From Blame to Learning: The Evolution of the London Protocol for Patient Safety

Over the past two decades, patient safety and clinical risk management have become strategic priorities for healthcare systems worldwide. In this context, the London Protocol has emerged as one of the most influential methodologies for investigating adverse events through a systemic, non-punitive lens. The 2024 edition, curated by Vincent, Adams, Bellandi, and colleagues, represents a significant evolution of the original 2004 framework. It integrates recent advancements in safety science, human factors, and digital health, while placing a stronger emphasis on resilience, proactive learning, and stakeholder engagement. This article critically examines the structure, key principles, and innovations of the London Protocol 2024, highlighting its departure from incident-centered analysis toward a broader understanding of both failures and successes. The protocol encourages fewer but more in-depth investigations, producing actionable and sustainable recommendations rather than generic reports. It also underscores the importance of involving patients and families as active partners in safety processes, recognizing their unique perspectives on communication, care pathways, and system failures. Beyond its strengths—holistic analysis, multidisciplinary collaboration, and cultural openness—the systemic approach presents challenges, including methodological complexity, resource requirements, and cultural resistance in blame-oriented environments. This paper discusses these limitations and explores how leadership, staff engagement, and digital technologies (including artificial intelligence) can help overcome them. Ultimately, the London Protocol 2024 emerges not only as a methodological tool but as a catalyst for cultural transformation, fostering healthcare systems that are safer, more resilient, and committed to continuous learning.