The London Protocol

RELEASE OF THE NEW LONDON PROTOCOL – A SYSTEM BASED TOOL FOR ANALYSING AND LEARNING FROM SAFETY INCIDENTS IN HEALTHCARE

Reflecting on the journey of a patient through the healthcare system can be illuminating in many ways. The experiences and illnesses of patients have, from time immemorial, been used to educate medical students on patterns of symptoms, the process of diagnosis and the underlying pathologies. Patient journeys can also be used to illustrate the process of clinical decision making, the weighing of treatment options and the critical role of the patient and family themselves in managing and living with the illness. Incident analysis, for the purposes of improving the safety of healthcare, may encompass all of these perspectives but critically also includes reflection on the broader healthcare system, its strengths and vulnerabilities and opportunities for change.

Over 25 years ago, a group of researchers, clinicians and risk managers collaborated to develop a method of incident analysis, the ALARM/CRU protocol, which was published in the British Medical Journal. The group used the organisational accident model of James Reason as the underlying model, but the method was developed by constant iteration and testing in multiple clinical settings. An expanded version, the London Protocol, was published in 2004. The purpose, then as now, was to develop a structured approach which did not constrain those reviewing an incident, but which fostered incisive analysis and thoughtful reflection.

The London Protocol has been widely used around the world and we now have considerable knowledge of its use for education and training, research and for analyses to support patient safety programmes in low, middle and high incomes countries. However, healthcare has changed in many ways since 2004 and our approach to incident analysis and prevention needs to be refined to reflect these changes in terms of patient engagement and care outside the hospital, as well as the recognition of patient safety as a global priority. We have drawn on developments in safety science, human factors and ergonomics, the findings of incident analyses and our own experience to produce a new, expanded version of the London Protocol. The authors and reviewers of this document come from many different countries and backgrounds, each with its own particular culture and healthcare system. We use examples from many different systems, but we have deliberately not aligned the new London Protocol with any particular organisation or country.

We believe the London Protocol can be used in any healthcare system, though we appreciate that some adaptations may be needed in different contexts. We believe that it is important to adhere to the core ideas and principles. However, we encourage people to adapt the London Protocol for their own needs and situation under the terms of the Creative Commons licence. We know from experience that the approach can be used both for long and complex investigations and for quick team-based discussions and reflections that only require a little shared time together.

We hope you find the new London Protocol useful in our shared quest for safer healthcare.

Charles Vincent

Sally Adams

Tommaso Bellandi

Helen Higham

Philippe Michel

Anthony Staines