3 Situation awareness

Maintenance of SA demands vigilance and good monitoring at all times. It may easily be lost if agreed actions, protocols or guidelines are not followed or do not have the expected effect. Such events should be treated as red flags.

After the task is completed, a well-managed team will conclude with a debrief through which everyone can understand what occurred. This process will enhance their own mental models, improving SA next time.

Clearly, it is vital that every team member values all the information they are offered. The most junior person on the team should always feel empowered to speak up if they are worried and the most senior should always be ready to listen – it might just save the situation. This is discussed in more detail in Chapter 4.

The rest of this chapter will explore the mechanisms of SA failure. In this, it is helpful to consider the process of achieving, acquiring and maintaining SA. This may be referred to as situation assessment.

Situation assessment is a dynamic state in which Endsley (1995) identifies three levels:

1 Perception of elements in the environment: task-relevant information is misinterpreted.

2 Comprehension of the current situation: specific information is wrongly perceived.

3 Projection of the future status: future status is wrongly predicted, either from a poor initial mental model or personal memory failure.

Getting ahead of the task is important in situation assessment but staying ahead of the task is the ultimate goal. SA can help a practitioner to stay ahead and is a key component of safe practice.

Situation Assessment

In order to achieve and maintain SA, information must be gathered accurately (input), remembered and sorted (memory) and then processed to anticipate the future (cognition). This process is not linear; for example, the process of sorting incoming information for storage will be interpreted according to existing models and perceptions, while information continues to be accrued and processing has started.

Perception and Mental Models

The brain deals with different kinds of information in different ways. Sight is the predominant sense and auditory information is most easily shut out. Suppression of visual stimuli requires a positive action, for example, shutting your eyes on a roller coaster. By contrast, consider how easy it is to ‘tune out’ of a conversation and focus on something else. As talking is our primary method for aligning our mental models, there must be a focus on maintaining effective communication between all team members.

It is easy to illustrate how input can be distorted by considering well-known optical illusions such as the one illustrated in Figure 3.2.

Figure 3.2 Optical illusion.

Stare into the middle of this image – can you see the black dots flashing on the white discs? You know that they cannot be flashing, but can you convince your brain? So why does this happen?

Illusions occur when the brain tries to make sense out of conflicting information or adds stored information based on experience or cultural conventions. Sight is fallible and images can easily be ‘misread’ giving rise to errors in information processing. A practical example that many have experienced is the sensation that you are moving when sitting in a stationary car while the vehicle next to you moves slowly alongside. In this case, unlike the illusion above, the interpretation can be corrected by gathering further information to confirm your stationary state relative to other nearby objects.

It is worth considering the issue of conflicting information in a little more detail. When a new piece of information presents, that is not entirely consistent with an individual’s current mental model, there is a high chance that they will disregard it without actually questioning the overall model on the basis of that information. Only the information that fits a preconceived concept is accepted. This is known as conformational bias. A good example of this can occur during patient handover. The patient is admitted and a presumptive diagnosis is made. This diagnosis is handed over as part of the history. The receiving clinician may adopt the diagnosis as the framework for their mental model and then subsequently be blinded to the emerging but differing picture as further information becomes available.

Thus erroneous information can be fed in at the beginning of the situation assessment. An ability to dismiss this will be affected by our own mental model of the world. We assemble our mental models based on:

1 Experience – past experience that has been internalised.

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