Working from the Bottom Up
Natalis Counseling and
Improve lives as a
When Jonathan Hoistad was a Vista volunteer in north Philadelphia in the 1960s, he could have worn shoulder-length hair and looked just like many of his contemporaries. But because he was working on behalf of welfare mothers who might need phones or credit cards, he had to persuade phone-company and department-store managers to bend the rules that demanded a phone deposit or credit history that the mothers didn’t have. So he stayed clean-cut—and he got the services his clients needed.
It was an early instance of what became Hoistad’s mantra: “Work from the bottom up.” That is to say, put yourself in the shoes of your clients, rather than deciding from your own perspective what they need.
enrepreneur,” says Hoistad. “I was
just doing my thing, and then other
people wanted to do that, too.”
Hoistad is a clinical psychologist. Since the day he hung out his shingle as a solo practitioner—“I incorporated myself,” he jokes—his company, Natalis Counseling and Psychology Solutions, has grown to include more than 30 staff members, numerous clients and services, and partnerships with the multiple hospitals and care centers where Hoistad is a staff member or consultant. It’s all been a kind of an unplanned, organic growth that supports his principle: When you work from the bottom up, people find you.
Actually, you could make the case that it all started in Philadelphia. Hoistad had opted for Vista (now AmeriCorps Vista) after two lackluster years as a business major at the University of Minnesota. He also did two other things there: He took a psychology class at Temple University and a job as an emergency room technician.
When he returned to the University of Minnesota, he continued on this dual track. He became a psychology major, and he got a job in the University hospital’s dialysis unit. He started taking graduate courses after getting his degree, but feeling “kind of burned out,” he took a job in San Francisco. There, the pieces really began coming together. He enrolled in graduate school and got a PhD, with a dissertation on the emotional health of patients undergoing dialysis and transplantation. He was now a neuropsychologist.
Back in Minnesota, he worked on hospital staffs and then opened his own practice in 1980, a move for which he barely takes credit.
“I really didn’t consider myself an entrepreneur,” he says. “People knew me because I was on all these staffs, and they wanted to work with me because I was working in hospitals. I was just doing my thing, and then other people wanted to do that, too.”
The business was called Hoistad and Associates in those days, but as he hired staff clinicians who specialized in different areas, he became uncomfortable being the headliner. The company’s name was changed to Natalis, but the “bottom-up” approach continued. At one inner-city clinic, for example, Hoisted worked with a large Hmong population. A psychologist deals in emotional health, but it seemed obvious to him that these new immigrants also needed practical help: finding a place to live, getting social services, filling out paperwork, for example. So that’s what he helped them do. He filled the need so well that word spread in other languages. Somalis sought him out next, then Hispanic immigrants. Today, Hmong, Somali, and Hispanic people all work for him.
Now, Hoistad is beginning what even he would call a true entrepreneurial adventure. As a neuropsychologist, he had worked with hundreds of patients as they prepared for, went through, and recovered from surgery. What no one had developed, though, was an objective measure to evaluate these patients’ outcomes.
“I saw that health care was moving more and more in the direction of results-based interventions,” he says. That was the genesis five years ago of Natalis Outcomes, his company that is developing and will market an online assessment tool to provide an objective measure of emotional health.
It’s still in the pilot-study stage, but “the rocket is taking off,” he says of his new company. “I want it to become more and more sophisticated. I want the questionnaire patients fill out to be so appealing that you are inspired to be healthier in all aspects of your life.”
Natalis may have evolved, while Natalis Outcome is more deliberate, but the principle is the same: You must always imagine the experience of the patient walking through the door.
“Students need to have faith in themselves that they can be whatever they want.”
“If I want to have a good health outcome tool, I have to imagine myself as the patient walking in the door. To meet the needs you’re trying to meet, you need to imagine the other person’s experience.”
“If you want to help, it’s not top-down, it’s bottom up.”