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BEM (Business Evaluation and Management) is a term of art describing the iterative and incremental better-practices framework by the same name used in service organizations for generating accurate assessments and effective management of problems in business functions. The framework has particular application in the setting of healthcare organizations because it reflects the iterative hypothesis testing performed in generating clinical assessments and plans in the medical management of patients. Although the practice of systematic evaluation and management is well known in the practice of medicine, its origin as an applied theory in healthcare process management can be traced to Clayton Christensen and Steven Spear. Christensen, the father of the theory of disruptive innovation, in his book titled “The Innovator’s Prescription: A Disruptive Solution for Health Care” states, “Just as physicians are trained to arrive at a diagnosis through iterative experimentation, they should be taught to do the same with 'ill' processes within the health-care system”, pointing to the article by Spear, noted MIT-Sloan School of Management professor, appearing in the Journal of the Association of American Medical Colleges.
In healthcare services organizations, the application of evaluation and management in business operations has been widespread, in no small part evidenced by the longevity of such healthcare business management associations as the Medical Group Management Association, the American Association for Physician Leadership and the American College of Healthcare Executives.
Although the BEM process framework itself may, in service organizations and especially in healthcare service delivery organizations, be referred to as “strategic management”, “business process management”, and carry other business terms, and while the details of such local processes might vary, at a high level the framework within which these processes reside can be best described as business evaluation and management. That is, the identification of a problem, the characterization of the problem through subjective and objective means, the generation of hypotheses that can be put through an authentication process to discover diagnoses or causes at the root of the problem, and the subsequent monitoring of the dysfunctional state for changes or the problem's enduring resolution.
Similar processes, such as DMAIC and PDSA (PDCA) exist in various non-clinical care industry settings, mainly in product manufacturing. However, such processes primarily aim to control quality in technical settings, whereas evaluation and management aims to diagnose and treat problems in such complex systems as business organizations, and living beings.
Evaluation and management in the setting of clinical care services is a well-established methodology by which physicians and other healthcare professionals evaluate and plan a patient’s treatment and monitor, over time, the patient’s health, disease and progress. Clinical evaluation and management is a process framework with a long history of application dating to Rudolf Virchow and William Osler in the modern era, and to the Babylonians, Hindus and the Greco-Roman world in antiquity. Indeed, explaining the manifestation of thrombosis is an example of the careful characterization and iterative hypothesis testing necessary in generating accurate explanations of the causality of observable dysfunction.
The intended output of the medical evaluation is the generation of medical diagnoses that explain the cause of a disease state. A large component of the medical evaluation is the systematic information gathering known as the medical history. While medical history taking as a procedure dates to antiquity, the stepwise process and informational architecture of a medical history as part of the clinical evaluation is observed only in the last several hundred years.
In the BEM framework a problem is a function’s or an activity’s consequential deviation from its intended performance or goal. Therefore, in the context of service organizations, a problem is a significant dysfunction. That is not to say that problems in one organizational context cannot be advantageous in a different context.
A principle of BEM is that functions performed collaboratively by groups of co-workers in the service of customers, whether directly or indirectly, in which human judgment is a component are necessarily complex. This is because organizations of people are complex systems, and a healthcare system can be understood in terms of complexity. Further, since living things are, themselves, complex systems, every level of hierarchical organization of life exhibits the characteristics of complexity, from the smallest unit of the cell, to biosphere networks. Conversely, functions carried out by non-living machines are simple - although such functions might be extremely complicated, meaning multi-faceted.
Inherent in the BEM framework is iterative hypothesis testing as a means for generating solutions, that is, accurate, authenticated explanations of causal mechanisms at the root of observed problems. Business solutions, in this way, are the output of the evaluation arm in the framework.