In 1995, organizational psychologists Mayer, Davis, and Schoorman published what became the most widely cited model of trust in academic literature. They called it the ABI model. Trustworthiness, they argued, isn't a single quality. It's built from three distinct dimensions:

Ability: Can they actually do what they're supposed to do?

Benevolence: Do they care about my interests, not just theirs?

Integrity: Will they follow through on what they said they'd do?

A meta-analysis of 132 independent studies by Colquitt, Scott, and LePine in 2007 confirmed that these three dimensions don't just predict trust behaviors. They predict affective commitment: the emotional bond that drives a person's desire to stay in a relationship. In healthcare terms, that's the bond that determines whether a patient remains loyal or switches providers.

Now here's what this means for your contact center.

When a patient calls with a billing question and your system resolves it completely on the first call with clear next steps, something powerful happens. The organization is demonstrating all three dimensions at once. Ability (you were competent enough to fix it). Benevolence (you cared enough to confirm I understood). Integrity (you followed through on what you said you'd do).

Resolution is the only Trust Signal that simultaneously activates all three dimensions of trustworthiness. That makes it the most trust-dense moment in the entire patient journey.

And it means the FCR number on your dashboard isn't just an efficiency metric. It's a proxy for whether your organization is proving it deserves to be trusted. Every single call.

Your dashboard says 85% First Contact Resolution. Your patients say they called back three times. Both can be true.

Because you're measuring whether the ticket was resolved. They're measuring whether their problem was resolved. The system measures its own behavior. Trust measures the patient's belief about that behavior.

According to SQM Group's healthcare benchmarking research across 500+ call centers, the healthcare industry average for Voice of the Customer FCR is 69 to 72%. Only approximately 1% of healthcare call centers achieve the world-class standard of 80% or higher. Compare that to retail at 78% and insurance at 76%. Healthcare, with its higher complexity and higher stakes, resolves less than both.

And the behavioral science tells us exactly what happens to trust when resolution fails. Research on trust violations shows cascading effects: lower subsequent trust, reduced cooperation, reduced information sharing, and negative effects on the patient's willingness to engage with the system at all. Satisfaction drops 16% for each additional call required to resolve an issue. By the fourth call, satisfaction is 47% lower than first-call resolution.

In ABI terms: each failed resolution is a failure of Ability (you couldn't fix it), Benevolence (you didn't care enough to confirm it was actually fixed), and Integrity (you said it was resolved when it wasn't). One unresolved call doesn't damage one dimension of trust. It damages all three.

Here's where resolution becomes more than an operational metric. It becomes a moral argument and a growth strategy.

Trust in healthcare has declined across the board over the past half-century. But that decline is dramatically steeper for Black and brown communities. Research from the Commonwealth Fund, Deloitte, and the AMA Journal of Ethics consistently documents that Black patients carry higher levels of institutional distrust rooted not in individual attitudes but in generations of systemic failure.

A study published in Behavioral Medicine on medical mistrust among African-American men concluded that trust is "theoretically history-based, cumulative, and thickens and thins as individuals transact with individuals and systems." Each unresolved billing question. Each callback that never comes. Each scheduling confusion that nobody explains. These aren't isolated incidents. They're data points in a pattern that communities have been tracking for generations.

I told you about my father-in-law at the top. Insurance. Transportation. Family support. Every structural barrier removed. And still, distrust. But here's what makes his story a pattern, not an anecdote: my aunt Shadidi lived the same story years earlier. Different person. Different diagnosis. Same distrust. She delayed care for years. The cancer was found too late.

Two people in one family. Both with access. Both with people who loved them pushing them toward care. Both held back by the same thing: a lifetime of interactions with a healthcare system that never proved it could be trusted to actually resolve their concerns.

The behavioral science validates what my family has lived. When a patient from a community with a history of being systematically failed calls your contact center, they aren't just bringing a billing question. They're bringing every prior interaction with every system that failed to resolve their concerns. A single unresolved issue doesn't just create frustration. It confirms a pattern. It validates the expectation of failure.

The National Academy of Medicine's landmark report "Unequal Treatment" documented that racial and ethnic minorities receive lower-quality healthcare even when insurance, income, age, and severity are comparable. In the contact center context, this translates to differential resolution quality. Not necessarily whether the call is answered, but whether the issue is truly resolved with the same thoroughness and follow-through for every patient who calls.

Mistrust is not an attitude problem in patients. It is a performance problem in systems. And Resolution is where that performance is measured in real time.

For the CFO in the room, here are the numbers.

According to SQM Group research, every 1% improvement in FCR equals $286,000 in annual operational savings for the average healthcare contact center. That same 1% improvement correlates with a 1% improvement in customer satisfaction and a 2.5% improvement in employee satisfaction.

Healthcare FCR sits at 69 to 72%. World-class is 80%+. That gap represents millions in operational savings and trust-building capacity. A system moving from 71% to 80% saves over $2.5 million annually. That's just the cost side.

On the revenue side: patients who experience failed resolution are four times more likely to switch providers. At a $12,000 patient lifetime value, every unresolved call carries real financial risk. And health inequities add $320 billion annually to U.S. healthcare spending, projected to reach $1 trillion by 2040. Resolution failures are a direct contributor. Every patient who disengages due to unresolved concerns represents revenue walking to a competitor or, worse, no healthcare at all.

