Stealing From Aviation to Build Safer Virtual Care

Executive Summary

• Virtual care lacks traditional safety nets. Without hallway consultations or colleagues nearby to catch errors, quality must be deliberately designed into workflows, technology, and oversight mechanisms.
• Virtual care quality is genuinely uncharted territory. NCQA only released virtual care-specific guidelines last year, and the entire community of specialists doing this work at scale numbers around 30 people nationwide.
• Bridge borrows from aviation's 45-year-old Just Culture framework. Rather than punishing individuals, Just Culture asks whether another provider in the same circumstances would make the same mistake—shifting focus from blame to system design.
• Health plans should evaluate the quality approach, not just the metrics. Every virtual care partner of sufficient size will have incidents. The most important consideration is whether they have systems that learn from incidents and prevent recurrence.

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Bridge operates as a medical group that partners with virtual care companies across the country. When a clinic joins Bridge's platform, their providers practice under Bridge's umbrella, which means their quality becomes Bridge's quality. Quality at any partner clinic reflects on everyone in the network, which means Bridge has a genuine stake in each organization's success. This structure creates a powerful incentive to get quality right from the start, to build actual systems that prevent errors before they happen.

Why quality in virtual care is harder than it looks

In traditional healthcare, quality has decades of established practice. Hospital systems have Joint Commission accreditation, NCQA certification, PCMH recognition, and mature frameworks developed over generations. When a hospital administrator wants to build a quality program, there are templates, consultants, and regulatory bodies providing clear guidance. Virtual care has almost none of this. NCQA only released virtual care-specific guidelines last year, and they're still catching up to how virtual care actually works. The regulatory bodies, accreditation frameworks, and established best practices that make quality management predictable in brick-and-mortar settings simply don't exist yet for virtual care.

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The isolation of virtual care compounds this challenge. Providers in traditional settings work surrounded by colleagues. Someone can tap your shoulder when something seems off. A nurse might catch a prescribing error before it reaches the patient. The system has redundancy built in through human proximity. In virtual care, that physical surrounding safety net disappears entirely. A provider sits alone in their home office, making decisions without the informal peer correction that hospitals take for granted. You can't rely on hallway consultations or a colleague glancing at your screen. Instead, you have to build the safety net into the workflows, technology, policies, and oversight mechanisms themselves.

An emerging field that needs pioneers

This is genuinely new territory, and the people mapping it form a remarkably small community. Erin Flynn, Bridge's Clinical Quality and Informatics Lead, is one of approximately 30 people in the United States doing this work at scale. She brings a decade of virtual care-specific quality experience from Midi Health, Oshi Health, and others, holds a master's in informatics alongside her doctorate in nursing, maintains licenses in 16 states, and has built quality programs from the ground up at multiple virtual care companies. This small community of virtual care quality specialists, who all know each other and trade insights at conferences, represents the entire body of institutional knowledge for quality assurance in virtual care. There's no textbook for this or certification program. The frameworks are being written in real time by the people doing the work.

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When Flynn describes the challenge, she puts it simply. "In virtual care models, clinicians are working alone so there's no one there to rescue you if something goes wrong," she explains. "And so a lot of what I do is set up those processes to rescue them." The work requires inventing solutions to problems that traditional healthcare never had to consider, borrowing from adjacent industries, and testing approaches in real clinical environments where the stakes are patient safety.

Borrowing from aviation

When established frameworks don't exist, you build them by finding what works elsewhere and adapting it. That's why Bridge uses Just Culture as the foundation for every quality program. The framework has been keeping planes in the air safely for 45 years, and it emerged from the same recognition that healthcare is slowly reaching. The traditional approach to quality focuses on finding and punishing the individual who made a mistake. This feels decisive and satisfying, but it has one fundamental problem. The error wasn't unique to that person. It was waiting to happen to whoever encountered those circumstances first.

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Just Culture shifts attention from errors and outcomes to system design and behavioral choices. The core insight is that focusing only on individual punishment perpetuates problems rather than solving them. But Just Culture is not blame-free. It distinguishes between three types of behavior that require different responses. Human error means unintentional mistakes by competent people, which warrants support and system fixes. At-risk behavior means conscious drift from safe practices, which warrants coaching. Reckless behavior means conscious disregard for risk, which warrants discipline or termination. The key question in any incident investigation is whether another provider in the same circumstances, working within the same system, would make the same error. If yes, you're facing a system problem that requires systemic solutions.

The 70-90% reality

Most errors are policy or procedure problems rather than individual failures. Sarah Thomas, Bridge's Chief Legal Officer and Co-founder, has spent years investigating incidents across healthcare settings. "When something goes wrong, was it a person problem or a policy problem?" she explains. "Seventy to ninety-percent of the time it's a policy or procedure problem." Ambiguous protocols, EHR workflows that make the wrong action easier than the right one, policies that exist on paper, but nobody can find when needed. These failures exist at the organizational level before any individual provider makes a mistake. When you investigate with this lens, you find fixable problems rather than scapegoats.

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The consequences of blame culture extend beyond unfairness to the individuals involved. When people fear punishment, they stop reporting near-misses. They don't mention the close calls that almost became patient safety events. They don't flag the workarounds everyone uses because the official process is impossible to follow. Near-miss reporting is the early warning system for patient safety, and a blame culture systematically destroys it. Just Culture creates psychological safety to report problems, and people understand that honest reporting leads to system improvement rather than personal punishment. Flynn asks the same question every time she investigates an incident. "What process wasn't there that led an error to happen? What policy wasn't in place? Or maybe the process was there and just no one was using it because it's not easy."

How Bridge builds quality programs with partners

Every client that joins Bridge's platform gets a quality program designed around Just Culture principles, and the work follows a continuous cycle. Bridge conducts ongoing chart reviews to identify patterns across visits. The goal is finding system-level issues that create conditions for errors, and the patterns often reveal problems that would be invisible when looking at individual cases in isolation.

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When incidents or patterns emerge, the investigation focuses on the key Just Culture question. Would another provider in the same circumstances make the same error? This shifts the conversation toward understanding what in the system allowed a problem to happen. Based on findings, Bridge works with partner clinics to redesign workflows, update policies, improve documentation templates, or add system safeguards. And after changes are implemented, Bridge monitors to verify they actually worked. Quality requires this continuous cycle of auditing, analyzing, implementing changes, and re-auditing. The work is never finished because the system is always evolving.

What this means for health plans

For health plans evaluating virtual care partners, the quality approach matters as much as the quality metrics themselves. In blame cultures, incident reports decrease over time. This looks like improvement on paper, but the reality is that safety hasn't improved. Reporting has simply decreased, and the organization knows less and less about its actual safety profile with each passing month.

A Just Culture organization produces the opposite trend. Visibility increases as near-misses get reported, system weaknesses get identified, and improvements compound over time. When a virtual care partner uses Just Culture principles, problems actually get solved. Health plans can trust they're working with a system that continuously identifies failure modes and eliminates them, rather than one that removes individuals while leaving underlying vulnerabilities intact. The question for health plans isn't whether a virtual care partner has ever had an incident. Every organization of sufficient size will have incidents. The question is whether the partner has systems that learn from those incidents and prevent recurrence.

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Bridge partners with virtual care organizations and oversees their clinical quality using Just Culture principles. If you're a health plan looking for virtual care partners with rigorous quality oversight that actually prevents errors and learns from incidents, we should talk.

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