Georgia Institute of Technology Business Sucess Factors Case Analyses

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REV: FEBRUARY 10, 2017
BORIS GROYSBERG
COLLEEN AMMERMAN
JOHN D. VAUGHAN
BrightStar Care: The Evolution of a Leadership
Team
I grew up as the only child of someone who wanted a son. Maybe there was hard wiring from the beginning?
being told ?You can?t? and thinking ?I?m going to prove you wrong.? And today I rarely take no for an answer.
? Shelly Sun, CEO and co-founder, BrightStar Care
After a week-long absence to attend a board meeting of the International Franchise Association,
Shelly Sun, CEO and co-founder of BrightStar Care, warmly greeted several employees at the
company?s suburban Illinois headquarters and glanced into her assistant?s office. Sun?s assistant was
already approaching with a list of updates. While traveling, Sun had reflected on the tremendous
growth BrightStar had experienced over the past decade; today she was contemplating the company?s
path forward with a fresh eye.
Since selling its first franchise in 2005, BrightStar had expanded to almost 300 locations across the
United States; her aim was to grow from $340 million in sales in 2015 to $3 billion by 2025. Sun was
intent on positioning BrightStar Care as the premier provider of home health care in the United States
and, she hoped, abroad. By early 2016, BrightStar was poised to enter several international markets and
had recently completed a debt recapitalization. It had a fully staffed team of senior executives (see
Exhibit 1 for executive biographies and Exhibit 2 for a corporate overview). Sun was ready to focus on
setting a strategic vision, becoming active in policy advocacy for the franchise industry, and keeping
abreast of the rapidly evolving health care and home care fields. Meanwhile she wanted to make sure
that BrightStar?s senior leaders were prepared to usher the company into its next phase of growth as
she took a step away from day-to-day operations.
Shelly Sun: Starting a Business and Starting a Family
Launching BrightStar
Shelly Sun grew up in Knoxville, Tennessee. While her mother instilled a sense of competence and
capability in Sun, her father often suggested that her gender limited her potential. As a result, Sun
sometimes struggled with self-doubt but also developed perseverance and determination that would
Professor Boris Groysberg, Gender Initiative Director Colleen Ammerman, and independent researcher John D. Vaughan (President’s Program in
Leadership (PPL) 2012) prepared this case. This case is part of the YPO/OPM research project. It was reviewed and approved before publication
by a company designate. Funding for the development of this case was provided by Harvard Business School and not by the company. Professor
Groysberg has performed paid work for the company. HBS cases are developed solely as the basis for class discussion. Cases are not intended to
serve as endorsements, sources of primary data, or illustrations of effective or ineffective management.
Copyright ? 2016, 2017 President and Fellows of Harvard College. To order copies or request permission to reproduce materials, call 1-800-5457685, write Harvard Business School Publishing, Boston, MA 02163, or go to www.hbsp.harvard.edu. This publication may not be digitized,
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BrightStar Care: The Evolution of a Leadership Team
be key to her later success. She decided to stay close to home for college, putting herself through an
undergraduate degree in accounting at the University of Tennessee. Sun then earned a master?s degree
in accounting from the University of Colorado and joined CNA Insurance in Chicago in 2000 as a vice
president overseeing Securities & Exchange Commission reporting. A year later she joined Avolar, a
subsidiary of United Airlines. When United decided to shutter Avolar, Sun played a key role in
winding down the business; in exchange for recovering significant fuel costs, she negotiated generous
severance pay. Meanwhile she was also experiencing personal milestones: in 2001 she met JD Sun, who
was a stock trader at the time, and the two married in 2002.
