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Loke / Tan30-40 appliances a year within a compliance of about61%. However, the number of appliances fabricatedfrom each clinic is dependent on the order fromthe orthodontist and this is influenced by individualtreatment modality preference.Thus, it is not realistic to set a standard targetoutput for all technicians as a KPI. It is probably morepragmatic to have equitable overall workload fortechnicians in the same clinic and set a minimum annualtarget output for better compliance and improvementin skill. Perhaps better communication betweenorthodontists and technicians and continuous trainingand updating in knowledge will lead to improvementin skills 8,9 . Good dental care is delivered by a dedicatedteam; thus working holistically together for the patientand continuous quality improvement interventionsmay be effective quality assurance measures 10 .CONCLUSIONMean compliance in Selangor was about 55%with plastic retainers having the highest compliancefollowed by acrylic retainers, quadhelix, functionalappliance, TPA and URA. There was statisticallysignificant difference in compliance to deliveryin different clinics, orthodontists, seniority oftechnicians, individual technicians and appliance typewhen analyzed individually. However, multiple linearregression showed that only the seniority of technicianand individual technician were variables whichinfluenced compliance, although they contributed toonly 24% of factors.RECOMMENDATIONManagers should set minimum annual outputtargets for individual technicians based on their scopeof work. Those with more non-clinical responsibilitiesor with heavier denture workload may be allotted lessorthodontic work and vice versa. Technicians withless exposure to orthodontic work need to do morecases to improve and may be given more training andsupervision. Recognition for excellent work output bydepartment Heads is suggested as an incentive andmotivation for continuous improvement in technicians.ACKNOWLEDGEMENTThe author would like to acknowledge thecooperation of all orthodontists and staff in Selangorparticipating in this study and the assistance ofDr.Cheong Wai Sern and Dr.Praveen Gil Kaur. Wewould like to thank the Deputy Director of Oral HealthServices in Selangor for her support and the Ministry ofHealth Malaysia for permission to publish this studyREFERENCES1. Atta AE. Total quality management in orthodonticpractice. Am J Orthod Dentofacial Orthop 1999Dec:116(6):659-602. Al-Awadhi EA, Wp;stemcrpft SJ, Blake M. An auditof the laboratory service provided to the HealthService Executive Orthodontic Department, St.James Hospital, Dublin. J Ir Dent Assoc. 2006Winter;52(3):149-523. Laporan Tahunan Jabatan Kesihatan NegeriSelangor 2008. Jabatan Kesihatan Negeri Selangor.Published by Vermillion Network.4. Sistem Maklumat Pengurusan Kesihatan (Healthmanagement Information system) KementerianKesihatan Malaysia. Laporan Bulanan Individu/Klinik/Negeri bagi Perkhidmatan Pakar OrtodontikSelangor. PG208 Pind.2/2007 Tahun 2008.5. Mesyuarat Kepakaran Pergigian KKM Bil 1/2009(12-14 Julai 2009). Key Performance Indicators2009. Bahagian Kesihatan Pergigian, KementerianKesihatan Malaysia.6. Griffiths E. Functional forum: a laboratory surveyof 1,250 Twin Blocks. Funct Orthod 1995 May-Jul;12(3):34-87. Heidermann J, Witt E, Feeg M, Werz R, PiegerK.Orthodontic soldering techniques: aspects ofquality assurance in the dental laboratory. JOrofac Orthop 2002 Jul;63(4):325-388. Jusczyk AS, Clark Rk, Radford DR. UK dentallaboratory technicians’ views on the efficacy andteaching of clinical-laboratory communication. BrDent J 2009 May 23;206(10):E21: 532-39. Murphy MT. Collaboration interdisciplinaryagreements: A new paradigm in laboratory andspecialist communication and patient care. JADA2006 Aug; vol 137:1164-116710. Bluth EI, Lambert DJ, Lohmann TP, Franklin DN,Bourgeois M, Kardinal CG, Dalovisio JR, WilliamsMM, Becker AS. Improvement in ‘stat’ laboratoryturnaround time. A model continuous qualityimprovement project. Arch Intern Med. 1992Apr;152(4):837-40Address for correspondence:Dr S T LokeHead of Orthodontic UnitOrthodontic Specialist Clinic, Jalan Tengku Kelana,41000 Klang, SelangorTel:03-33713811Fax: 03-33737940e-mail: shuetl@yahoo.com11Malaysian Dental Journal Jan-Jun 2011 Vol 32 No 1