Every two weeks, a member of Chile’s Government Lab sits down with an advisor to the President to decide what the country’s most urgent problem is. Then, they try and find a new way to fix it.
This fortnightly process, in which tasks are prioritised by urgency, is one part of the “Agile” approach to working through problems. It is based on breaking down complex problems into simple tasks with basic deliverables, and putting users at the forefront, something that can be uncomfortable for traditional models of public service.
But, as the Chilean government has found, using Agile working to solve complex policy problems can garner significant results for public servants and citizens alike, particularly in the area of health.
Putting users first
The Government Lab was founded in 2014, with the intention of bringing citizens closer to the operations of governments.
The team call themselves “co-creators”. Lab director Roman Yosif said they don’t fulfil the traditional role of a consultancy — going into a department, making some recommendations and leaving. Instead, his team works in partnership with the departments they’re advising.
Yosif believes the Agile methodology, which the Lab applies to 70% of its projects, means they stay honed to the most important issues. Innovation can only be sustainable, he said, if it is focused on “high priority problems” — those that are “connected with the core business of an institution, not solving problems at the margin.”
Recently, the team from the Government Lab and the President’s office decided that the most pressing public policy issue was the country’s national health insurance system — a notoriously complex part of any government.
At FONASA, as the state insurer is known, waiting periods for answers to basic queries were spiralling out to a month at a time for users, and there were significant problems with unpaid debts. The insurer covers 14 million Chileans, more than three-quarters of the population.
To bring down waiting times at FONASA, they had to change the behaviour of thousands of public servants, as well as the processes, standards and protocols those workers used.
“The challenge was how to pass from a product-focused strategy to a service-focused strategy,” Yosif says.
To do that, they needed to talk to the people who rely on FONASA to help cover their health costs. In this case, the Government Lab surveyed 1,000 health service users before designing a basic chat tool that allows FONASA workers to provide quick-fire answers to simple customer queries.
The team created a “knowledge base”, which contains answers to the most frequently asked questions at FONASA. When a worker in a branch office anywhere in the country is faced with a question from a user, they can now use the chat tool to get a quick answer drawing from the knowledge base.
“We set up a standard that 85% of cases had to be solved immediately,” Yosif says, adding that more complicated queries had to be answered within 24 hours
Users were also given an online platform called “You Choose” that allowed them to see the different hospitals or medical centres available for a given treatment, a system designed to increase transparency and drive down prices.
More recently, Government Lab has instituted a program that sends a text message to people who have just received a medical treatment. The message shows how much FONASA contributed to make the treatment happen, compared to how much the user paid themselves.
Yosif hopes this will help tackle the problem of underpayment into the health system, by showing users the value of FONASA’s contribution. The results of the trial will be available in two years.
The promise of agile
Agile was initially created as a project management process for software development teams, but is increasingly being implemented in other sectors, championed by organisations like the Government Lab as a way to get public services to operate more efficiently.
Gavin Freeguard, Head of Data and Transparency at the Institute for Government in the UK, said Agile is becoming more and more popular among public servants worldwide, and not just for digital projects.
“We often think of Agile in a purely digital context,” he says, “but a lot of its features – sprints, iteration, breaking larger problems down into smaller ones, responsiveness to change, the use of multi-disciplinary teams, putting users at the core, open working – can be applied to other parts of government, like policy making.”
But, he warned, it can’t be applied to all situations, and the machinery of government sometimes just doesn’t fit with an approach that relies on making quick-fire changes and about-faces depending on developing circumstances.
“Like any project management approach, Agile won’t necessarily suit all types of project,” he says. “There are tensions between Agile project management and accountability and scrutiny structures that are much more used to plans being submitted up front, with the need for certainty in how much money is being spent.”
That’s why the Government Lab insists on buy-in from the highest possible level — either a minister or department head — Yosif said. But while high-level support is vital to get things done, the end user and their experience is never far from his mind.
“Public problems happen in specific realities,” he said, “not on the 10th floor of a ministry.” — Megan Clement and Amelia Axelsen