Working Paper: NBER ID: w10027
Authors: Robert S. Huckman; Gary P. Pisano
Abstract: Several observers have suggested that highly skilled workers convey little in the way of competitive advantage for firms due to their mobility. Implicit in this view is the belief that organizations are not important in determining the performance of such individuals. In this study, we address this issue by examining skilled individuals who work within multiple organizations roughly simultaneously. Specifically, we consider the performance of cardiac surgeons, many of whom perform operations at multiple hospitals during the course of a given year. Using patient mortality as an outcome measure, we find that the quality of a surgeon's performance at a given hospital improves significantly with increases in his or her annual procedure volume at that hospital but does not significantly improve with increases in his or her volume at other hospitals. Our findings suggest that surgeon performance is not fully portable across hospitals (i.e., some portion of performance is firm specific). We consider the implications of our results for settings beyond health care.
Keywords: organizational context; individual performance; cardiac surgeons; healthcare
JEL Codes: I1; D2; M0
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| surgeon volume at specific hospital (I11) | lower risk-adjusted mortality rates (I14) |
| surgeon volume at other hospitals (I11) | lower risk-adjusted mortality rates (I14) |
| surgeon performance independent of hospital (I11) | patient outcomes (I11) |
| hospital performance independent of surgeon (I11) | patient outcomes (I11) |
| hospital-specific performance of surgeon (I11) | patient outcomes (I11) |