title: Forgetting the learning curve for a moment: how much performance is unrelated to own experience?
abstract: Volume-outcome relationships are of clear importance for most participants in the health-care industry; research and appropriate policy implications are of critical importance. In this letter we critique the prevailing 'learning-by-doing' view in cardiac surgery. We illustrate the very wide disparity in empirical findings on volume-outcome relationships there, in the context of broader open issues in 'learning curves' in general. Potential complementary mechanisms, e.g. 'social learning by knowledge spillovers' are introduced; these cast into doubt the prevailing policy recommendations of simple regionalization and volume smoothing.
authors.affiliation: Policy Academic Area, The Anderson Graduate School of Management, Los Angeles, CA 90095-1481, USA. mhuesch@anderson.ucla.edu
authors.forename: Marco D
authors.initials: MD
authors.lastname: Huesch
authors.forename: Mariko
authors.initials: M
authors.lastname: Sakakibara
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D001026:Coronary Artery Bypass / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007858:Learning; D017063:Outcome Assessment, Health Care; D010820:Physicians / Q000592:standards; D011787:Quality of Health Care; D006113:United Kingdom / Q000453:epidemiology