The Suns immediately began to explore starting a business, encouraged by JD?s parents. ?I never
imagined being an entrepreneur until my husband and I were talking about it,? Sun recalled. But after
struggling to coordinate reliable care for JD?s grandmother, who died shortly before their wedding,
they both felt inspired to help families who needed quality home health care. The couple opened the
first BrightStar agency in Lake County, Illinois just months after their wedding, in part using Shelly?s
severance pay from Avolar. (Shelly contributed two-thirds of the capital to launch BrightStar and JD
contributed one-third.) ?We realized that there were other people out there who were like us?so let?s
do something about it.? JD recalled. ?We got married in March. We wrote a business plan. And we
opened our doors in October 2002.? BrightStar steadily added customers as JD made daily visits to
doctors’ office, hospitals, clinics, and other health care businesses that might refer their patients to
BrightStar. After focusing on sales for eighteen months, JD stepped away from the company while
Shelly remained as CEO and considered ways to grow BrightStar.
Franchising the Business
By the end of 2004, three BrightStar locations were open in Illinois. (See Exhibit 3 for a map of
locations.) With some of the profits generated by the business, the Suns and JD?s mother bought two
hotels in an existing hotel franchise brand, and the experience piqued Shelly?s interest in growing
BrightStar through franchising. The Sun family was expanding too; Shelly delivered the couple?s twin
sons shortly after filing legal documents to franchise BrightStar. In 2005, the franchising entity, this
time capitalized solely by Shelly, was formed. But selling BrightStar?s first franchise wasn?t easy.
Shelly Sun knew that the quickest way to start scaling the business was to gain access to the network
of franchise brokers who functioned as middlemen between franchisors and potential franchisees. As
a brand-new franchisor, and the first home-care agency providing skilled medical care to franchise,
BrightStar was largely snubbed by the brokers Sun contacted. But when a former hospital
administrator, John Botsko, began to search for a health-care franchise opportunity, his broker
reluctantly introduced him to Sun, cautioning him that BrightStar had yet to sell a single franchise.
Intrigued, Botsko asked a close friend?a managing partner at KPMG in Chicago?to vet the business.
Aware that this could be a pivotal moment for BrightStar, Sun was determined to make a strong case.
She also recognized that her financial acumen would differentiate her from many other business
owners, and might make up for BrightStar?s lack of a track record. She recalled:
It was just a big make-or-break moment in our history. I knew that I needed to stress
my accounting degrees and CPA experience?that would resonate with the managing
partner of a Big Four firm. And I expected our discussion to focus on the ROI of building
(if John started a similar business on his own) versus buying (if John became a franchisee).
I was prepared to explain all the investments BrightStar had made, and I was so close to
the numbers that I think I spoke his language in a way he might not have expected.
We met at the Palm Restaurant in Chicago. I could barely eat. He first said, ?I told John
that he should just go do this on his own. He shouldn?t do anything with you; you don?t
2
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BrightStar Care: The Evolution of a Leadership Team
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have any franchisees yet.? But we spent the next hour on his questions. The way he might
have approached things was similar to how BrightStar was building systems and metrics.
I walked him through the lack of existing technology for both the medical and nonmedical aspects of the business model, and explained that BrightStar had invested
millions to develop technology to support the business. I emphasized that we had already
invested $30,000 to build the BrightStar website and another $20,000 to design the brand
and collateral materials.
I helped him understand that, while John did have the experience and talent to start a
home-health-care business on his own, the ramp-up time would be longer and it would
cost more. The franchise fee and royalties that he would pay as a BrightStar franchisee
meant that he wouldn?t have those large costs in branding and technology. And he would
have training and support to open, to be ready to go on day one. Otherwise, he would
spend hundreds of thousands of dollars before opening the doors and have to hope the
business was successful enough to recoup the major start-up costs of doing on his own all
these things that BrightStar had already invested in.
At the end of lunch I said, ?What are you going to tell John to do?? And I?ve never
been in sales; I didn?t even know I should have asked for the sale at that moment! But he
said, ?I?m going to tell John he should do this. And I also want to set up a meeting within
the next 30 days to talk to my brother about buying a franchise.? And his brother did.
Botsko bought the first BrightStar franchise, which he opened for business in 2006. Meanwhile, JD
returned to BrightStar in a sales role and spent the next few years selling franchise territories around
the country. Ten franchise locations were doing business by the end of 2006.
