee take a targeted approach to monitoring personal measures). Fresenius Helios then reviews the occupational health services to external companies at numer- the various aspects of occupational safety and health pro- implementation process and effectiveness. The procedure ous locations. For example, our range of services encom- motion. The meetings held by the Occupational Health and used is the equivalent of a classic PDCA loop, i.e., Plan, Do, passes about 300 institutions in Spain that provide occupa- Safety Committee meet the legal requirements set for com- Check, Act – for continuous improvement. tional health management. Via these prevention centers, position and number of participants. In addition, specialist In loops for mental health risk assessments, for example, we examine about five million employees annually, working personnel and managers in special steering groups at the specialized employees work together with managers to in cooperation with companies. hospital sites work on dealing with specific areas, such as develop cross-functional measures. Similar procedures can occupational health management. be found in occupational health management and occupa- Organization and responsibilities Helios Spain works continuously to ensure the safety and tional rehabilitation management, for example. The business The senior management team of Fresenius Helios and the health of its employees. With the implementation of SAP segment is currently reviewing whether to introduce an Helios Occupational Health business segment have the task at all our hospitals in Spain, we changed the management of integrated management system for health and safety in Ger- of coordinating occupational health and safety in Germany. occupational health and safety from local systems to one many. In terms of organization, the Helios Occupational Safety seg- company-wide system. Based on ISO 45001 (former 18001) Helios Spain strives to develop an exemplary culture ment is assigned to the area of Authorized Officers & as well as Spanish regulatory provisions, all hospitals are within health care provision, in order to avoid occupational Environmental Management in the Infrastructure business required to report occupational health and safety incidents, health risks and promote healthy habits among its work- segment. It was founded in 2019 and currently looks after cause, lost time, illnesses and absenteeism as well as other force. This is also implemented in the company’s policy on about two-thirds of all the employees in the business seg- KPIs in one tool. The local management which is responsible Fresenius | Annual Report 2020 ment, 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 clin- ics and their subsidiaries (e.g., cleaning, logistics or cater- 148


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor for ensuring that regulatory requirements are met for occu- approach to occupational health and safety. Due to the Training pational health and safety, is guided by a handbook as well diverse range of services and the different responsibilities Fresenius employees receive regular occupational health and as standard operating procedures. A central department for involved, the implementation process is organized in very safety training in all four business segments. To avoid inci- corporate health prevention coordinates all activities and different ways throughout the business segment – nationally dents and increase awareness, we also provide training on the reporting. and internationally. In the context of our business areas, this health and safety. In our clinics, employee training courses is particularly the case for the project and service business cover topics such as the safe use of sharps and disposables Policies and regulations as well as for the overall management of operations and and hand hygiene. Further topics include infection preven- In Germany, Fresenius Helios uses the statutory regulations the technical services provided by the individual Fresenius tion, and emergency control. Training provided in our pro- and guidelines of accident insurance institutions as the Vamed locations. In the area of occupational health and duction sites focuses, for instance, on the safe handling of basis for its work. The business segment also cooperates with safety, all locations are subject to the respective local laws work equipment, hazardous chemicals, emergency preven- authorities at a more local level in Germany, such as the and regulations. Compliance with these regulations is also tion and response. Fresenius Kabi, for instance, holds train- “Unfallkasse Hessen” accident insurance fund. Fresenius ensured at local level. ing sessions on work-related risks at all locations. Fresenius Helios Germany is currently planning to develop a corporate Vamed offers employees a separate e-learning module on policy on workplace safety. This guideline for occupational Policies and regulations employee protection. health and safety will be interdisciplinary, developed together Due to the decentralized organizational structure of Fresenius with Helios Occupational Health in the first quarter of Vamed, a range of different legal and internal guidelines PROGRESS AND MEASURES 2020 2021. It will then be reviewed and adopted by management. play a significant role in occupational health and safety. The Helios Spain wants to develop an exemplary culture Code of Conduct covers administration and the area of Fresenius Medical Care within health care provision, in order to avoid occupational technical services, while the Clinical Code of Conduct regu- In 2020, Fresenius