Hospitals with excellent patient experience achieve 4.7% operating margins versus 1.8% for lower-rated facilities. Resolution is the most direct operational lever for moving from transactional to trust-building. And the populations most underserved by current resolution quality represent the largest untapped growth opportunity.

Equity isn't a compliance checkbox on your resolution dashboard. It's a $320 billion market signal that the organizations who fix resolution for everyone will capture patients that the rest of the industry is losing.

Most health systems try to improve resolution by hiring more agents. The data says that doesn't work.

Contact center agent turnover runs between 30% and 45% annually. Staff burnout is the top source of call center inefficiency, cited by 39% of healthcare respondents. And only 0.6% of the annual budget goes toward technologies that prevent it.

Think about what that means through the ABI lens. An agent who is burned out, undertrained, or handling their 200th call of the day cannot demonstrate Ability (cognitive overload prevents thorough resolution), Benevolence (emotional exhaustion prevents genuine care), or Integrity (system pressures incentivize ticket closure over problem completion). Burnout doesn't just hurt agents. It destroys the organization's capacity to prove trustworthiness.

The Super Agent model changes this equation. When AI handles the 30-second balance inquiries, the appointment confirmations, the prescription refill status checks, human agents get cognitive space. They stop being transaction processors. They become the people who demonstrate Ability, Benevolence, and Integrity in every complex interaction.

Houston Methodist proved this. Partnering with Syllable's AI voice assistant, they achieved 91% of calls resolved through automated and self-service workflows, answering 100% of calls on the first ring, 24/7. Not by deflecting patients. By designing workflows that actually completed the task. Complex cases went to humans with full context. The 91% resolution wasn't despite the AI. It was because of what the AI freed humans to do.

If Resolution activates all three dimensions of trustworthiness, and if the trust deficit isn't evenly distributed, then your resolution metrics need to reflect both realities. Here's the framework:

1. Patient-Confirmed Resolution (the trust standard)

Add a simple follow-up to your top call types: "Did this resolve your issue?" One question. Compare it to your system FCR. The gap is your trust leak. Organizations implementing Voice of the Customer FCR measurement see an average ROI of 450% with a payback period under 3 months.

2. Resolution Equity: Stratify by Who's Getting Resolved

This is where your measurement becomes diagnostic, not just descriptive. Stratify your patient-confirmed resolution by:

•       Patient language preference: Are non-English speakers getting the same resolution quality?

•       ZIP code / demographics: Do historically underserved communities experience resolution differently?

•       Payer type: Do Medicaid patients have to call back more than commercially insured patients?

•       Channel preference: Do the channels used by diverse populations get the same resolution priority?

If your overall Resolution score is 78% but 62% for Spanish-speaking patients, the signal is unmistakable. That's not a language problem. That's a trust problem with a specific address.

3. Repeat Call Rate (within 7 days)

Track how many patients call back about the same issue within a week. This is your reality check against system FCR. If your dashboard says 85% and your 7-day repeat rate says 25%, you have a trust gap hiding in the data.

4. Confidence in Next Steps

Resolution isn't just about fixing the immediate problem. It's about whether the patient leaves the interaction knowing what happens next. "Your claim will be processed in 5 to 7 business days and you'll receive a text confirmation" builds all three ABI dimensions. "It should be taken care of" builds none of them.

If you can only answer "What's our FCR rate?" with the system number, you're measuring your own behavior, not patient trust. If you can't tell whether resolution quality differs by patient demographics, you have a blind spot that's costing you patients and contributing to a $320 billion equity gap.

The math is straightforward. $286,000 per 1% FCR improvement on the cost side. A 4x increase in provider switching when resolution fails on the revenue side. And the largest untapped growth opportunity sits in the communities that have been underserved by resolution quality for decades. That's not a philanthropy line item. It's a market.

Start with the Quick Win below. Then ask the harder question: is your resolution quality equitable across patient populations? If you don't know, building that measurement capability is your first project. And it is, in itself, an act of institutional trustworthiness.

Add "Did this solve your issue?" to your top 3 call types this week.

One question. Compare the patient response to your system FCR for those same call types. The gap is your trust leak.

Then do something nobody else is doing: break the results down by patient language preference and payer type. If you see a disparity, you've just identified where your organization is proving trustworthy for some patients and not for others.

It costs nothing to measure. And it will tell you more about patient trust than your last HCAHPS report.

Take the Trust Assessment: patientexperiencestrategist.com/#/assessment

Accessibility gets patients to your door. Resolution determines whether they trust what's behind it.

The behavioral science is clear: trustworthiness requires Ability, Benevolence, and Integrity. Resolution is the only moment in the patient journey that activates all three simultaneously. When you resolve a problem completely, with clear next steps and genuine follow-through, you're not just closing a ticket. You're building the behavioral proof that your organization deserves to be trusted.

But proof of trustworthiness only matters if it reaches everyone. For patients from communities that have experienced generations of unresolved concerns, your Resolution score isn't just an operational metric. It's the answer to a question they've been asking their entire lives: "Is this system built for someone like me?"

Resolution is not a customer service metric. It is the single most measurable moment where a healthcare organization proves, or disproves, that it is worthy of trust.

Next week: Trust Signal #3, CONTINUITY. "Can you tell me your date of birth again?" Why patients who've been with you for 12 years still feel like strangers. And what it takes to make them feel known.

What's the gap between your system FCR and what patients actually experience? And does that gap look different depending on who's calling? Hit reply and tell me. I read every response.

Let’s get to work.

— Ebony

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