Organizational learning-by-doing in liver transplantation.

Organizational learning-by-doing implies that production outcomes improve with experience. Prior empirical research documents the existence of organizational learning-by-doing, 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.