Medical Care started to assess local health health risks and promote healthy habits among its workforce. lates the area of health care and medical personnel. and safety policies and goals in all regions. In the region This is also included in Fresenius Helios policy on work- Europe, Middle East and Africa, for example, the health and place safety in Spain. The policy is applicable at all levels of Reporting systems safety targets relate to incident rates, safety training and work and at all locations in Spain. All four business segments have notification systems for incident reporting. accidents at work. Fresenius Helios uses a Critical Incident Fresenius Vamed Reporting System (CIRS) at all its German hospitals, for The health and safety of employees is firmly embedded example. This system is anonymous and can be used in all in our company’s culture and the Fresenius Vamed mission areas of a hospital site. It is used for the preventive protec- statement. All employees, and in most instances patients tion of both employees and patients. The reporting system Fresenius | Annual Report 2020 and customers too, are covered by the company’s holistic can be used to make preventive corrections in processes and workflows and thus eliminate risks from everyday work. 149


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Helios Fresenius Kabi tion, various audits of Fresenius, sometimes internal, enable In addition to occupational safety aspects, Fresenius Helios Experts in the global Environmental and Occupational Man- a consistent analysis of existing procedures, process vali- in Germany has also specifically addressed the matter of agement department analyze and evaluate working proce- dation and effective optimization of the occupational health fire protection at clinics in order to take a holistic approach dures, risks, objectives, and occupational health and safety and safety management already in place. to avoiding risks. In the year under review, Fresenius Helios programs, and enable exchange about occupational health Commissioning personnel set up online training and put and safety throughout the company. Fresenius Kabi performs Fresenius Vamed effective practice grading in place for fire safety assistants. global internal audits at its organizations to identify poten- All Fresenius Vamed locations are subject to regular occu- For example, employees learn how to handle fire fighting tial for improvement. If necessary, the company develops pational health and safety inspections. At Fresenius Vamed, equipment in their roles as fire safety assistants, and how measures to tap this potential together with local responsible work-related incidents must not only be reported, but they to respond in the event of a fire and during evacuation from persons. Due to the COVID-19 pandemic, audits have been also trigger an audit of existing work processes as well as any affected areas. This can be introduced at all locations. conducted virtually in 2020. proposed changes and implementation thereof. Correspond- Quarterly telephone conferences with representatives ing internal guidelines are available. EVALUATION from the certified organizations are held to foster exchange No Group results are available for occupational health and about work-related accidents and their prevention. Work-related injuries and diseases safety in fiscal year 2020. Although no effects can yet be reported at Group level, we report on the measures initiated Fresenius Helios Fresenius Kabi in the reporting year and related progress in the business Qualified occupational health and safety specialists as well as Fresenius Kabi documents all accidents that lead to lost segments. occupational physicians check whether or not the require- working time – worldwide and for all employees, including ments for occupational health and safety are met at Fresenius temporary workers. All reported cases are categorized Fresenius Medical Care Helios in Germany. In addition, the requirements are regu- according to their impact on an employee’s health and their Fresenius Medical Care’s goal is to prevent work-related larly reviewed by supervisors from the German Institution for severity. Furthermore, the local management assesses illnesses and injuries. For this reason, the business segment Statutory Accident Insurance and Prevention in Health the documented cases to decide whether technical improve- tracks and analyzes work-related accidents and injuries and Welfare Services (BGW). In 2020, this was carried out, ments, other working equipment or instructions, or further at local and regional level, identifies their root causes, and among other locations, at the Helios clinic Leipzig. Various training are required to avoid future work-related accidents implements corrective actions. As part of these activities, audits, sometimes internal, of Fresenius Helios in Germany and improve occupational health and safety for employees. Fresenius Medical Care has introduced different performance enable us to consistently analyze existing procedures, Occupational health and safety reports are submitted to the indicators for occupational health and safety in its produc- review processes and effectively improve the management management board as well as other relevant functions of tion sites and dialysis clinics based on local requirements. of occupational health and safety. Working together with Fresenius Kabi on a quarterly basis. Fresenius | Annual Report 2020 These indicators generally focus on work-related accidents, experts from the field of occupational health and hygiene, including the incident rate and lost time incident rate. specific project groups monitor the management of occupa- tional health and safety, coordinating continuously across segments and developing improvement processes. In addi- 150


