دانلود رایگان مقاله انگلیسی یادگیری سازمانی با انجام پیوند کبد - اشپرینگر 2018

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.

Conclusion

Liver transplant centers learn by doing, but only shortly after entry. The importance of learning-by-doing varies among centers with some centers starting at a low survival rate and improving, while others enter with high survival rates. The effect of learning-by-doing increases in contexts with greater technical uncertainty, as measured by differences in the timing of entry, across survival durations, and across types of organ transplants.

These results highlight the importance of focusing on learning-by-doing shortly after entry rather than seeking to identify a constant return to experience, regardless of how experienced an organization is when it first appears in the data. The pattern of early learning-by-doing I identify follows what has been found in many studies in manufacturing, indicating that organizational learning-by-doing is not a phenomenon unique to reducing unit costs or production defects. Organizational learning-by-doing seems to operate quite similarly in complex industries with team-based production processes, such as organ transplants, shipbuilding (Thornton and Thompson 2001), semi-conductors (Irwin and Klenow 1994), air craft (Benkard 2000), auto manufacturing (Levitt et al. 2013), and in healthcare, for minimally invasive cardiac surgery (Pisano et al. 2001) despite vastly different information dissemination mechanisms from proprietary manufacturing practices to medical research published in a highly competitive academic environment.