Presentation on theme: "Situation Awareness “the perception of the elements in the environment within a volume of time and space, the comprehension of their meaning and the projection."— Presentation transcript:
1 Situation Awareness“the perception of the elements in the environment within a volume of time and space, the comprehension of their meaning and the projection of their status in the near future.” Endsley (1995)From University of AberdeenThe term was developed from the military in the First World War when the concept of “gaining an awareness of the enemy before the enemy gained a similar awareness” first appeared.Developed by the operator having a good mental model “picture in their head” representing the status of current task and the surrounding work environment.
3 We don’t have to look very far to find accidents where problems in situation awareness were implicated. Chernobyl in 1986, Three Mile Island in 1979, 175 aviation accidents, pilots who land aircrafts at the wrong airport, and surgeons who operate on the wrong side.Endsley, 2005
5 RetrospectivelyComments from system operators where failures in situation awareness occur include:“I didn’t realize that…”“I didn’t notice that…”“I wasn’t aware that…”“We were very surprised when…”“I was so busy attending to…”“We were convinced that…”Understanding the human brain’s information system presented (sensory, working, and long-term memory requirements.Flin et al., 2008
6 Non-technical skillsWhen looking at non-technical skills, it can include the skill of gathering information, recognising and understanding the situation, and anticipating future events.
7 Teamwork & Cooperation A1 1 CategoryRoleRateExampleTeamwork & CooperationA11S1 asks if the ABG was done, A1 answers yes, and does not volunteer the result. S1 then asks for the result, and at this point, A1 addresses At and admits to looking for the result, having forgotten to do the ABG. He then asks At to do an ABG. Does not provide any explanation to S1 for the oversight.S14Asks A1 if he would mind ‘sharing’ the ABG result. S1 did not make any comments about it when he realizes that it was not done at all.Conflict resolution: concentrates on what is right.Leadership & Management3Authority and assertiveness. Persistent when asking for the ABG report (which was a long time in coming).
8 Getting/Gathering Information (Perception) Information is not availableData is difficult to detect/perceiveFailure to scan or observeMisperception of data“Fixation errors or tunnel vision”I can teach you how to help with perception and projection, but comprehension is much more complex.Mental model is “wisdom”Endsley, 2005
9 Understand/Interpret Information (Comprehension) Lack of poor mental modelsUse of incorrect mental modelsOver-reliance on default valuesIncorrect assumptionsMemory failureEndsley, 2005
10 Thinking Ahead / Anticipating Future (Projections) AmbiguityFixationConfusionLack of required informationFailure to maintain critical tasksFailure to meet expected target or checkpointDifficulty resolving discrepanciesClues when the team is losing the correct situational awarenessCAA, 2006; Okray and Lubnau, 2004
11 Teamwork & Cooperation A1 1 CategoryRoleRateExampleTeamwork & CooperationA11S1 asks if the ABG was done, A1 answers yes, and does not volunteer the result. S1 then asks for the result, and at this point, A1 addresses At and admits to looking for the result, having forgotten to do the ABG. He then asks At to do an ABG. Does not provide any explanation to S1 for the oversight.S14Asks A1 if he would mind ‘sharing’ the ABG result. S1 did not make any comments about it when he realizes that it was not done at all.Conflict resolution: concentrates on what is right.Leadership & Management3Authority and assertiveness. Persistent when asking for the ABG report (which was a long time in coming).
13 What can we do to improve situation awareness? Good briefingsFitness for workMinimizing distraction and interruption during critical tasks“Sterile cockpit”UpdatingMonitoring (“zoning out”)Speaking upTime management (“hurry up syndrome”)
14 What can we do to improve situation awareness? Good briefingsFitness for workMinimizing distraction and interruption during critical tasks“Sterile cockpit”UpdatingMonitoring (“zoning out”)Speaking upTime management (“hurry up syndrome”)
15 Examples of situation awareness Proceeding only with agreement from everyone“Are we ready to start the procedure?”From University of AberdeenGood briefings = good questionsWhat is your immediate goalWhat
16 Your turn Find someone in the room who you have never met before Together, come up with two questions that have/would improve situation awareness in your teams.
17 What is your immediate goal. What are you doing to support that goal What is your immediate goal? What are you doing to support that goal? What are you worried about? What is the current problem, size, and intention? What do you think this situation will look like in ____minutes, and why?You’re not asking “God” questions, you are focusing on questions related to the task at hand.Funny (or not so funny story), as I was reviewing my slides with my husband last night he mentioned a coworker at a previous job.He asked the owner of the company “Why am I here” and the owner said “well if you don’t know why you are here then you don’t need to be here” he was fired on the spot.
18 Communication failures related most frequently to equipment and keeping team members updated as to the progress of an operation.Better understand vulnerabilities of intraoperative communication150 hrs of observationType of error, subject of error and effect of error
20 Teaching Situation Awareness Easiest to work with is data exchangeBetter form, better printout, better handover, better briefingTeach tricks and clues to identify projection errorsMost difficult is building ‘better’ mental modelsExperience, competence
21 Decision MakingDecision-making is the process of reaching a judgement, choosing an option, or making a diagnosis about a situation in both normal or time-pressured situations. Flin et al., 2008
22 Non-technical Elements of Decision-making Situation AssessmentDefining problemGenerating OptionsConsidering responseSelecting Option(s)ImplementingOutcomeReviewSBAR,
23 Recognition-primed (Intuition) Decrease cognitive effort and stressRecognition-primed (Intuition)Rule-basedChoiceCreativeIncrease cognitive effort and stress
24 Decision Traps Jumping to solutions Not communicating Unwilling to challenge the expertsComplacency (worry too much)Assuming no timeFailure to consultFailure to reviewWalters, 2002: p 15
25 Training decision-making Tactile decision gamesStorytelling
26 A Storytelling Example How can we teach non-technical skills through this example?
27 Delay in patient awakening: At the end of the case, when informed about the changes in the MEP recording, S2 decided to clinically assess motor power in the lower limbs before shifting. This request was conveyed to A1 and A2. The team ends up waiting for almost one and half hours, but the patient is still not awake enough to follow commands. S2 blames Clonidine for the delay and is very vocal about how he disapproves of the drug. A1 explains to him that it is the synergy between Gabapentin and Clonidine and not the latter alone. A1 gives no explanation to S2 about why the latter was given if this synergy was known to occur. A1 also says that for a patient on clonidine, the anaesthesia requirement would only be 2/3rd of the normal, but its unclear if the maintenance anaesthetic was toned down as recommended in this case. S2 is getting frustrated at the delay and conveys it non-verbally by crossing arms and shaking head. At one point while A1 was away from the room, A2 says out loud that he was not party to the clonidine being given. The surgical and nursing team seem to be unhappy with the delayed wake up scenario – not explicitly conveyed, but very evident in body language. A1 comes back to the surgical suite and gives titrated doses of Naloxone to the patient to help her wake up – S2 was not very happy with this, since an overshoot of the dose of naloxone would cause the patient to wake up in severe pain. Eventually after 1 hour and 45 minutes, the team decides to shift her anyway, and A1 offers to give her some neostigmine just in case there is some residual muscle paralysis from the relaxant that can be reversed (technical observer suggests that residual paralysis – not likely and Neostigmine at this point – quite unnecessary). To this suggestion, S2 says – ‘No, I don’t want her given any more drugs’ in a curt manner. This process took 2 hours before the patient left the OR.
28 Teaching Decision Making GoodGathers information and identifies problemReviews causal factors with other membersConsiders and shares risks of alternative course of actionPoorFails to diagnose problemDoes not search for informationFails to inform team of changes in decision path