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Fresenius Kabi calculates the lost time injury frequency rate of coordination on-site is to monitor the effectiveness of risk DIVERSITY (LTIFR) 1 from the data it collects and uses it as an indicator assessments and to monitor the effectiveness of local occu- for occupational health and safety; the LTIFR improved by pational health and safety management systems. DIVERSITY AND EQUAL OPPORTUNITIES 12% compared to the previous year. Fresenius Kabi also Helios Spain collects data for preventive occupational considers the lost time injury severity rate (LTISR) in its analy- safety on a monthly basis. The division has defined key fig- OUR APPROACH sis. No work-related fatalities were recorded at Fresenius ures to document absenteeism and accident rates as well as At Fresenius we support equal opportunities for all and con- Kabi in 2020; the company recorded 3 serious work-related the status of compliance with important legal requirements sciously oppose discrimination of all kinds. No one may accidents, which were mainly caused by employee behav- at employee level. Each hospital in Spain reports monthly on be discriminated against on the basis of skin color, ancestry, ior, for example not following work instructions. This has the development of the key figures. faith, political views, age, sex, sexual orientation, physical prompted additional preventive measures at the respective condition, appearance or other personal characteristics. We sites, e.g. training. In the reporting period, Fresenius Kabi Fresenius Vamed work in an atmosphere of mutual respect. Our dealings saw only a limited number of COVID-19 cases at its facilities Fresenius Vamed documents locally all occupational acci- with each other are open, fair and appreciative. We do not with no significant impact on production output. dents as well as all events that almost led to an accident. In tolerate insults, humiliation or harassment. Our managers addition, the human resources department reports all acci- have a special responsibility in this respect and act as role LOST TIME INJURY FREQUENCY RATE 1 dents with lost days (i.e. also accidents with less than 3 days) models. These values are laid down in the Fresenius Code Fresenius Kabi 2020 2019 2018 to the accident insurance. When incidents occur, it is essen- of Conduct, which is binding for all employees. This lays the LTIFR 2.3 2.6 3.1 tial to assess the existing hazards accordingly in order to foundation of our cooperation and corporate culture. prevent a recurrence. Risks must be minimized accordingly, which is why all incidents are subject to a structured evalu- Diversity lived in the business segments Fresenius Helios ation by means of a root cause analysis including the corre- Fresenius promotes international and interdisciplinary coop- Fresenius Helios documents accidents locally and assesses sponding improvement measures. These are prioritized in eration as well as diversity in our business segments and the potential for risk associated with them, with a specific terms of technical, organizational and personnel criteria. The regions. The diversity of our markets and locations is also assessment carried out on-site, which is then discussed and effectiveness of the measures is validated on site by the reflected in the workforce of the four business segments. assessed together with the relevant supervisory authorities. responsible local safety specialist. To ensure a holistically In our home market in Germany, we have employees of more In Germany, hospitals use time management reports inter- structured approach, a standard operating procedure has than 150 nationalities. All business segments attach great nally; these include downtime or absence periods and how been implemented. importance to equal opportunities for all employees in the these develop at the location. Various KPIs, including absen- workplace as well as in the application, selection and teeism and work-related injuries, are consolidated in a development procedures, and implement diversity concepts Fresenius | Annual Report 2020 standardized system. Local accident figures are evaluated at adapted to the requirements of the respective business every meeting held by the Health and Safety Committee. models and regions. Based on this, a Helios clinic then implements measures to reduce absenteeism or to avoid accidents at work. The fig- ures resulting from accident reporting aside, the main aim 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. 151


