Takeaways on Connection and Behavior Change from APIC

This year’s APIC conference brought the usual lineup of clinical data, infection rate trends, and protocol updates. Alongside the main conference sessions, SwipeSense and SCJ hosted a breakfast event featuring a keynote from Dr. Michelle Johnston, author of The Seismic Shift in You, who spoke about behavior change through the lens of connection rather than compliance.

The talk covered ground like protecting personal time, running better conversations, and building trust as the basis for influence, all in service of one argument: people change their behavior because of relationships, not mandates.

It was a change of pace from the usual lineup and a useful one. Infection prevention has spent years building better data, better sensors, and better dashboards. What that keynote was really pointing at is the piece none of that solves on its own, which is the human relationship between the person asking for a behavior change and the person being asked to make it.

This is ground that SwipeSense has been covering for a while through our own research into hand hygiene compliance, and the talk was an insightful look into a familiar topic.

Presence > Surveillance

One of the more resonant points from the keynote was about presence: showing up fully in a conversation instead of running through assumptions about what the other person already knows or needs.

Applied to hand hygiene compliance, that distinction is seen in how data gets used. A compliance report can function purely as a scorecard, a number pulled up at the end of the month to sort staff into good and bad columns. Or it can function as a prompt, a signal that opens an actual conversation between a frontline nurse and a unit leader about what’s getting in the way that week.

That distinction lines up with SwipeSense’s own thinking on punitive versus positive accountability: when compliance data gets used as a disciplinary tool, staff learn to optimize for the number instead of the underlying behavior. Compliance rates climb on paper while the actual practice stays inconsistent, because the response to being watched under threat is self-protection, not true improvement.

Presence works the opposite way. It treats the data as an opening for a real conversation rather than a verdict, which is the same principle behind pairing every SwipeSense customer with a dedicated Partner Success Manager instead of just handing over a dashboard and walking away.

In practice, presence-based conversations tend to look different from surveillance-based ones in a few specific ways:

•     They start with a question about what’s making a shift hard, not a recitation of last month’s numbers.
•     They treat a low score as information about a workflow gap, not a verdict on a person’s character.
•     They happen regularly and informally, not only when a number has already dropped.
•     They come from someone staff already trust, which is why PSMs work alongside clinical leaders on an ongoing basis rather than showing up only when there’s a problem to fix.

Protecting Time Protects Performance

Another important idea is that protecting personal time and energy is a prerequisite for showing up well for other people. That applies to every person working in an organization, from the bedside nurse who spends half a shift looking for an available IV pump, to the infection preventionist manually piecing together a week’s worth of compliance data from paper logs and spreadsheets.

Each version of this is the same shortage of capacity, just showing up at a different point in the org chart. When the basic operational friction of a job eats someone’s time and attention, there’s less of both left for the human part of the work that actually drives behavior change. Reducing that friction, whether through automating manual audits or getting equipment into people’s hands faster, allows people to show up for each other in the first place.

Trust as the Foundation, Not Control

The keynote pointed out that high-performing teams are built on trust and collaboration rather than top-down control. That principle holds up against everything SwipeSense’s own work on intrinsic versus extrinsic motivation has shown.

Extrinsic motivation, driven by the fear of being caught, is fragile. It only works while the threat feels credible, which is why compliance numbers often spike right before a Joint Commission visit and drift right back down once the visit ends. Intrinsic motivation, the kind rooted in professional identity and a true investment in patient outcomes, holds up whether or not anyone is watching. But it can’t be built through control; it has to be built through trust.

That’s the thinking behind approaches like passive voice reminders and gamified positive reinforcement instead of disciplinary callouts, and it’s also the thinking behind the Hand Hygiene Acceleration Pathway more broadly: technology paired with a systematic, trust-based method for turning compliance data into a shared project between staff and leadership rather than a scorecard leadership holds over staff.

Reconnecting Staff to Purpose

Compliance rates can drop even among staff who know exactly why hand hygiene matters. Usually it’s not a knowledge gap but something more mundane: repetition and fatigue have turned the habit into autopilot, disconnected from the outcome it was meant to protect.

Reconnecting the behavior to its purpose, framing hand hygiene as an expression of the reason someone went into healthcare in the first place rather than a box to check, tends to produce compliance that holds up even when nobody’s watching. That’s the same principle behind aligning any change initiative with an organization’s broader mission instead of just issuing a new protocol and expecting adoption.

The Human Element

What made the keynote land wasn’t the specific framework so much as the reminder that behavior change is fundamentally about people. Data has its place; it shows where the gaps are and whether an intervention is working. But data alone doesn’t change behavior. People do that, in conversations, through trust, and through leaders who protect the conditions that let good habits stick.

Ultimately, that’s the same conclusion that shows up across SwipeSense’s own work on burnout, punitive accountability, and behavior change. It’s worth repeating, since the pull toward quick fixes makes it easy to forget, and because it’s the kind of change that holds up long after the initial push wears off.