The Brilliance, Attitude, Leadership and Materials (BALM) framework of clinical excellence: an adoptable model for sub-Saharan Africa

Clinical excellence is the ability to provide rigorous, evidence-based, and rewarding care to the right patients. The BALM (brilliance, attitude, leadership, and materials) framework is a novel model for adjudicating clinical excellence. There are a few models and frameworks for evaluating clinical excellence, but each has its flaws and does not consider the peculiarities of economically-challenged regions such as sub-Saharan Africa. Coincidentally, such low-resource areas have an urgent need for a framework to assess clinical excellence because of their low health-related indices. The five-step model of professional excellence is a well-recognised tool and was the model upon which the BALM framework was built. So, the BALM framework determines to what extent, using the five-step stages of novice, advanced beginner, competent, proficient, and expert, a clinician has achieved in each of the four critical domains, namely brilliance, attitude, leadership, and materials. Therefore, a clinician, who strives for excellence, aims to be an “expert” in each of the domains of the BALM framework. The framework is concise, practical, easy to use, and multidimensional, although it still needs to be applied widely to assess its reproducibility.