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees Media Hub Diversity Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor In 2019, Fresenius Medical Care started a new global initia- At Fresenius Helios, the aspiration to be non-discriminatory In 2020, Fresenius Medical Care developed a global policy tive as part of its Global Sustainability Program. The com- and provide equal opportunities extends not only to employ- on respectful work behavior. This policy specifies company pany focuses on identifying and implementing effective ways ees but also to patients. Fresenius Spain’s management, standards in the areas of non-discrimination, non-harass- to enhance the benefits from a diverse workforce. In 2020, for instance, is committed to using gender equality tools – for ment, and non-bullying. The business segment plans to roll Fresenius Medical Care’s objective was to gain a global over- example, through integrative language and training, or in out this policy worldwide in 2021 together with a global view of the current situation and define the scope of global procedures such as personnel selection processes and inter- policy on the prohibition of child labor and modern slavery, initiatives for inclusion and diversity. In 2021, the company nal promotions, as well as in cases of sexual harassment or including forced labor and human trafficking. is planning to further develop its global initiatives and gender discrimination. Helios Spain, meanwhile, is currently Fresenius Kabi has guidelines and reporting systems for enhance its communication activities. For example, Fresenius in the process of negotiating equality plans for all compa- reports of potential violations of the principles defined Medical Care is planning to initiate a global communica- nies in the hospital group. This kind of equality plan respects in the Fresenius Kabi Code of Conduct. At Helios Germany, tion and awareness campaign, as well as dedicated leader- the European directives and the national rules in Spain on incidents involving discrimination are processed via the ship and employee focus sessions on diversity. equal opportunities and wage transparency between men and clinic management in cooperation with the human resources Inclusion and diversity in leadership is an important fac- women, and also guarantees non-discrimination in the managers and, depending on the severity of the incident, tor for the development of our business. Fresenius Medical workplace. escalated to regional or central level. As a rule, in the event Care’s management team reflects the company’s interna- Fresenius Vamed focuses, among other things, on of incidents of discrimination, a crisis management team tional footprint in various markets. Of the more than 1,150 addressing diversity in effective promotion of young talent is deployed to advise on the specific procedure to be used senior leaders of the Company who take part in our Long and management of succession planning. In the area of train- on a case-by-case basis. The company’s head of Corporate Term Incentive Plan (LTIP), 85% are non-German. ing and development in particular, the diversity of employ- Social Responsibility (CSR) is part of this team. At Helios Fresenius Kabi emphasizes equal opportunities for all ees is taken into account and, for example, online training is Spain, incidents involving discrimination can be reported employees in daily work as well as in recruiting, application offered in various languages. via the Human Resources Department, the intranet and and development processes. Numerous projects are placed the employee portal. At Fresenius Vamed, suspected cases in an intercultural environment. In many areas of the com- Dealing with incidents of discrimination are raised, assessed and reported via the Compliance pany, transnational teams are working on solutions to the Information about violations of the principles of the Fresenius Organization. manifold challenges in the health care sector. As the basis Code of Conduct and other possible misconduct can be for the shared understanding of collaboration, Fresenius Kabi reported via various reporting systems – anonymously if nec- has defined company values that have been introduced essary, as described on pages 159 f. in this report. All infor- worldwide. The company values of Fresenius Kabi – customer mation is carefully examined and appropriate action taken focus, quality, integrity, collaboration, creativity and pas- according to the results of the investigation. Depending Fresenius | Annual Report 2020 sion and commitment – form the basis for day to day actions on the type and severity of misconduct, sanctions, such as of all Fresenius Kabi employees. actions under employment, civil or criminal law, can be imposed. After finishing the investigation, measures that pre- vent future misconduct, or at least make it more difficult for it to take place, are implemented. 152


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees Media Hub Diversity Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Organization and responsibilities Policies and regulations cultural integration, as well as aiding professional and lin- In order to integrate equal opportunities in all processes Our aspirations with regard to diversity are laid down in the guistic integration. This is supported and complemented by and workflows, the business segments have put structures Fresenius Code of Conduct. This code makes our stance local initiatives at each hospital location. A wide range of in place that are tailored to their requirements. In 2020, clear, i.e., to support equal opportunities for all and to oppose measures are being implemented in all hospitals in Germany Fresenius Kabi created a Center of Expertise Leadership & discrimination of all kinds. It forms the framework for all to promote diversity and equal opportunities. These include Talent, Talent Acquisition & Employer Branding, Organiza- the rules and codes of conduct applicable in the business (selection of examples): tional Development, Diversity & Inclusion, which reports segments of the Fresenius Group. Our commitment to directly to the head of the Global Human Resources Depart- inclusion and diversity is also integrated in our Code of Eth- ▶ Intercultural after-work meetings ment. The Center of Expertise aims to anchor diversity and ics and Business Conduct. Fresenius Kabi has formulated ▶ Prayer rooms for different religions