At the same time, Shelly Sun was building a leadership infrastructure by hiring the company?s first
senior-level employees: an IT director, a controller, a vice president for franchisee support, and a vice
president for clinical operations. (See Exhibit 4 for a 2005 organizational chart.) She also created a
formal advisory team, recruiting successful entrepreneurs and business leaders for BrightStar?s first
board of directors. Early on, she approached Gloria Kvetko, founder of the Gloria Jean?s Coffee Bean
franchise, to serve on the board. Kvetko recalled how carefully Sun cultivated mentors and advisors:
?Shelly has never been afraid to have smart people around her and listen for advice. She had on her
board other people who had franchised companies, and each one was different. This way, she would
feed off the difference of each one and make it work for her.?
The Home Health-Care Industry
BrightStar agencies provided home care, a type of service that can include medical and non-medical
care. Providers traveled to clients? homes, often on a regular schedule for weeks, months, or even years.
BrightStar also offered supplemental medical staffing to institutional clients like hospitals, clinics, and
nursing homes, but these services accounted for only 6% of revenue in FY2014. 1 (See Exhibit 7 for a
summary of BrightStar?s services.) The bulk of BrightStar?s services consisted of ?private-duty? home
care, provided by non-professional staff like home health aides and certified nursing assistants. These
services included ?companion care,? such as light housekeeping, transportation, and meal preparation,
as well as ?personal care? like bathing, dressing, and mobility assistance. Such services accounted for
70% of BrightStar?s revenue in FY14. The remaining 24% flowed from delivery of skilled care, provided
by such licensed professionals as nurses, physical and occupational therapists, and social workers. 2
3
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Approximately 12 million people in the United States received care from a home health agency or
hospice, reported the National Association for Home Care and Hospice in 2010. 3 BrightStar was unique
among home-care agencies in offering skilled medical care in addition to personal and companion care.
Most BrightStar clients were older adults who did not need the level of care provided by residential
facilities, such as assisted-living centers and nursing homes, but did require support to continue living
at home. And the population of older adults in the United States was increasing. In 2014, people 65 and
older numbered over 46 million, and represented 14.5% of the U.S. population; that fraction was
projected to grow to 21.7% by 2040. 4 Concurrently, home health care spending was strong and
predicted to accelerate. The Centers for Medicare and Medicaid Services reported that home medical
care expenditures totaled $83 billion in 2014. 5 (This figure excludes companion care and personal care.)
Medicare and Medicaid were the largest sources of funding for home health care, accounting for about
$35 billion and $30 billion, respectively, in 2014, while over $15 billion was spent by private insurers
and by consumers paying out-of-pocket. Out-of-pocket and private health-insurance spending on
home health care was projected to reach $25 billion by 2024. 6
Unlike many other home-care agencies, BrightStar did not accept Medicare payments for its
medical-care services. Clients? care might be covered by another government program, such as
Medicaid, or by commercial health insurance or clients themselves. Government programs accounted
for just 9% of BrightStar?s payers. More than half of payers were clients who paid out of pocket; onequarter were commercial payers like insurance companies. Eleven percent of payers were ?national
accounts??that is, institutional and corporate clients that contracted with BrightStar to provide
services to their employees or clients. (See Exhibit 8 for BrightStar?s payers and revenue sources.)
Competitors and Labor Supply
Billing and legal regulations in health care could be complex, but opening a home-care agency did
not require specialized experience or training. Potential purchasers of a home-care franchise could
choose among several competing companies. The two largest were Home Instead, with $1.1 billion in
annual sales and 609 locations, and Comfort Keepers, with sales of $449 million and 671 locations. 7
Visiting Angels and Right at Home were also larger than BrightStar: the former had 508 locations and
$365 million in sales, while the latter had 433 locations and $358 million in sales. BrightStar was in turn
larger than Synergy HomeCare (291 locations and $112 million in sales), Seniors Helping Seniors (278
locations and $32 million in sales), Senior Helpers (255 locations and $242 million in sales), and
Homewatch Caregivers (208 locations and $100 million in sales). 8
As part of a quality-focused strategy, BrightStar set a higher bar for entry than its competitors; its
net-worth and liquid-capital requirements for new owners were both more demanding (see Exhibit 9
for BrightStar?s franchisee requirements and characteristics). Even with these stringent standards for
franchisees, the company grew rapidly. By 2014, BrightStar had 270 franchises across the United States,
and system-wide net revenue exceeded $290 million. Over 90% of BrightStar franchisees remained with
the company year to year. In FY14, average annual revenue for BrightStar franchises in their sixth year
of operation was $1.75 million, compared to $1.25 million at its closest competitor. (See Exhibit 10 for
average franchise revenue growth and Exhibit 11 for revenue comparisons between BrightStar and
other competitors.)
