Performance, Presence, and What We May Be Missing
“Reconnection begins when we stop asking others merely to join our conversation and become willing to let their ways of knowing change it.” — Mary Coughlin
I've been thinking a lot lately about performance and presence.
Healthcare is extraordinarily good at measuring performance. We measure outcomes, productivity, throughput, efficiency, compliance, length of stay, and utilization; the things we can count, compare, track, and put on dashboards.
While those things matter, I’ve been wondering about what happens between the measures. Things like:
How did it feel to be cared for?
Did you experience yourself as a human being or as a task to be completed?
Did you belong?
Were you understood?
Was your dignity protected?
Did the person holding knowledge, authority, or power know how to hold that power humanely?
And these questions just don’t belong to healthcare! Recently, I found myself thinking about the human capacities we should expect of anyone entrusted with consequential responsibility for other human beings.
Humility. Curiosity. The ability to tolerate disagreement. Self-regulation. Accountability. Discernment. The capacity for repair. Respect for boundaries. Recognition of another person's humanity.
As I pondered this, I realized these capacities are already nested within the six relational capacities of the BUFFER Framework that I’ve been developing in trauma-informed developmental care:
Belonging. Understanding. Forgiveness. Frameworks. Equanimity. Respect.
BUFFER grew from an understanding that trauma-informed care isn’t about summing the suffering but building the buffering. That simple insight compelled me to examine: so, what is buffering; what is it to be a buffer?
My deep dive into this concept led me to another question: How do these relational capacities support the principles of trauma-informed care/trauma-informed developmental care, and actually become embedded in practice?
We can proclaim the importance of safety; trust and transparency; healthy relationships and interactions; empowerment, voice, and choice; and equity, anti-bias efforts, and cultural and gender affirmation. But principles do not enact themselves. Something happens - or fails to happen - between what we say we value and what another human being actually experiences in our presence.
This has brought me to describe BUFFER as a bridge: Principles → Relational Capacities → Presence → Practice
But as I began exploring what other scholars and philosophers have said about relational capacity, something else happened. I encountered extraordinary thinkers in caring science, care ethics, philosophy, relational leadership, and stewardship; folks like Jean Watson, Joan Tronto, Virginia Held, Martin Buber, Mary Uhl-Bien, Robert Greenleaf, and Peter Block.
And then I realized something. Where were the other ways of knowing?
Where were African philosophies of Ubuntu? Black feminist thought? Indigenous understandings of relational accountability and stewardship? Paulo Freire's work on dialogue, humanization, and liberation? The scholars who have insisted that we cannot understand care without understanding power, history, culture, oppression, and whose knowledge has been allowed to count?
The fact that I had to ask stopped me because perhaps the absence was itself part of what I was trying to understand.
It would be easy to respond by simply diversifying the bibliography. But I think the invitation is much deeper. If we are trying to understand something as fundamentally human as relationship, how readily can we construct our understanding predominantly through one intellectual tradition and never notice what is missing?
I nearly did.
And when Ubuntu and Freire entered the conversation, they didn't simply add perspectives to what I already thought. They changed the question.
Ubuntu asks us to consider whether relationship is something that happens between already separate human beings or whether our humanity itself is constituted through relationship.
Freire reminds us that relationship can humanize, but it can also dominate; that being with another human being is fundamentally different from doing something to them.
Black feminist thought asks us to confront power: Who is expected to care? Who is allowed to speak? Whose knowledge counts? Who carries the relational labor? Who is asked to forgive? Who gets to belong without having to become someone else first?
Indigenous traditions of relationality invite an even wider understanding of stewardship—one grounded not simply in ownership or management, but in reciprocity, responsibility, community, place, ancestors, and generations yet to come.
These aren't additional voices to place around the edges of an existing framework. They change the framework itself and that has caused me to look differently at BUFFER.
Belonging—but who gets to belong, and on whose terms?
Understanding—but whose knowledge are we willing to recognize?
Forgiveness—but who has been harmed, who holds power, and who is being asked to forgive?
Frameworks—but whose frameworks have been legitimized, and whose have been excluded?
Equanimity—but when does regulation support presence, and when might expectations of calm silence legitimate anger or resistance?
Respect—but can respect exist without attention to dignity, agency, justice, and power?
These are uncomfortable questions and I believe necessary ones.
Perhaps relational capacity isn't simply the ability to communicate well, demonstrate empathy, or behave compassionately. Perhaps it is something deeper: the capacity to remain fully human in relationship while protecting and recognizing the humanity, agency, knowledge, and dignity of another.
And this is where stewardship enters.
We spend enormous energy preparing people to perform, such as clinicians, teachers, executives, researchers, and leaders. We credential expertise. Measure productivity. Reward achievement. Track output. But perhaps we should become equally serious about cultivating the capacities required to hold responsibility for other human beings well.