inclusion in the organization and to support the regional and and implemented company values for all employees. These ▶ Changing rooms for transgender employees divisional human resources functions in their activities with values contribute to a common understanding of the corpo- ▶ In-hospital interpreter pools for foreign patients a global framework. rate culture. The company values of Fresenius Kabi underline ▶ Regional campaign days in the form of an ongoing At Helios Germany, the Director of Human Resources has the importance of respectful collaboration between all series of events for active intercultural exchange overall responsibility for diversity, with the Central Human employees and are part of its Code of Conduct. Fresenius among employees (Erfurt) Resources Service and the company’s Head of Corporate Vamed and Helios Spain also commit to a diverse corporate ▶ A queer community with drop-in centers and Social Responsibility (CSR) responsible for the design and culture in their codes of conduct. regular meetings implementation of measures. In the hospitals, the clinic management is responsible for implementing the diversity PROGRESS AND MEASURES 2020 In addition, Helios Germany’s Corporate Inclusivity Agree- concepts. In Spain, the business segment is working on ment envisages the introduction of online training for exec- creating the position of equal opportunities officer who will Initiatives to promote diversity utives on inclusivity from 2021 onward. also act as a consultant for the management of each loca- and equal opportunities tion. At Fresenius Vamed, a gender representative oversees Fresenius Vamed gender issues. Fresenius Helios Fresenius Vamed has developed concepts for the integration To support its foreign employees, in particular foreign nurses of foreign nursing staff. The Leadership Program, newly as described on page 136 in this report, Helios Germany introduced in 2020, provides participants with an understand- began to train staff as integration managers in 2020. These ing of other cultures as part of the learning module Inter- future integration managers will support nurses who come cultural Competence Management and promotes intercultural to us from abroad when they arrive in Germany, helping them action skills as well as mutual adaptability. Fresenius | Annual Report 2020 to deal with authorities and providing support in other situations. The aim of doing this is to help with social and 153


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor COMPLIANCE AND INTEGRITY As stated in our Fresenius Code of Conduct, we are fully com- Organization and responsibilities mitted not only to adhere to statutory regulations, internal COMPLIANCE guidelines, voluntary commitments, but also to act in accor- Involvement of the Management Board For Fresenius, compliance means more than acting in accor- dance with ethical standards. Violations will not be tolerated. Responsibility for Compliance within the Fresenius Group dance with the law. As we see it, Compliance rather means If a violation is detected, we perform an investigation, initiate lies with the Management Board and has been assigned to doing the right thing. We aim to comply not only with all the measures necessary to remediate the misconduct and the board member responsible for Legal Affairs, Compliance, kinds of regulations, but also with ethical principles. With our impose sanctions if applicable. In addition, incidents prompt and Human Resources of Fresenius Management SE. The compliance activities, we want to ensure that everyone can us to anchor ethical and compliant behavior even more Management Board member assumes the function of Chief rely on us as a trustworthy partner of integrity. firmly in our corporate culture as well as further sharpen our Compliance Officer of Fresenius SE & Co. KGaA. We have set-up risk-based compliance management compliance programs and prevention mechanisms. In our four business segments, Chief Compliance Officers systems, which are aligned with the business of each of our In all four business segments and at Fresenius SE & Co. or Compliance Committees are responsible to develop and business segments. It is our key ambition to prevent cor- KGaA, we have set up dedicated risk-oriented compliance monitor the Compliance management system in their busi- ruption and bribery in our business environment. Beyond management systems. These are based on three pillars: Pre- ness segment They report to the respective management that, prohibiting violations of antitrust law, data protection vention, detection and response. Our compliance measures of the business segment. regulations, trade restrictions, anti-money-laundering laws as are primarily aimed at using preventive measures to avoid well as the prevention of potential human rights violations compliance violations. Key preventive measures include The organizational structure are key areas, which we address with dedicated compliance comprehensive risk identification and risk assessment, appro- The business segments have established compliance organi- measures. priate and effective policies and processes, regular training, zations, which are based on the business organization. This and ongoing consultation. We also carry out internal con- includes respective Corporate Compliance departments, OUR APPROACH trols to identify possible compliance violations and ensure which develop global compliance initiatives for their business At Fresenius, we strongly believe that compliance protects that we act in accordance with the rules. segment and support their respective compliance