Despite BrightStar franchises? favorable performance, labor supply was a challenge for owners, as
it was throughout the home-care industry. Wages for certified nursing assistants and home health aides
were low nationwide, averaging in the $10 to $12 per hour range. 9 Turnover was high among these
workers. Home Care Pulse, an industry consulting firm, found in a 2015 survey that median turnover
among home-care workers exceeded 60% in 2014. 10 Recruiting and retaining front-line staff was
4
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BrightStar Care: The Evolution of a Leadership Team
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expected to remain problematic. In the words of one BrightStar executive, ?The ability to hire enough
quality caregivers to meet demand is a threat to growth.? Franchisees Jeff Tews and Susan Rather, who
operated four BrightStar agencies in southern Wisconsin, described the challenge in their region:
Our biggest challenge is finding quality employees at the $13-an-hour level. The
competition for those employees, when the unemployment level in Wisconsin is 2%, is
big. We?re the highest-priced agency in town. We do that for strategic reasons, but also
because we want to pay more than anyone else. At $27 per hour, we?re one of the highestpriced agencies in the country in terms of an hourly rate for straight supportive work for
our customers. It?s a squeeze play, and we?ve raised wages, but it hasn?t made that big a
difference in our recruiting.
Changing labor regulations also impacted the company. In 2015 the National Labor Relations Board
(NLRB) assigned joint-employer status to companies with authority over ?essential terms and
conditions? of employment, such as a company that subcontracts staffing to a temporary agency. 11
Under this ruling, companies that had not previously been considered joint employers would be
subject to collective-bargaining processes. The decision did not directly address franchises, but a prior
ruling by the NLRB had determined that a franchisor (McDonald?s) could be considered a joint
employer; it seemed likely that the latest ruling would apply to franchise businesses. 12 Other
employment legislation had implications for BrightStar as well. Seattle?s new minimum-wage law,
which raised the minimum wage to $15 an hour, classified franchises as large employers rather than
small businesses, subjecting them to more stringent requirements to comply with the law. 13
Scaling the Franchise
In 2007, 17 new BrightStar locations opened, for a total of 27 open franchises. This same year, Shelly
Sun acquired JD?s ownership interests in BrightStar, becoming the sole shareholder. Also in 2007, the
company began serving institutional and corporate clients through its national accounts program,
which grew from $3 million in billings in 2008 to $10 million by 2010. Franchise growth accelerated
further in 2008; 79 locations were open by year?s end, and the number of corporate employees had
more than doubled from 10 to 27. In 2009, 61 additional locations opened and 18 new employees were
hired at company headquarters.
Franchisee Relationships: Building the System
Sun formed a Franchisee Advisory Council (FAC) in 2007 to serve as a liaison between the growing
number of franchisees and BrightStar headquarters. It was typical for franchisors to create advisory
bodies, whose members often piloted new initiatives or provided feedback on system-wide changes
before they were rolled out across the franchise. The BrightStar FAC had as many as 12 members at
various points in time, but by 2016 it had stabilized at eight members. The franchisees who served on
the FAC participated in topical subcommittees, including technology, marketing and advertising,
skilled business, and employee engagement. For Sun, one key function of the FAC was to give her a
window onto what BrightStar franchisees were experiencing, given that she could not maintain
personal relationships with dozens and then hundreds of franchisees.
