Organizational learning differences in healthcare services: the case of medical centres in Taiwan

This study presents an individual-based evaluation of the within- and between-organization learning differences in Taiwan's medical centres. Drawn from Taiwan's National Health Insurance Research (NHIR) database, a sample of 32 285 Laparoscopic Cholecystectomy (LC) surgery cases performed in all 18 medical centres during the period 1998 to 2004 is analysed. All the medical centres in Taiwan are Not-For-Profit (NFP) in nature. This study thus provides a clear-cut delineation of the learning differences between public and private hospitals. The individual-based approach creates surgeon-specific learning distributions within each institution through a parametric estimation of the hyperbolic model, after controlling for patients’ heterogeneity. Investigation of the within- and between-hospital learning differences is accomplished through two nonparametric tests. The results indicate both within- and between-organization learning differences. Compared to senior surgeons, an overall dominance of learning effects among junior surgeons is found. Furthermore, the between-organization comparisons indicate junior surgeons affiliated with private hospitals learn faster than their peers in public hospitals. This suggests potential learning differences in terms of hospital costs may result from hospital ownership.