Robert Frist16:10
Thank you, Dr. Lowry. Good morning. It's great to be here. Thank you very much for that introduction. I was thinking this morning when I was shuffling out of the house, I told my wife, I said, I've got to go do this little interview. And she looked at me like, oh, that's one less thing I have to worry about. She said, just go, go to your interview. And I started thinking on the drive over, well, it's a little nicer to go to this breakfast and have a nice setting with 400 adults compared to the relative insanity of trying to get four pre-teen daughters to school on time from 6:30 to 7:30. So I thought I would enjoy this calm and fun breakfast with all of you. It would be relatively simple compared to the logistics this morning. We all know who does the really hard work. It's my beautiful wife Melissa keeping the trains running and everybody on time. So I was asked to share a little bit about the history of HealthStream and how we got where we are today, and maybe tell a few stories about me that might give you some insight into that journey. It's a 23-year journey. I'll start with the end. At our company, we think about the challenge of improving patient outcomes and how big that problem is. The problem is so great, we all look for how we can be a part of the solution. At HealthStream, we have a unique thought process about how we can be a part of the solution in healthcare. There's a seminal event that kicked all this process off: the Institute of Medicine publication 'To Err is Human.' That document kicked off the process of thinking about the number of deaths attributable to preventable mistakes. There's nothing like a grounding to know that there are this many accidents occurring. The real problem with this is that now there's new science coming out that is showing that the methods we use to assess the preventable deaths due to human error were underestimating the problem. There's new research coming out now that says the error rates may be much greater than we thought back in 1999. We think about HealthStream, the purpose of the company and our teams, which we have here today. Thank you, HealthStreamers, for coming out to support me this morning. We're on a great journey to try to figure out what our niche is, how we can contribute to reducing these preventable deaths and improving outcomes in healthcare. What we settled on is that there are a lot of companies out there that focus on process innovation, building new medical devices and technologies. But HealthStream was going to focus on the human side of healthcare. We were going to look at where the problems are with the workforce, where the lack of knowledge or skill contributes to the mistakes that are made and creates these errors that we can prevent. At HealthStream, we decided a few years back, about nine years ago, we settled on this vision statement focused on the people of healthcare. We would assess, develop, train, and figure out how we can help them be better at what they do. In turn, that would help solve the problems we face in healthcare, these preventable errors. That's the journey of HealthStream, capturing this vision statement. We as an organization try to rally around this cause of how we can be a part of solving this big problem. When we look at the kind of data that comes up and smacks us in the face, you see statements like this one where 10% of patients are harmed as a result of errors which are thought to be avoidable. So if you're a visionary, one out of 10 some kind of avoidable mistake. This tells us where we should focus. We choose as an organization where to focus our energies, and we've spent now over a decade being the leading provider of compliance and safety education and training in the workforce today. With millions of subscribers to our service, we focus on teaching the basic principles of avoiding transmission of disease, infection control, and all the basic principles of safety to help be a part of the solution. Just a few more examples: this is a problem here that we were just talking about, how do you get people prepared for the job they're going to do? I was over at St. Thomas recently, and we talked about the nervousness of new graduates trying to come in and be effective nurses, the fear they have as they come into their job. It's one thing to be prepared academically and to know what you need to do; it's another thing to be confident and develop confidence in your job and career. HealthStream is seeking ways to build the confidence and knowledge of the workforce. By the way, some of the great things that are being done here at Lipscomb, the new sim labs they're building and the way they're training their students, are preparing them in ways that we think are more appropriate. I think the missing element in our industry is not really what we're doing while they're in school, but do we keep doing that kind of training? How do we continue the education and training? What are the new models for keeping people's skills sharp? I think simulation-based training is a big part of the future of healthcare, so I'm glad to see Lipscomb making that part of their curriculum. Today we focus on six or eight core areas where we can provide solutions and make a difference in healthcare. We talked about just two of them just then, and you can see others here in front of you. We're on this great journey. Our 700 employees are out to change the world. We think that we can contribute through our education, training, development, and assessment programs, and delivering those programs over the internet into these critical areas where we can help reduce risk and improve clinical outcomes for America's hospitals and caregivers. About 5 million people work in these different acute care facilities, another 3 million in post-acute long-term care, so it's 8 million caregivers. Our mission at HealthStream is to make them as sharp, as confident, and as prepared as we can for that job. I think of that as the end point. I go back 23 years, and I picked four little stories to take you on the journey. The first one goes way back, it predates the founding of HealthStream. It's the founding of a business. Every idea concept, I was a junior in high school and I said, okay, I don't want to cut grass, but I want to do something and earn a living in the summer so I have some extra cash. I got this idea that I would build a car wash business, a detailing business, wash and wax. So you need your first customer. Who