Are Your Treatment Guidance Systems on "GO"?
Treatment monitoring is an essential management tool in orthodontics for the control of treatment flow. It is a calendar of expectations with regard to the completion of each of the key steps in treatment. Much orthodontic treatment today is organized into one system or another, which involves a sequence of corrections. A typical sequence might include bite opening, Class I molar, Class I cuspid, retract incisors, torque, and finishing. In a treatment monitoring system, each step is ,flagged in some way. When each flag is reached, the orthodontist and staff evaluate whether the step is completed. This affords an opportunity to praise and encourage those who are on schedule, and, for those who are not, to determine why not and to take steps to get them back on schedule. The process coordinates well with progress reports to patients and parents, and the setting of numerous short-term treatment goals is motivational to patients and staff.
Cases that are behind schedule are costly to the practice, because the case load gradually increases, adding more and more patients whose payment is completed, but whose treatment remains to be completed. As case load increases, expenses increase. More personnel, space, chairs, supplies, utilities, and other overhead items are required. In addition, these are the cases that are nagging to know when their treatment will be completed.
Anything that interferes with the orderly completion of each step in treatment prolongs active treatment time. Broken and cancelled appointments do it, and many practices compound the problem by postponing reappointment by two to four weeks. That only penalizes the practice. The appointment schedule should be managed in such a fashion that BAs and CAs can be seen as quickly as possible, in order to keep them on schedule. Emergency appointments are in the same category. Emergencies should be seen as quickly as possible to take care of the emergency, but also to keep those patients on schedule. The nature of the emergency and the operator involved should be recorded, so that, if a pattern develops, steps can be taken to reduce the occurrence. Some practices have a great many more emergency visits than others, and they are controllable to a large extent. Poor scheduling that does not allow enough time to complete the procedure required at a visit also prolongs treatment time.
Lack of cooperation is undoubtedly the greatest contributor to prolonged treatment time. If those patients could be identified in advance and not started in treatment, practices would be happier, healthier, and probably no less prosperous. However, we do not seem to have an adequate screening method. In the past, many practices simply refused to start treatment for anyone who said they would not wear appliances. This did screen out many of the potentially uncooperative patients, but it also screened out those who said it and didn't really mean it, those who were fearful, and those who had not been given sufficient explanation of what is involved in orthodontic treatment. That type of screening denied treatment to many individuals who might have completed treatment successfully and enjoyed its benefits.
Furthermore, this was a luxury that was more affordable by more practices in the past. In today's economy, we need a more sensitive screening method, before turning away potentially successful patients along with potentially unsuccessful patients. Today, it is more appropriate to indoctrinate prospective patients more thoroughly in what orthodontic treatment is all about, and for orthodontists to be more conversant in patient motivation and behavior modification. If, after the patient has been given appropriate information in an appropriate manner, treatment is still refused, there might still be better approaches than just refusing treatment to the patient. Such patients might be educated some more, they might be given a separate, individual case presentation, they might be placed on observation to see if their judgment might change in time, or they might be started in treatment with the understanding that it was to be a three-to-six-month trial period. If a good, cooperative relationship was not established in that time, then treatment could be terminated, but at least an appropriate effort would have been made.
As soon as an active patient is identified as being uncooperative, special efforts must immediately be made to ignite his cooperation. He might be seen more often--sometimes once a week. The treatment plan might be changed to one requiring less of his cooperation. A trial period might be set, and treatment terminated if progress cannot be made in a reasonable time.
A treatment monitoring system is extremely simple to install. Reasonable expectations for the completion of the key events in treatment can be determined from actual past experience in the practice, to set up the timing pattern. The key events can be identified with symbols that are entered in advance on the blank treatment card at the predetermined time intervals. Completion of each step in treatment must be evaluated at the visit at which its symbol appears on the treatment card. The future will probably produce more sophisticated treatment monitoring systems. For the moment, this simple manual system is both efficient and effective.