The relationship between headquarters and franchisees had its share of ups and downs. At times
FAC members and Sun disagreed; FAC leaders recalled that defending a particular point of view could
be challenging, especially when Sun reminded them that BrightStar was under no obligation to
maintain a franchisee advisory body. Meanwhile, fellow franchisees often expected FAC members to
convince the corporate office to reverse or modify unpopular decisions or practices, though they had
5
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BrightStar Care: The Evolution of a Leadership Team
no formal authority. As one past FAC co-chair noted, ?It takes a strong, confident voice to say to the
franchisees ?We?re not here to fix all your problems,? and also to the corporate office ?We?re not just an
extension of you.??
A disconnection between the corporate office and BrightStar franchisees became painfully obvious
during the recession of the late 2000s. Sun recalled:
We had a franchise convention in 2008, and I was upbeat and saying ?Things are great
and we?re growing.? And what the franchisees were feeling was very different: they were
taking it in the shorts because they were having to drop prices to keep customers, or
customers were dropping hours because they had lost their jobs, or things like that. I was
just out of touch with the franchise system and lost credibility with my franchisees during
that period of time, because I had gotten so removed from their day-to-day. I had stepped
away. I was no longer running the Franchise Advisory Council; one of my employees was.
And so I stepped back in, took over the Franchise Advisory Council, asked Jeff [franchisee
Jeff Tews] for his help, and was very humble with my whole Franchise Advisory Council.
I actually got on several calls with my entire franchise system and said, ?Here?s how I
failed you and here?s what I?m going to do differently.?
After this pivotal moment, Sun maintained a close connection to the FAC as a way of keeping in
touch with franchisees? experiences. To Tews, this shift was an example of Sun?s commitment to
supporting BrightStar?s franchisees:
She truly cares what franchisees are thinking. The franchisors who struggle with
relationships with franchisees are focused on the top line, and the top line is where they
get royalties. But franchisees really only care about the bottom line. So if you?ve got cost
structures in place where you don?t have cost efficiencies that you?re helping franchisees
with, your franchisees aren?t going to be as successful. They?re going to be dissatisfied
about paying 6% or 7% [in royalties] every week, and you?ve got an opportunity for
tension. Shelly really turned her field support team toward bottom-line, not just top-line,
sales.
Undercover Boss: Building the Brand
In 2010, 58 new BrightStar locations opened, bringing the total to 198. Sales of new franchises were
also healthy; an additional 48 locations had been sold but not yet opened by the end of 2010. Amid this
robust growth, Sun was thinking about expanding into complementary lines of business. She increased
the technology staff to 14, intending to position technology as a centralized function that could support
multiple brands. (See Exhibit 5 for a 2010 organizational chart.) Soon an opportunity arose to
dramatically increase BrightStar?s national visibility and brand recognition: CBS producers asked the
International Franchise Association (IFA) for a list of franchisors who could be featured on the popular
reality television series Undercover Boss. Sun, who had recently received the IFA?s Entrepreneur of the
Year award, was on the list of 25 names provided to CBS, though BrightStar was smaller than the other
franchises listed. Sun remembered the screening process for the show:
CBS came in and screened me and did the filming. We were sending live feedback to
CBS, educating them about the business model, and I got the thumbs-up. Then they got to
the last part, which was just filling out forms about the size of my company and things like
that. And they had an unofficial criterion, where the business had to be $100 million or
greater. So they said, ?Oh, you really would have been great, you?re full of energy. So now
we really like the industry, and thank you for being the leader for your industry. We?re
6
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BrightStar Care: The Evolution of a Leadership Team
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going to recruit other CEOs in this space.? I was so disappointed for about 20 minutes, and
then I got irritated. I thought, ?Wait a minute. I helped you understand the industry, and
now one of my competitors is going to get the opportunity for that kind of exposure and
their franchisees are going to benefit, versus my franchisees? No. No, no, no.?