do you go to first when you need a customer? You go to your parents. Yes, I went to my grandfather. I said, can I wax your Caprice Classic? He said, sure, come on. He loved that Caprice Classic mostly because it was a humble car and he'd had it forever and he was running it to the end of its lifespan. But he said, sure, you can wax them. So I took it over in the shade, I worked for two hours polishing that car. I went in to get my grandfather, brought him out to the front door of the porch, and I hadn't really looked at the car in the direct sunlight. So this was a problem. This is my first car, and I'd pulled it up to the front of the patio and we walked out the patio to stand at it. All of a sudden, the sun was as bright as it could be right on that car. We looked at it, and you could see every swirl mark that I had done. I pretty much just ruined his paint. I think in his mind he might have thought, well, you might need to go get me a new paint job. But what he did instead was he turned to me and he put his arm around me, and we stood there in the sun. I'll never forget. He looked at the car and he said, I am so proud of you for starting a business. What kind of person does that? When you ruin their car, ruin their paint, he turns to you and says, I am so proud of you for starting a business. It's a great moment and a great lesson, and someone we can aspire to be like that provides that immediate courage. From that, I ended up building a little business. Here's my grandfather, who's since passed, but this constant encouragement that came from my family, they always strove to support me in whatever I did, and it helped push me along. From that, I actually built a little business, and it went through every high school. I don't know whether to bring blame. I think my father and parents might rather see me sharpen my golf skills and tennis, be a little more competitive. I always used the excuse that I wasn't a great athlete, not because I couldn't have been a great athlete, but because I preferred to wax cars every summer while everybody else was playing tennis and golf. But I think it's probably the other way around. You migrate to what you're better at, and I was better at running a business. So for four years every summer, I washed, waxed, and polished cars. I think over a cumulative four summers, we did about $15,000 in revenue total. I had about four employees, and it was quite the journey. Here you see me in all my glory with all my equipment. I was so proud. I bought this $100 vacuum from Sears, and we've got all of our equipment. We would polish and wax about three hours each car, two a day. On days we didn't have a car, we had no revenue, so I'd be off selling and trying to get more cars to work on. This is the way that I spent my summers doing this car wash. A lot of the lessons of this car wash informed the creation of HealthStream because pretty much whatever I did there, I wanted to do the opposite of when I grew up. You had manual labor, hot in the sun, non-recurring revenue. You had to go find each customer each time. You couldn't promise the next car the next summer any work would be there. Everything about this business I learned that it's the opposite of what I want to do when I grew up. The other great thing about this city is access to people that can help you along the way. I had a great privilege just based on my family and connectivity. I had incredible initial access to people. I'm very appreciative of that privilege, and I know how hard it can be to build a network. It's always the number one piece of advice that I give to an entrepreneur: go out, build a network, meet people. The great thing about this city is some of the very same people that were my mentors I know make themselves available through programs like entrepreneurship programs at Lipscomb. They're mentors down at the Entrepreneur Center, and they're out there. They want to help. It's a great thing about our city. When I think back, enough can't be said about my co-founder Jeff McLaren. He's off as CEO of another company now, MedAxiom. He's doing great. He's still on the board of directors. I go back to the founding, September 27, 1990. Paige Davidson, who's in the audience here, helped write the first incorporation documents. She's been an incredible advisor to me for 23 years now. Sam Brooks, you can't have a better financial advisor than the late Sam Brooks, who helped me structure the first cap table, the ownership structure between me and Jeff McLaren. Charlie Martin, when no one else would fund our company, we went east to west to do a venture funding for our company. No one else would fund. 17 different presentations from California to New York. Charlie Martin stepped up, gave us a term sheet. Right after he gave us a term sheet, Morgan Stanley, GE, everybody wanted to invest. So you have this great community that steps up and backs their entrepreneurs. Then Tom Dent, our longest standing board member, 23 years, incredible experience, a moral compass for our company, and always there with me on the whole journey. Still on our board and a great advisor. The great thing about this city and the people that have been on my journey is they're still there with me today. They provide that constant support and encouragement. A little bit of background: when I first created it on September 27, 1990, the next thing you've got to do is go get a customer. To this day, 23 years later, there's still a dispute inside of my family who the first customer of HealthStream was and who was the cheapest, who gave us the most leg up and helped us get started. Within 90 days, I was approached by both uncles. Lee Barfield is a well-known medical malpractice attorney, and Bill Frist. They both said, what are you doing? What's this new business you have started with Jeff McLaren? We said, well, we're using technology to educate and train. Lee Barfield was on the circuit at the time giving talks about the right to die, and he needed an animated teaching presentation. So he quickly hired us. He wrote us a check for somewhere between $1,500 and $2,000, and we built this great presentation for him, and he hit the circuit. Bill Frist was out creating the transplant centers, the first multi-disciplinary transplants in the country, and he had to raise grant funds for it. So we did him a great presentation so he could travel across the country. This was before PowerPoint, so we built these animated presentations. To this