BiteSizeQI Engages the Whole Team for Quality Improvement

BiteSizeQI Engages the Whole Team for Quality Improvement

Today we are interviewing Jon Nicolla, MBA, Project Director - Global Palliative Care Quality Alliance and Project Planner - Cancer Control and Population Sciences. Jon has worked with a team at the Duke Cancer Institute to make Quality Improvement more accessible to those working in healthcare through the use of technology.

 Interview conducted by Katie McMillan

Tell me a little bit about what sparked your interest in creating BiteSizeQI.

The concept of BiteSizeQI was born out of series of conversations between members of our research team and their experience with quality improvement. Dr. Arif Kamal and Steve Power, both quality directors at the Duke Cancer Institute (DCI), have been conducting quality coaching to healthcare professionals for several years through programs with the American Society of Clinical Oncology. Within their roles of quality coaches, Dr. Kamal and Steve were noticing that many of the skills taught during their sessions were often misused or forgotten by participants after several weeks apart from their quality coaches, leading to decline in the quality of projects they were seeing. 

In parallel, I completed a Six Sigma Green Belt training course at NC State that was mostly comprised of Duke Performance Services staff and Duke clinicians. Because the class was two weeks, 8-5 pm, Monday through Friday, many clinicians expressed concerns that they were falling behind on their clinical responsibilities and thought that the content could be condensed for utility of a clinician whose primary responsibility is to treat patients. Through our conversations, we noticed that there was a deficiency in the current model of learning quality improvement in healthcare and thought we may be able to help fix it. 

Can you give me an overview of BiteSizeQI? What is the key functionality?

BiteSizeQI was made to provide clinicians and staff the skills necessary to enact positive change within their work environment.  It is a web-based application that helps users identify a problem or deficiency in their workplace, and then walks the user through the fundamentals of quality improvement to help fix the problem.  Upon logging into BiteSizeQI, users will work their way through a series of short, Lean Six Sigma-inspired videos that build their quality improvement skills.  After completing a video, the system then engages the user to apply the skills they have learned by completing simple quality improvement activities.  As a user completes each activity, the system records the progress made and builds a guide for implementing a solution to the problem using the responses from the activities.  We call this guide a Project Blueprint.  BiteSizeQI gives all members of a team a voice to highlight problems in the workplace and propose fixes for those problems in a structured way consistent with validated quality improvement principles. 

How do you think this will help enable quality improvement projects at Duke in the future?

BiteSizeQI was created to foster micro-innovation within large organizations.  Micro-innovation promotes small, positive changes to be made to an existing process by stakeholders that interact with the process.  We believe that the best ideas don’t always come from the top and, when given the right tools, all staff can drive meaningful change. BiteSizeQI can promote micro-innovation within clinical teams at Duke, give all team members a voice in the day-to-day operations of their job, and empower all Duke staff to highlight operational deficiencies to their superiors. 

Flow chart.png

What are some of the lessons learned from going through the app development process that you’d like to share with other Duke innovators?

Commit to your vision, but be open-minded to change.  When we started creating BiteSizeQI, we knew that we needed to create a platform that was easily accessible, as well as easily understandable, to give busy employees a voice to promote improvement. This was the only construct we put on ourselves. We tried to be flexible and agile in the design of our app. As we spoke to stakeholders, we frequently would pivot on concepts, designs, and approaches. Treat your application like it is never finished and continuously strive to improve upon it, even once it is launched. 

If you’d like to use BiteSizeQI at Duke or another health system, contact Jon Nicolla at jonathan.nicolla@duke.edu

Fundamentals of FHIR

Fundamentals of FHIR

"Now you're speaking my language!" - How to talk to an app developer about your research app

"Now you're speaking my language!" - How to talk to an app developer about your research app