Dr Rory Gallagher: One Year On for Behavioural Insights in NSW

18 December 2013Behavioural Insights Unit


Tagsdebts, health, nsw, return to work, tax

As we approach the end of 2013, it is a good opportunity to reflect on what has been achieved over the past year, and what lies ahead for the next 12 months. The headline message is that a there is a real sense of momentum growing behind the use of Behavioural Insights (BI) in the NSW public sector.

Dr Rory Gallagher

As we approach the end of 2013, it is a good opportunity to reflect on what has been achieved over the past year, and what lies ahead for the next 12 months. The headline message is that a there is a real sense of momentum growing behind the use of Behavioural Insights (BI) in the NSW public sector. We are very encouraged by the progress we have made over the past year - the tax, fines and debt trials provide a nice replication of work in the UK, whilst our projects in health, return to work and early education are breaking new ground in the application of BI to public policy. Looking ahead, we have projects scheduled in increasingly complex policy areas next year, and we hope to be able to bring some of the world’s leading thinkers in BI, from academia, government and the private sector, to Sydney to share insights. 2014 looks set to be even more exciting and challenging.

Establishing BI in NSW

DPC’s engagement with BI started in earnest in November 2012, when a partnership was established with the UK’s Behavioural Insights Team, which resulted in me moving to Sydney to see how these approaches work outside of the UK. Both personally and professionally it has been a fantastic year, and I would like to thank Chris Eccles, Steve Brady and Georgina Harrisson, for not only having the vision and conviction to set up this partnership, but also for putting their personal backing behind it and creating the environment for it to succeed. We now have a 4 strong team based in DPC – Chris, Simon, Zhi and Alli (look out for the ‘meet the team’ blog early in the New Year) – who are driving forward our work program with agencies from across the sector with relentless passion and determination. 

Positive early results from our major projects

Our initial priority was to get some quick runs on the board by establishing a series of BI interventions and randomised controlled trials (RCTs) that could provide measurable and monetisable results. Given our experience in the UK, the obvious place to start was in tax, debts and fines, but we had no idea if the Office of State Revenue (OSR) would be willing to work with us and be the first cab off the rank for these techniques in NSW. I can honestly say that I have never worked with a central government department that has so openly embraced a new approach and partners, and proactively sought feedback on its processes. Great credit must go to Tony Newbury, Peter Steele, Mick Mioduszewski, Mark White, Anthony Johnston, as well as Michael Coutts-Trotter (DG of DFS at the time) and the rest of our OSR colleagues for the effort and expertise they dedicated to giving this a go, and the speed with which they got a series of RCTs off the ground. 

The first trial we ran was with repeat land tax debtors, which tested the use of social norms (e.g. ‘more than 8 out of 10 people in NSW pay their land tax on time’) as well as clearly highlighting the consequences of non-payment, rather than quoting legislation. We waited anxiously for the results, so were very encouraged to see a 12 percentage point increase in payment (from 27% to 39%) in the first three weeks, bringing forward the payment of around $180k and saving over 80 hours of human resource spent chasing this debt.

We also ran a series of trials that focused on encouraging the payment of fines, using a variety of penalty notices, penalty reminder notices and enforcement orders. These notices were already of a high standard, but we made tweaks in the use of language, colour, tone and format, for example introducing a series of stamps with clear calls to action (e.g.’ pay now’), which we devised during a workshop with OSR’s frontline staff.

This proved successful, with the ‘pay now’ enforcement order increasing payment by 3.2 percentages points compared to the control group (representing a 20% bump in payments). These new notices are being rolled out and it is estimated that the new Enforcement Order alone will bring in an additional $1.02 million in revenue over the next year. We are now in the second phase of our interventions with OSR, which are taking some of the early trials to scale, as well as tackling a raft of new taxes, fines and client groups. As recently reported, BI is also being successfully used by the Australian Tax Office, who is leading the application of these approaches at a federal level - alongside the Departments of Human Services, and Finance and Deregulation. This reflects a burgeoning interest in BI across the Commonwealth and other States, which we hope will continue to grow next year. 

Our second major project involved us working with the Ministry of Health and Westmead Hospital, to support patient choice and increase the use of private health insurance (PHI). Given the various pressures facing the state’s busiest Emergency Department at a time of record admission volumes, this presented a unique set of operational challenges in trialling behavioural interventions –  i.e. in a - quite literally - life and death environment.

