Nearly-perfect mental health practice

Four hallmarks of a wonderful, nearly-perfect practice

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Most of us begin our professional lives hoping to find and work in the nearly-perfect practice. However, many have similar experiences to mine. Early in my career, I despaired of finding a healthful workplace. Certainly, the owners where I worked were kind enough. It’s just that developing the organization or its staff was not a top priority. The focus was mostly on seeing clients with some attention to case management. I see nothing wrong with those priorities, yet nearly-perfect practices require more. I began to doubt that a healthy workplace existed anywhere in mental health. 

My early yearnings

In my case, some of my disappointment was doubtless about my youthful idealism. And yet, that was not all of it. I was identifying genuine problems in mental health management. It was not great then, and today in far too many places, it has not improved much. 

Not far into my career, my thoughts focused on starting my own practice. Of course, I wanted it to grow into a nearly-perfect practice. And even though I had not seen many examples of that ideal practice, I thought it might be possible. I decided to try it. (I have written about my early career here: From nothing to something: The beginning of my practice.)

Cultivating a healthy, thriving, nearly-perfect practice still animates me. In some ways, this web site’s goal is to do my part to contribute to robust practice management. I hope to inspire you to construct your own nearly-perfect practice. 

Let’s get started by defining the four hallmarks of a nearly-perfect practice.

1. Nearly-perfect practices have excellent managers 

I previously wrote an article on exceptional managers–Five key attributes of excellent managers. In that post, I go into detail about these five characteristics:

  • Responsiveness
  • Fairness
  • Wisdom
  • Kindness + Directness = Respect
  • Able to take reasonable risk

I’m sure there are more, but this is a pretty good start. 

Most importantly, nearly-perfect practices significantly dependent on the managers’ abilities. They make daily decisions that establish and support a healthy work environment. No organization achieves greatness without excellent managers.

Summarizing, the first hallmark of a nearly-perfect practice is its excellent managers.  

2. Nearly-perfect practices use the mission to genuinely guides decisions

Whether overtly expressed or not, most organizations have a mission statement. We had a mission that faced in two directions. First, our primary purpose was to take care of our clients’ mental health needs, as best we could. This mission faced the public and was evident in our marketing and branding. 

Our second mission was less publically prominent but equally important to us. We worked hard to make the workplace the best we knew how to make it. This second mission was about developing our internal culture. See more on how we did that in these posts:

I suspect most mental health organizations have a similar dual mission.

But the real test arises when challenges appear. Sadly, when the pressure mounts, the mission may become one of its first casualties. Typically during a crisis, the focus of the decision-makers narrows. Time speeds up in the press of the crisis. 

These moments are dangerous not just because of the crisis, but rather because the crisis invites compromises. Amid an emergency, one rarely stops to ask, “what is getting compromised by going this direction?” (See these posts on Overcoming Setbacks.)

I would contend that in the nearly-perfect practice, crises do not derail the mission. Instead, only the alternatives that uphold the mission remain on the list of acceptable options. The mission sets the guardrails for all deliberations.

For more on these topics look at these posts:

Summarizing, the second hallmark of a nearly-perfect practice is that the mission genuinely guides decisions, especially during crises.

3. Nearly-perfect practices have an exceptional culture

When I began my practice, I never gave a thought to creating an exceptional workplace culture. I was preoccupied with keeping all the plates spinning. (See The boss’s boss–Unrelenting business demands in practice for my take on the essential daily tasks, i.e., the spinning platters.)

As my organization grew, I became more conscious of how my colleagues depended on me to set the daily tone. There were comments: “Are you okay today?” “You look tired.” My mood seemed to ripple through the office and affect everyone else’s mood. 

Now some of this is just therapists being therapists. Of course, therapists notice moods. But it seemed to me that the therapists’ “concerned look” was more intense when observing me. Clearly, they were taking their cues from me. 

I wanted to build a culture that was not about my daily mood. And I wanted everyone to know how to contribute to the culture. 

After some early experiments with definitions of our culture, we eventually settled on a description. Internally, we described our culture as: 

Encouraging everyone to: 

  • enjoy ourselves and each other, 
  • while collaborating and mentoring each other

Those were meaningful values for us. And I think these are pretty close to defining a nearly-perfect environment and culture.

Adding to these values, we tried to develop methods for teaching our culture to our staff. Mostly this education occurred in our meetings and events. 

I have written on how we attempted to create that culture in these posts. Check them out:

Summarizing, the third hallmark of a nearly-perfect practice, is an exceptional culture with intentional methods for instilling the culture’s values

4. Nearly-perfect practices have efficient systems for everything

We tried to create excellent systems for everything we did. When the process of accomplishing mundane tasks is inefficient, they become a daily irritant. Cumbersome, bureaucratic, or time-wasting tasks are the enemy of the nearly perfect practice. 

We worked hard on developing efficient ways to process billing, records, and scheduling. These tasks frequently happen every day. We had daily routines for insurance collections and monthly ones for client collections. Any glitches or friction was noticeable.

Improving these daily and monthly tasks is a blend of working on both the human and tech sides. Sometimes, we had everyone involved in discussing methods to improve the process, like collections. And sometimes we were looking at new software solutions for some tasks. And frequently, it was back and forth with both training staff and finding tech solutions. 

My point is that we had to work at our systems for doing things all the time. Even aspiring to create a nearly-perfect practice meant a continuous process of self- and organizational improvement. 

I have a whole section of the web site that focuses on these daily and weekly systems for getting the work done. The first link is to the overview of these posts:

Summarizing, the fourth hallmark of a nearly-perfect practice is that they have developed excellent systems for all their routine tasks


In conclusion, I have outlined four hallmarks of nearly-perfect practices:

  • Excellent managers
  • A mission that guides decisions
  • An exceptional culture
  • Efficient systems for everything

Now is the time to get going. See these posts for some next steps:

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