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COMMENTARY
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1423--1424

Situational Analysis in Neurosurgery

Manjul Tripathi, Aman Batish 
 Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Dr. Manjul Tripathi
Neurosurgery Office, Nehru Hospital, 5th Floor, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India




How to cite this article:
Tripathi M, Batish A. Situational Analysis in Neurosurgery.Neurol India 2020;68:1423-1424


How to cite this URL:
Tripathi M, Batish A. Situational Analysis in Neurosurgery. Neurol India [serial online] 2020 [cited 2021 Feb 26 ];68:1423-1424
Available from: https://www.neurologyindia.com/text.asp?2020/68/6/1423/304075


Full Text



The term situational analysis is derived from two words, situational and analysis. The word “situational” is rarely used on its own, and it means “a person or thing regarding its surroundings or circumstances,” while “analysis” is a process of studying or examining something in an organized way to learn more about it. The terms, when put together, mean the analysis of the various factors of a business. It identifies a business's capabilities, customers, potential customers, business environment, and their impact on the company.[1] Situational analysis, when pertaining to the health sector, plays an essential and crucial role in the planning of health services. It aims to give a voice and accountability to all those providing the health services, thereby concretizing roles and responsibilities, and strengthening all the aspects of healthcare.[2] Situational analysis should aim to realistically assess the current health sector situation, including the assessment of the lacunae in the health sector and also the root cause of these weaknesses. It should also provide evidence-based directions to improve the health sector and how to respond to the needs of a particular situation faced by health providers.[3]

Situational analysis should be done as the initial step in the development of a health setup and service. It should be undertaken at the time once the planning of the health policy and setup is being done. It should involve all the health sector stakeholders; for example, all the members of an operating team should be involved in the situational analysis. The surgeons, anesthetist, operation theater (OT) technician, and scrub nurses should be given their specific roles and responsibilities.[3] The emphasis should be made on establishing excellent communication and rapport between the members of the team irrespective of the “so-called” hierarchy of the operating theater.

In an article by Tripathi et al., the real-time operation theater scenario was compared to the Hollywood biographical movie “Sully.” There is no event as dramatic in an aviation simulation as the intraoperative rupture of an aneurysm. What was questioned by the author was the role of simulation and how it helps a surgeon prepare for facing catastrophe when all that stands between life and death is the surgeon's decision, knowledge, and experience. There can be no substitute for experience and knowledge.[4] However, one can prepare oneself for such a situation by analyzing all the possible scenarios that can occur during a particular surgery. Nothing can prepare us enough for the “moment of truth,” when we may minimize errors in our surgical practice by analyzing the various components of patient care and try our best to avoid any shortcomings at each level.

The approach towards situational analysis should be as participatory and inclusive as possible. All members should be given adequate space and dialogue time as much as possible so that a wide range of expertise and viewpoints are addressed. The focus should be on issues that are relevant to the health status and outcome of the patients. The analysis should be comprehensive, and the consequences should provide an evidence-based strategic direction to the response to the real health sector needs of the patient/population. Methodically, a situational analysis should also analyze the health system performance and an analysis of the implementation of health sector activities, budgets, and finances.[4]

Though the practice of situational analysis in the setting of an operation theater is rarely practiced in our setup; however, the use of a preoperative checklist is an essential task in reducing errors. For example, a surgical checklist comprises a questionnaire that has to be filled and signed by the operating surgeon, scrub nurses, anesthetists, and the OT technician.[1] Any problem in the checklist has to be addressed and sorted out before the surgery is started. Another model is the lean sigma six approach. This is a model that relies on a collaborative team effort to improve the performance by systematically removing waste and reducing variation.[5]

All these models have been introduced from the marketing and production point of view. However, seeing the positive impact it had, the same principles can be used in the field of medicine to improve the planning efficacy and outcome of the various health services. Whatever simulation one may think, the real-time challenges would surprise us with their spontaneity, ferocity, ability to shake us, and in neurosurgical scenario risk the life of a patient and the honor of a surgeon. Situational analysis is necessary not only for our preparations as a healer but also to safeguard our community from medicolegal obligations. In a broader sense, maintenance and periodic evaluation of situational awareness would provide an objective safety parameter for the high yielding branches such as neurosurgery. Despite everything, neurosurgery would continue to challenge the human capabilities to differentiate between a better and a good health specialist.

References

1Sarkar H. “Being Aware!” – Situational Awareness and Its Importance in Safety and Quality Assurance in Neurosurgery. Neurol India 2020;68:1166-9.
2Endsley MR. Measurement of situational awareness in dynamic systems. Human Factors 1995;37:65-84.
3Briggs A, Raja AS, Joyce MF, Yule SJ, Jiang W, Lipsitz SR, et al. The role of nontechnical skills in simulated trauma resuscitation. J Surg Educ 2015;72:732-9.
4Tripathi M, Yagnick NS, Mohindra S, Batish A, Gupta SK. Sully, simulation and neurosurgery. World Neurosurg 2018;118:400-1.
5Salah S, Rahim A, Carretero J. The intergration of six sigma and lean management. Int J Lean Six Sigma 2010;1:249-74.