Opinion, South Africa

Koert Pretorius: On Leading Change with eHealth

CEO at Mediclinic Southern Africa, Koert Pretorius, talks about the Group’s aim to be a leader in quality and efficiency by harnessing eHealth.

Koert Pretorius - EHN

CEO at Mediclinic Southern Africa, Koert Pretorius, talks about the Group’s aim to be a leader in quality and efficiency by harnessing eHealth and what we can learn from international trends in healthcare going forward.

Tell us a bit about yourself and your background in healthcare. 

I have a financial and management background and started my career in the private healthcare industry more than 25 years ago. I worked for two hospital groups in various capacities. I also served as a Board Member of HASA for ten years, and was the Chairman between 1999 and 2001. I joined Mediclinic in 1998 as the Regional Director in the central region, and was appointed the first Group Chief Operating Officer in 2003. After our international expansion to Dubai and Switzerland in 2006/2007 I was appointed CEO for Mediclinic Southern Africa.

You must have seen enormous change in healthcare from 1990 up until now. What changes would you still like to see in SA’s healthcare system?

Given the country’s social and economic context within which we operate, we need to look at strategies to maximise the value of the entire healthcare system. We need to improve access, quality and affordability to benefit all South Africans. However, it’s well known that healthcare funding is a challenge and we don’t have enough skilled health professionals in the country.

Therefore we believe the best model for the country is to have a well-functioning public sector as the backbone of healthcare delivery, significantly supported by a vibrant private industry. For this to happen though we have to find ways for the public and private sectors to work more closely together and to form public private partnerships (PPPs). I believe there’s a huge opportunity in our country to do that, but unfortunately there’s currently unwillingness from the National Department of Health (NDoH) to look at PPPs as a solution.

When you say unwillingness, what do you mean?  

I personally asked the Minister of Health last year at an industry meeting why we don’t embark in PPPs, and his response was that it’s not viewed favourably within Cabinet. He used the example of some prison services that have been outsourced to the private sector, and according to them they don’t think it’s working. However, they didn’t define why it’s not working or according to which criteria it’s being measured. So generally speaking, there doesn’t seem to be a lot of interest in PPPs and outsourcing to the private sector but I don’t think that it’s limited to healthcare; I think it’s the general view of government.

What’s your take on eHealth as a potential mechanism to realising improved access to quality healthcare?

 eHealth will be an important mechanism in addressing quality and efficiency, but at the moment it’s underutilised. As a company, we plan to develop our eHealth strategy going forward, but it’s a process because you can’t just rip and replace all the systems currently in place.

Mediclinic believes that using eHealth as an enabler to share information between hospitals and supporting doctors will greatly enhance the quality and efficiency of patient care. We are working on a number of interesting projects. For example, we opened a new hospital in March 2015 in Midstream that has a fibre optic ICT backbone between the hospital, all the clinicians, radiology and pathology that allows us to share information across the board. We have a vendor-neutral archiving system where we record and store all the radiology images, theatre procedures and pathology results that are then available to the doctors along with demographic information. It’s the most advanced system we have in place at the Mediclinic Southern Africa, and as we upgrade hospitals we will migrate them all to that type of model. Our other high priority project is to find solutions for an electronic medical record (EMR).

Give us some insights from a Healthcare CEO’s perspective. What role does the CIO need to play to support business and patient care objectives?

It’s critical that the CIO functions as part of a multi-disciplinary team and not in isolation. That means that they must be closely aligned with clinical experts and end users to ensure that software solutions support clinical workflow and doesn’t only focus on data collection.We know from our experience in Dubai and Switzerland that functional requirements and usability are far more important than technical specifications when it comes to EMRs; you have to get your nurses and doctors to use the system and to that end, clinical users must be involved in sourcing the most appropriate solutions. Obviously collecting the data is as important, but I think the overall message is that the CIO’s plan must fit in with the clinical services strategy of the hospital group.

What advice would you offer healthcare executives and hospital managers about the global shift from patients to consumers?  

