The Three Levels of Situational Awareness in Healthcare

31 May 2015

David Marshall

Situational awareness in healthcare


Not everyone has the same level of situational awareness, but those who regularly practice it become more adept. The more skilled you are at situational awareness, the more effective you will be as an individual and a team member. Situational awareness is often described as an ascending scale with three levels of ability:


Level 1: Perceiving critical factors in the environment

Situational awareness begins with perception or your mental picture of reality. You perceive information through your five senses—such as examining a patient, reading a medical chart, interpreting test results, or listening to input from other team members. The perceived information must be timely and useful so that you can take action on it as needed. In other words, you must gather all the relevant data that’s needed at the right time. As you get more skilled in the SA mindset, your perception of the environment more closely resembles reality.


However, your perception is affected by three factors:

  1. Past experiences: You might act on information based on experiences and the knowledge gained from them. When something looks similar to what you’re familiar with, you may react as if it were the same.
  2. Expectations: You may interpret in- formation in such a way that it affirms the expected action you plan to take. You also may pay more attention to the information that fits your expectations.
  3. Filters: You may unconsciously “filter out” some information and disregard it. For example, you may not pay attention when something doesn’t match your mental picture.

Level 2: Understanding what the critical factors mean, particularly when integrated with the decision maker’s goals.

You must also be able to properly process the information. The next level of SA involves understanding, analyzing, classifying and integrating the information you perceive, and serves as the basis for your subsequent decision- making and performance. At this level, you grasp the meaning and importance of your perceptions as the basis of what actions to take. You are also able to determine how much time might be required to take and complete the action. However, if you’re confronted with a situation that’s beyond your knowledge, you may misunderstand the information, interpret it incorrectly, or rely solely on what you know or have experience with.


Being situationally aware doesn’t mean you keep an equal focus on every piece of information or every element in your environment. If you can’t process in- formation effectively and efficiently, you can easily lose focus. SA helps you identify what’s relevant (and disregard what isn’t), analyze it, make your evaluation, and take the appropriate action. With SA, you also can reassess the results of your actions, updating your perceptions as needed.


Level 3: Understanding what may happen within the situation in the near future.

The highest level of SA is the ability to project events that might happen based on your analysis of the information and the results of your actions. As in Level 2, you can estimate the amount of time it might take to resolve these potential events. However, a pitfall of projecting into the future based on what has occurred in the past is applying an established procedure without first questioning whether it is appropriate for the patient’s situation.


The Shared Mental Model

When each team member has a different perception of the reality of a situation, the result is ineffective teamwork. Therefore, members first need to share a common understanding of the team’s mission, the goals to be accomplished, and each member’s assigned tasks, roles, and responsibilities. This concept is the shared mental model, in which every team member is “on the same page” and focuses on the most relevant aspects of the situation. It includes a shared understanding of the action plan, derived from five basic CRM principles:

  1. Knowing the game plan.
  2. Following known procedures. 
  3. Cross-checking and verifying. 
  4. Providing ongoing update through cross-talk and callouts.
  5. Anticipating next steps and possible events.
With the shared mental model, you can anticipate and predict member needs while adapting to task demands and changes.

By drawing on the shared knowledge base, you and your team develop accurate expectations of each other’s performance during the situation. With the shared mental model, you can anticipate and predict member needs while adapt- ing to task demands and changes. If at any time you feel confusion or ambiguity about the game plan or your assigned tasks, immediately seek clarification, so that it becomes clear to you. On the other hand, if you feel a team member is confused, clarify (or ask the appropriate team member to clarify) the desired expectations.


Once the shared mental model is established, team members must maintain an ongoing dialogue during the task by sharing relevant information, feedback and questions in a clear, concise and timely manner. This includes regular updates on what’s happening, reassurances when the situation follows the plan, reassessments when it doesn’t, and contingency plans if the situation changes dramatically. Also, when a team member deviates from procedures or the overall game plan, you can recognize the change and communicate it to the rest of the team.


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