Indeed, the trial was only possible due to dedication and support from the hospital’s executive and frontline staff, most notably Danny O’Connor, Shaun Drummond, Tony Hickmott and Jenny Hart. Our approach was to understand the issue from a patients’, clerical and clinical staff’s perspective through a series of interviews, workshops and conversations in the wards. This enabled us to develop a series of interventions focused on simplifying processes and communication, as well as creating tangible benefits for staff and patients (such as gift bags for patients containing toiletries, which are popular as most patients do not plan to visit the ED). Initial results have been extremely encouraging, with usage of PHI increasing from under 15% to over 18.5% last month - patients are a third more likely to use their health insurance compared to a baseline of the previous two years’ usage rates. The first three months of the trial produced an estimated $538,629 in additional accommodation revenue and prosthesis offsets (excluding medical offsets). A proportion of this money will be reinvested in frontline equipment and services (including revamping the ageing staff room early in the New Year). We are currently working with the Ministry of Health and the Western Sydney Local Health District to explore rolling out similar interventions in other hospitals in the District and if successful, state-wide.

Our final major project this year has been focused on helping injured employees return to work, in partnership with the Department of Education and their claims agent - Allianz. This enabled us to provide more streamlined communications with injured workers, who in turn are encouraged to engage more actively in their return to work process. The workers make specific commitments to undertake activities that will support their return to work, for example doing yoga, walking or exercising at specific times of the day. Results for this trial are expected early next year, when we will also begin partnering with WorkCover to explore wider application of these techniques in the return to work arena. 

Wider advisory support

In addition to these three major projects, the team has also provided advisory support for a range of BI trials and interventions. For example, we have provided input to a large scale RCT on the Home Power Savings Program undertaken by the Office of Environment and Heritage, which tests the use of commitment devices and different communication channels. The recommendations we made to the Kings Cross Management Plan Board regarding the take up of late night public transport has also recently resulted in the implementation of simplified pricing and routes, as well as more salient way-finding and signage. Lastly, we are supporting the Cancer Institute NSW to test which BI interventions are most effective at increasing cervical and breast screening rates.

Thanks for being part of our Community of Practice

Alongside our major projects and advisory support, we have also been building awareness of BI, and capability to apply this in practice. We have trained over 300 NSW public sector officials through 11 workshops, and ran four ‘Community of Practice’ events with a range of international and local speakers from academia and public policy. Encouragingly, all these events have sold out! As well as this, we now have over 1,000 people signed up to our website. So, we thank you for participating and hope we can maintain this level of interest next year. We would also love to hear from you - please do comment on the site or email us at [email protected] to let us know what you find helpful or would like to see more of. We really want to up our game in the online space next year and would greatly value your input to help us do this.

Our plans for 2014

In the New Year, we will produce a report that provides further details on all our projects and trial results to date, as well as setting out our plans for further embedding this approach across the sector. We would like to include a range of case studies of BI interventions in NSW (that we have not been involved in), so please do let us also know if you have suggestions for this. These do not have to have been completed under the banner of BI, but if they involve changing behaviour and demonstrate the principles of this approach we want to hear about it! The Clinical Excellence Commission’s ‘Between the Flags’ initiative is a great example of this (read more here). We know there is a lot going on out there across the state that we don’t know about and we want to make sure we capture the learnings from this work.

As I mentioned earlier, we also hope to be able to bring out some of the leading thinkers in BI to Sydney, which would be organised in conjunction with the newly established Harvard Behavioural Insights Group. This would be incredibly exciting and would further cement NSW as an international leader in the application of BI to policy. Indeed, a recent University of Toronto report cited the UK, US and NSW as examples of governments currently applying BI (read more here), which reflects the global thought leadership the state is demonstrating in this arena.

Until next year…

So, looking back, I realise a huge amount has been achieved. Thanks again to all of you who have participated in our events, trials and interventions, and made the last year so rewarding. I have too many highlights to mention, but talking with our trial partners on the frontline - in the state’s hospitals, call centres, and early education centres - has deepened my conviction that this approach can help humanise government and ground public services in the realities of how people actually make decisions in everyday life.  

Finally, I hope you have a fantastic Christmas and New Year. I’m going back to see my family in the UK for Christmas, but am looking forward to returning for the NYE celebrations, some summer sun (the Ashes fifth test, but the less said about that the better), and to working with you in 2014.