This is an important issue. Healthcare providers in the future will definitely operate in a more transparent environment where patients will be better informed and empowered. All over the world there’s a move towards an environment where clinical quality outcomes, patient experience, patient satisfaction scores and all sorts of other information will be in the public domain. So I don’t think management and the industry in general should resist this trend, it will become part of the world in which we operate in the future. We should be proactive and embrace it because it will empower patients to make better informed decisions.

I believe there are a number of principles to come out of the shift that are important. Firstly, the information should be gathered by an independent body and standards should be developed to measure clinical outcomes so that outcomes and patient satisfaction are measured in the same way. It should be a scientific methodology, and the process should be transparent. Following global trends, the government has established the Office of Health Standards Compliance (OHSC) to develop standards to accredit providers and publish quality indicators and patient satisfaction scores, etc. This will have a positive impact on the industry as a whole in the long term.

Tell us about Mediclinc’s commitment to innovation and some of the ways that you’re using technology to improve clinical care. 

When you talk about innovation you can talk about it in different contexts, but let’s start with medical equipment. We’ve been able to stay abreast of the latest developments in medical equipment and pharmaceuticals, and we try to provide the latest, state-of-the-art technology and pharmaceutical products to our patients. Obviously affordability is a major issue because almost all the items we’re talking about are imported, and with the weak currency it becomes difficult to afford everything.

We also firmly believe that we have to make a contribution towards research and development. We recently acquired, for instance, one of the Da Vinci robots, which we installed at Mediclinic Durbanville. Now, if we look at each and every individual case, we definitely make a loss. We can’t recover the full cost of doing the procedure, and believe that hospital groups, medical aid schemes and doctors will have to make a contribution otherwise we will not be able to offer that type of technology, not only to our patients but also to the doctors. Quite simply, if you want to attract the best specialists and give them the opportunity to develop and stay on top of world class developments, you have to make this equipment available. So we believe there is a place for high-end technology, and we all need to work together to make this possible.

At the other end of innovation, we need to experiment with more innovative business models particularly with regards to integrated care models and hospitals and doctors working closely together, which can all be supported and enabled by ICT as in the Midstream Clinic example that we discussed earlier.

There have been reports in the news about whether private medical schools are an option in SA to train more doctors and fill the skills shortage. Do you have an opinion on the matter?

It would be extremely expensive to establish a private medical school in SA and I think cost is the biggest prohibiting factor to doing so. We have eight medical schools in the country at the moment, so I believe we should rather focus on strengthening those. Mediclinic financially supports training at various universities, and a recent development in the Western Cape means that undergraduate medical students do their internal medicine rotation at some of our hospitals. It started at Durbanville, and now includes Panorama, Louis Leipoldt and Cape Gate as well. We believe we can make a contribution with financial support, and secondly by making our facilities available for the medical students so they can rotate with the private practice specialists and then, at registrar level, we can support the training of specialists where the public sector lacks the latest equipment and technology available.

Tell us about your experience with Mediclinic Dubai and Switzerland and what we can learn from that locally.  

It’s been a great learning experience to invest in Dubai and Switzerland because the healthcare contexts are totally different.

In Dubai, the healthcare industry is not very mature but it’s growing rapidly. The delivery model is completely different to the South African model. We’re using a fully integrated model whereby we employ all of our doctors – which is something we can’t do in South Africa but we could learn a lot from that approach.

Switzerland is a combination of what we have in South Africa and Dubai. We employ anaesthetists and doctors in Emergency Units and ICUs, but other admitting doctors are independent practitioners. There also isn’t a shortage of doctors or nurses in Switzerland, there’s a lot of money available in the system, it’s a very mature market so there’s not a lot of growth but the quality is very good.Their focus is on the patient experience because they compete with public hospitals, which are also very good. We can learn a lot from Switzerland in terms of delivering the core service. In SA we are more efficient in terms of back office operations, Mediclinic specifically developed a centralised and standardised system for back office functions, which is something Switzerland, on the other hand, can learn from us.

From pooling resources and negotiation power for procurement to standardising systems – there were many opportunities for us to learn from these two very different countries and unlock the synergies that exist.

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