Organizational learning-by-doing in liver transplantation
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Organizational learning-by-doing in liver transplantation Sarah S. Stith1
Received: 30 May 2016 / Accepted: 17 August 2017 / Published online: 30 August 2017 © Springer Science+Business Media, LLC 2017
Abstract Organizational learning-by-doing implies that production outcomes improve with experience. Prior empirical research documents the existence of organizational learning-bydoing, but provides little insight into why some firms learn while others do not. Among the 124 U.S. liver transplant centers that opened between 1987 and 2009, this paper shows evidence of organizational learning-by-doing, but only shortly after entry. Significant heterogeneity exists with learning only evident among those firms entering early in the sample period when liver transplantation was an experimental medical procedure. Firms that learn begin with lower quality outcomes before improving to the level of firms that do not learn, suggesting that early patient outcomes depend on the ability of new entrants to import best practices from existing liver transplant programs. Knowledge of best practices became increasingly available over time through the dissemination of academic research and increasingly specialized training programs, so that between 1987 and 2009, 6 month post-transplant survival rates increased from 64 to 90% and evidence of organization-level learning-by-doing disappeared. The lack of any recent evidence of organizational learning-by-doing implies that common insurer experience requirements may be reducing access to health care in non-experimental complex medical procedures without an improvement in quality.
I would like to thank Tom Buchmueller, Scott Masten, Jeff Smith, Mario Macis, and Steve Leider, for helpful comments. I am also indebted to the many staff members at the University of Michigan Transplant Center for their advice and information, especially Alan Leichtman, John Magee, and Anne Murphy, to Jennifer Wainright at the United Network for Organ Sharing, and to Guerry Johnson, transplant recipient. “This work is supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the author alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government”. http://optn.transplant.hrsa.gov/data/citing.asp. Electronic supplementary material The online version of this article (doi:10.1007/s10754-017-9222-z) contains supplementary material, which is available to authorized users.
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Sarah S. Stith [email protected] Department of Economics, The University of New Mexico, Albuquerque, NM, USA
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Keywords Organizational learning · Learning-by-doing · Liver transplantation · Firm heterogeneity · Firm performance JEL Classification D24 · D83 · I10 · I11 · L25
Introduction Kenneth Arrow first formally recognized the importance of organizational learning-by-doing in economics, observing
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