Abstract
Procedural failures of physicians or teams in interventional healthcare may positively or negatively predict subsequent patient outcomes. We identify this effect by applying (non)linear dynamic panel methods to data from the Belgian transcatheter aorta valve implantation registry containing information on the first 860 transcatheter aorta valve implantation procedures in Belgium. We find that a previous death of a patient positively and significantly predicts subsequent survival of the succeeding patient. We find that these learning from failure effects are not long-lived and that learning from failure is transmitted across adverse events.
Highlights
Physician learning is an umbrella term covering multiple types of learning, forgetting and knowledge transfer
The identification of the learning from failure effect on physician performance relies on previous experiences as patient mortality for a physician depends on mortality of the previous patient(s). Estimation of such learning from failure effects imposes two main econometric challenges: First, in the context of binary response fixed effects (FE) dynamic panel data models, the well-known incidental parameter problem and Nickell bias lead to possibly inconsistent coefficient estimates
We shed light on the question how procedural failures of physicians affect subsequent patient outcomes. We show that this “learning from failure effect” is an important source of physician learning besides the commonly identified factors such as economies of scale, learning from cumulative experience and human capital depreciation
Summary
Physician learning is an umbrella term covering multiple types of learning, forgetting and knowledge transfer. The literature on learning for physicians typically focuses on specific casestudies and the identification of different types of learning. In Van Gestel et al (2016), these three types of learning have been further investigated with a focus on patient subgroups. In a subsequent procedure, the provider might be better prepared and/or better motivated to obtain a positive outcome. This response might arise because of, among others, loss aversion. A failure may provide the physician with more information on specific aspects of the procedure. Subsequent to a failure, patients with different characteristics may be selected to undergo the procedure. Clearly a selection effect, this might indicate that physicians learn to more appropriately select patients over time. Our empirical strategy directly aims at addressing potential endogeneity issues when estimating learning from failure effects
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