Not instead of competence, but alongside it. Because a premature infant is not an output. A frightened parent is not a customer-satisfaction score. A healthcare professional is not a productivity unit. A community is not a market. Knowledge is not merely something to acquire. And power is not simply something to possess.
All of these exist in relationship. And, so, perhaps, performance and presence were never meant to compete. Perhaps the deeper question is whether our performance remains in service to our shared humanity. And I am beginning to wonder whether one of the most important forms of stewardship is the stewardship of relationship itself. Because perhaps disconnection begins long before we stop listening to one another. Perhaps it begins when we stop recognizing one another as sources of knowledge. And reconnection may require more than inviting different voices into an existing conversation. It may require allowing those voices to change the conversation itself.
Hugs and hope for a better world, Mary
For Further Exploration
A note about this list: This is not intended as a definitive canon of relational thought. In fact, creating another canon would run counter to the questions this reflection has raised for me. These are simply some of the thinkers and traditions I am currently learning with and from. I offer them as doorways rather than boundaries—and with an invitation to share the voices, traditions, and ways of knowing that you believe should also be part of this conversation.
Caring, Presence & Relational Capacity
Watson, J. (2008). Nursing: The Philosophy and Science of Caring (Rev. ed.). University Press of Colorado.
Watson's Caring Science is particularly relevant to authentic presence, relational ontology, dignity, equanimity, and human-to-human caring. Her contemporary articulation of the Caritas Processes explicitly includes loving-kindness, equanimity, authentic presence, trusting relationships, multiple ways of knowing, and human dignity. Watson Caring Science Institute
Hartrick, G. (1997). Relational capacity: The foundation for interpersonal nursing practice. Journal of Advanced Nursing, 26(3), 523–528. https://doi.org/10.1046/j.1365-2648.1997.t01-12-00999.x
Hartrick specifically challenges mechanistic, behavioral models of interpersonal nursing and proposed the development of relational capacity as an alternative.
Tronto, J. C. (1993). Moral Boundaries: A Political Argument for an Ethic of Care. Routledge.
Especially useful for understanding care as involving attentiveness, responsibility, competence, responsiveness — and as inseparable from politics and power.
Held, V. (2006). The Ethics of Care: Personal, Political, and Global. Oxford University Press.
Important for moving care and relationality beyond private interpersonal relationships toward institutions and society.
Relationship, Dialogue & Humanization
Freire, P. (2018). Pedagogy of the Oppressed (50th anniversary ed.). Bloomsbury Academic. (Original work published 1968.)
Essential to the distinction between being with people and acting upon them: dialogue, humanization, liberation, power, reflection and praxis. Bloomsbury Publishing
Buber, M. (1970). I and Thou (W. Kaufmann, Trans.). Charles Scribner's Sons. (Original work published 1923.)
The I–Thou/I–It distinction remains remarkably relevant to the difference between encountering another as a human subject and reducing another to something to be categorized, managed, or used. The Anarchist Library
Knowledge, Power & Black Feminist Thought
Collins, P. H. (2022). Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment (30th anniversary ed.). Routledge.
Especially important for emerging questions about whose knowledge counts, self-definition, power, oppression, and epistemology. Routledge
hooks, b. (2000). All About Love: New Visions. William Morrow.
Useful for thinking about love not simply as sentiment but in relation to care, commitment, knowledge, responsibility, respect, and domination. Bookshop.Org
Ubuntu & Relational Personhood
Ramose, M. B. (1999). African Philosophy Through Ubuntu. Mond Books.
An important philosophical treatment of Ubuntu, personhood, wholeness, knowledge, justice, and relational African philosophy. Google Books
Indigenous Relationality & Relational Accountability
Wilson, S. (2008). Research Is Ceremony: Indigenous Research Methods. Fernwood Publishing.
Wilson describes an Indigenous research paradigm grounded in relationality and relational accountability — including responsibility for how knowledge is gathered, interpreted, and presented. Columbia University Press
Kimmerer, R. W. (2013). Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge, and the Teachings of Plants. Milkweed Editions.
A particularly accessible entry into reciprocity, gratitude, relationship, responsibility, and different ways of knowing. Milkweed Editions
Smith, L. T. (2021). Decolonizing Methodologies: Research and Indigenous Peoples (3rd ed.). Zed Books.
Important for understanding that knowledge production itself occurs within histories and structures of power. Bookshop.Org
Relational Leadership
Uhl-Bien, M. (2006). Relational leadership theory: Exploring the social processes of leadership and organizing. The Leadership Quarterly, 17(6), 654–676. https://doi.org/10.1016/j.leaqua.2006.10.007
\Uhl-Bien distinguishes an individual-attribute understanding of relational leadership from leadership understood as a relational process of social construction