In a move reminiscent of her original determination to break into franchising, Sun did not accept
CBS?s rejection as the last word:
I went on the CBS website and contacted every single executive I could find, explaining
why they should pick us: female entrepreneur, self-funded, risking for the American
dream, which I think is motivating. Not some hired-hand CEO but someone who has got
sweat equity in the business every single day. And ?You haven?t had a female on yet, and
you should have that with BrightStar. I?m the only female founder in the industry.? About
three months later, they came back to us. And fortunately we?d been growing quickly?
so we weren?t quite to $100 million, but you could see that we would be when the show
aired. And we got selected.
The episode of Undercover Boss featuring BrightStar aired in 2011. Meanwhile the company was
poised to advance to a new stage of growth. At that year?s annual conference for franchisees, Sun
announced the launch of a new business, BrightStar Senior Living, and offered existing franchisees the
opportunity to make a case for opening the first Senior Living facility in their territory. BrightStar
Senior Living marked the company?s entry into a new field, one that complemented its existing
business model. Rather than providing care to clients in their homes, a Senior Living center would
serve those who needed more care, both medical and non-medical, and could no longer live at home.
Entering the assisted-living market meant not only serving new customers but also retaining existing
BrightStar customers, as Sharon Roth Maguire, BrightStar?s chief clinical quality officer, explained:
With our home-care model, people are supported to stay in their own home for as long
as possible. But there is a time when people just need more. Sometimes it?s with
socialization, sometimes nutrition. Our specially-trained staff can meet those needs at
home, but there are times when those needs are better met outside of the home. And so
we do lose some clients to a more residential care setting. Shelly?s vision was, ?Why not
build our own? Clients know our brand. When they need to go someplace other than
home, why not have a BrightStar Senior Living for them to go to??
A Higher Standard: Positioning the Brand
From the start, Sun?s vision centered on quality. BrightStar differentiated itself by emphasizing
exceptionally high standards of service, an orientation that helped the company recruit key talent.
Maguire, a longtime health-care executive, recalled Sun?s focus on quality as a decisive factor in her
decision to join the company: ?She talked about BrightStar as the Neiman Marcus of home care. And I
knew what she meant by that, this higher standard. With my background, hearing that was like an
aphrodisiac for me. I wanted to be on this journey with Shelly. She?s very motivating that way.?
BrightStar marketed itself as a premium home-care brand. Indeed, the company?s slogan was ?A
Higher Standard.? This strategy was central to the company?s branding in a field where consumers
tend to be price-conscious; many paid out of pocket for services not covered by health insurance.
Consumers typically have several agencies to choose from, all offering similar services and operating
under the same state and federal regulations. BrightStar distinguished itself by requiring all franchisees
to earn accreditation from the Joint Commission, a nonprofit body that accredits health-care
organizations across the United States. Franchisees were also required to staff the position of director
7
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BrightStar Care: The Evolution of a Leadership Team
of nursing with a registered nurse, a requirement that, in Maguire?s words, is ?unheard of in our
space.?
Making BrightStar a trusted name was, in Sun?s view, the best way to navigate the ever-evolving
health-care marketplace, and to appeal directly to consumers without competing on price and
squeezing costs. Thus far, the strategy seemed to be working: nine in ten clients said they would refer
friends and family to BrightStar. 14 In 2016, the company?s Net Promoter Score, a customer-loyalty
measurement, was 63 (out of 100). BrightStar?s leadership team believed the company could achieve
an NPS of 75; in pursuit of that goal, BrightStar planned to close underperforming locations, whose
lower scores depressed its composite NPS.
As BrightStar grew, Sun understood, expanding the company?s marketing reach would be key to
competing effectively. In 2009, Jayson Pearl had been hired as vice president of marketing, the
company?s first executive-level marketer. At that time, Pearl recalled, ?We weren?t doing much
electronic media. It was a lot of programs and launches and online advertising. We had our web
presence and internet marketing, that kind of thing. Then we really hit a point where we increased, or
had a need to increase, our general marketing fund to a much higher level?we were starting to see a
number of our competitors going on TV and we said, ?Boy, we need to be there.?? In 2014 BrightStar
began airing ads on national television.
Franchisee Jeff Tews described Sun?s strategic approach to managing the brand:
She has such a strong understanding of the things that are going to change in the homecare business as health-care chan