Ari Kalechstein, Ph.D.

They say it’s more difficult to write one page than five, and that holds true when taking into perspective some 25 years of business experience, of which almost the entirety has been focused on providing mental health support to residents at skilled nursing facilities. The challenge was to limit the learnings to just five. 

Truth be told, every week I become reacquainted with the limits of my knowledge, which I see as an opportunity to increase my knowledge base and gain new wisdom. Here are the top five things that would have helped me to know some 25 years back

1. Find a trusted advisor: Back in the late 1990s, when I had completed my training, was licensed to practice psychology in California and was preparing to embark on a career as a neuropsychologist, I received no shortage of advice from people who “knew” and had “been around.” At that time, and as a newly minted clinician and inexperienced businessperson, I was eager to hear what others had to say; however, at that time, it was more difficult to determine those individuals who had my best interests in mind versus their own. In retrospect, and in thinking through who would best serve as a trusted advisor, one might consider these suggestions:

  • Educate oneself in the area to be advised
  • Carefully check the track record of the potential partner
  • Ensure that, as best as one can, the advisor is not conflicted, e.g., the guidance that they provide is not connected to a specific benefit for them

2. Be patient when deal making: When I was younger, my goal was to “partner” with an entity that was more experienced and/or who had a particular skill set/expertise that I lacked. In one instance, I was so excited to forge an agreement that I became impatient and concerned that the deal needed to be closed quickly, and I did not sufficiently consider potential warning signs. Now, I would approach it differently by:

  • Having an independent advisor review the deal and provide unvarnished, clear guidance
  • Remaining open to that advice, even if it may not necessarily be the advice that you want to hear
  • Being prepared to walk away from a potential deal
  • Being aware of the degree to which emotion is affecting one’s judgment

3. Make time for healthy habits and self-care in your work/life balance: After years of graduate school, internships and fellowships, I was used to working up to 80 hours per week. I was excited about the prospect of building a practice and had no financial backstop. Moreover, I knew that I would someday become a father and wanted to give my family “the best of everything.” Hence, I prioritized building my practice and caring for my family, to the exclusion of important personal matters, such as my health. As a former competitive athlete and having maintained my fitness throughout my tenure as a student and a trainee, I knew the importance of being healthy and fit. 

Yet, I consistently reduced the priority of engaging in healthy behaviors. The consequence of those choices is that I experienced the onset of significant medical health conditions during my 5th decade of life (40-50), which could have been avoided had I made better choices. In retrospect, while my intentions may have seemed benevolent, i.e., placing my family’s needs above my own, the neglect of myself resulted in increased stress for the family, particularly my wife. My concerns related to building a practice and the “next referral” were reasonable, but not to the degree that I failed to attend to self-care.

4. Learn how to delegate: Within several years, my practice became busy. Really busy. At that time, I managed most aspects of the practice, e.g., ordering supplies, printing files, preparing correspondence and billing. It took me years to hire an assistant and, once I did, I asked myself why I waited so long to make that move. 

Looking back, it’s easy to see why I waited way too long to begin the process of delegation. At that time, I was tired, thought it was easier to just do the work rather than train someone and thought that I would get to it when I had a break. Each of those reasons was good, but, having become the delegator in chief at Executive Mental Health, I clearly see the value in hiring ancillary personnel, identifying and offloading those tasks that those team members can handle and focusing on those macrolevel, big picture matters.

5. The process is as important as the product: Much of what I’ve done in the past 25 years, whether it be working as a researcher, clinician, businessperson or athlete, has focused on product, e.g., how many papers did we publish last year? How many cases did we see? What was our year-over-year revenue? As a society, we focus on the end points and the outcome; however, and over time, it became clear to me that by emphasizing product, my team and I were missing out on the process of what we were doing at work, e.g., how clinicians managed various logistical and clinical decisions.

As the EMH exec team emphasized examination of the process that mediated particular outcomes, we became more effective in terms of troubleshooting. We started to examine various processes even when there was not a pressing problem or crisis. As a result, we prevented other potential problems and/or crises from occurring – now that’s a pretty good product.

These five points reflect some of the important life lessons that I’ve learned, but if you ask me to create the list in five years, it might be completely different (or not). This latter point underscores the importance of remaining flexible and nimble. Maybe I’ll just change the title to “Six things I wish I’d known.”

Ari Kalechstein, Ph.D. is the president and CEO of Executive Mental Health, which provides mental health services for patients from a wide variety of backgrounds, and offers 25 years of experience as a licensed psychologist in California and Nevada. With the support of his colleagues, Dr. Kalechstein spearheaded the development of a comprehensive suite of services at EMH, which include neuropsychological evaluations, clinical psychological interventions, and forensic mental health evaluations. 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.