officers. what is most important to us: the well-being of the patients The design of our compliance management systems is More than 400 employees throughout the Group are respon- we care for. Compliance is firmly anchored in our corporate based on international regulations and guidelines, such as sible for compliance tasks and support Fresenius managers culture and guides us in our everyday work. Integrity, respon- the ISO-norms on the set-up of compliance management and employees in all compliance-related matters. sibility and reliability form the core of our understanding systems and applicable audit standards of the IDW (PS 980). of compliance. Thereby, we design all our measures in such When implementing measures, we take into account the a way that they best prevent compliance violations. respective national or international legal frameworks. Fresenius | Annual Report 2020 154


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    To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity Media Hub Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor Corporate Compliance Department Best practice exchanges and compliance expert panels Despite the differences in business and risk profile in each of Fresenius SE & Co. KGaA To ensure ethical conduct, we continually review our busi- business segment, we strive to evaluate the design of the The Corporate Compliance Department of Fresenius SE & Co. ness practices and exchange on best practices with our compliance management systems using a uniform approach. KGaA sets minimum standards for the Compliance manage- compliance colleagues worldwide. While in 2020 travel In 2020, the Corporate Compliance department of Fresenius ment systems, especially for those Compliance risks that are restrictions did not permit an in-person meeting, the regular SE & Co. KGaA reviewed the maturity of the compliance mea- relevant to all business segments. The department supports exchange in cross-divisional expert panels continued. Areas sures of the business segments and Fresenius SE & Co. KGaA the work of the compliance officers of the four business seg- of collaboration included antitrust and foreign trade law as for all compliance risk areas by using a uniform methodology ments with standardized management tools, processes and well as cross-border investigations. (Compliance Management System Reporting). The results methods, and develops overarching compliance initiatives were presented to the Compliance Steering Committee as with them. Reporting structures well as the Management Board and Supervisory Board. This The Chief Compliance Officer of Fresenius SE & Co. KGaA is assessment is expected to be continued on a regular basis. Compliance Steering Committee informed on initiatives driven by the Corporate Compliance The Compliance Steering Committee (CSC) is the central department on a weekly basis. Compliance case reports of Guidelines and regulations advisory body of Fresenius SE & Co. KGaA for Corporate Com- medium severity for the segment Corporate are reported to The Fresenius Code of Conduct forms the framework for all pliance matters. The CSC is composed of the Chief Compli- the Chief Compliance Officer immediately. The Manage- rules applicable at Fresenius Group. The Code of Conduct ance Officer, the Chief Financial Officer, and the heads of the ment Board of Fresenius Management SE receives reports on lays out the principles of conduct for all employees, including Legal, Internal Audit and Corporate Compliance departments. the status of the corporate compliance management system managers at all levels and members of the Management If necessary, representatives of other governance depart- and selected initiatives regularly, at least twice a year. The Board. The Code is aligned with international regulations (see ments attend the meetings of the CSC. The Compliance Steer- Corporate Compliance Department also prepares an annual Our Approach) and was adopted by the Management Board ing Committee discusses the further development of the compliance report in text form. This report provides a com- of Fresenius Management SE. In addition, the four business Corporate compliance management system as well as import- prehensive overview of all Corporate Compliance initiatives. segments have implemented their own Codes of Conduct. ant compliance initiatives and relevant Compliance risk The Supervisory Boards of both Fresenius SE & Co. KGaA and These reflect the Fresenius Code of Conduct principles and areas. The members of the committee also discuss severe Fresenius Management SE are regularly informed about cover the individual characteristics of each business seg- Compliance cases and their remediation. All four business progress of Compliance measures, at least once a year, most ment. The Codes of Conduct are available to all employees at segments report annually to the CSC on the progress of their recently in December 2020. The business segments have all management levels and are also available on the internet. compliance management systems. The meetings of the established individual reporting lines to their respective man- Guidelines, organizational directives and process descrip- CSC take place every six to eight weeks. In 2020, seven meet- agement. The management teams of the business segments tions supplement and further define the rules of the Code of ings took place – due to the COVID-19 pandemic, most of receive regular reports on compliance by their Compliance Conduct. Fresenius | Annual Report 2020 them virtual. Officers. 155

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