day, there is quite a debate in our family on who was the first customer and who wrote the bigger check to get us started because they were our mentors, they're there for us. Great thing about our family, they're always there. Today, I will not resolve this conflict. They were both great supporters. Now there's another little story. This jumps forward to our IPO in 1990. So now we're 10 years past the founding. We have our first customers. We've grown a little bit. There's a little bit of a story here. Does anybody know what this date represents? I can't wait to get the Q&A because I think I'm going to ask more questions. I need help with my four daughters. They're about to enter their teenage years. We've got all kinds of great things going on. But who knows what happened in August 1995? I think I heard it: Netscape. I heard that. So it's a Netscape IPO. Many consider this the beginning of the dot-com boom. I won't call it a bubble just yet. That's later in my story. But it is a boom. The internet was going to change everything. So if August 9, 1995, was Netscape's IPO, that's considered the alpha, the beginning. That then stepped forward five years. In April 10, 2000, was a fascinating time. Look at what was happening the week of April 10th of 2000. If you think back and you know this era, it's a fascinating time. There's one other thing that happened the week of April 10th of 2000, and that was HealthStream's IPO on April 11th. Within hours of this week, which was the most volatile, the biggest day trading, biggest single point drop in Nasdaq history, that's when we decided to go raise our public funds. Here we are looking at the ticker. I don't know, you can see mixed emotions here. We traded from 9 to 11 within minutes, and then by the end of the day we were at 8. So it didn't have a great feel to it. Within a few months, we'd pretty much traded into obscurity with all the rest of the dot-coms, and we stayed there for about six more years at $2 a share or lower. It was a fascinating time. We were able to skate out and get our capital right at the very last. Some, in fact, you can see in this chart, you see that big drop. That's pretty much the day we were closing our IPO. Now people look at this chart in reflection and say, you know, that is the week that really was the beginning of the end of the dot-com bubble. For some of the groups that took us public, it was the last IPO they ever did. It's just a fascinating time. The following months, look what happened. It was an amazing time, and we were grateful to have our capital and be successful and be back locally. We were on our way as a company. But pretty much dot-coms were disappearing at an unbelievable rate. It was just a fascinating time for us. There are some that might say that if the alpha of the internet was Netscape, the omega, the end of the bubble, the end of the dot-com craze, was HealthStream. And it's true. We were there at the very end, the last week when the bubble burst, and we were very fortunate to get our capital financing. So it's a fascinating time and journey. Again, that capital is what helped us build a business over the next decade. One last story here. Our constitution. We try to be a principled company like everybody, have a vision and a mission and values by which we live and operate. We built a book actually to capture those in 2008. We call it our constitution, and we teach all of our employees the principles of the constitution. What's interesting about the constitution was I never really applied it to investors. By 2008, we've been public for eight years. I've done lots of investor presentations. But I went up to Baltimore. I met with the legendary and now late Jack Laporte, who ran the $8 billion New Horizons Fund. At the time, our market cap was probably $55-60 million. He quickly informed me that he just didn't know why he was meeting with me. He was just kind of curious about our business because we were the smallest little piece of his $8 billion portfolio. He had like a million dollars worth of our stock, which was nothing. I don't know how he got it or why, but he was curious about our business. What I did was, I'd been to hundreds of these presentations, and mostly people wouldn't listen. You go through the financials and your SEC filing documents and your business model. But with Jack, I don't know why, I pulled out our newly minted constitution. It wasn't about the business model, it wasn't about the finances, it wasn't about anything but our values and how we would proceed to move things forward. We're going to build and solve big problems in healthcare. We're going to generate recurring revenues. We're going to build product-based solutions. We're going to do that with individual integrity, and we're going to do that with a learning culture embodying our company. We had all of our principles captured in that document. I shared it with him. We spent about an hour talking about not the business or the business model, but the how we're going to go about it. He left the meeting and said, I'm going to become a bigger shareholder. To this day, T. Rowe Price is one of our biggest shareholders, and he stood with us along that whole journey. We're still a tiny piece of their $8 billion fund. But what a values-based investor to have. It's fun to think about. This constitution today looks like this, and we teach it to all of our 700 employees within the first month. Usually we try to do an orientation around the principles in this constitution. The constitution was an inflection point for growth and focus of our company. It helped us have a beacon in a direction of where we're going. It's been a fun way to think about how to direct and grow our business. So I bring you back to the present. That's my 23-year journey in 12 minutes. Recently, just in February this year, we surpassed 3 million subscribers to our platform. We deliver education and training to about 60% of U.S. hospitals. On any given day, over 100,000 nurses, physicians, and support personnel will log into our web-based platform built by some of the team right here in the room. They'll take curriculum, education, training, and tests to learn how to better do their job. We're really proud of what we've built as an organization. We're trying to be the little company that could. We can change an industry, make it better. We can do it on the people side of healthcare, and we can do it in a principled fashion. I'm really proud of our teams, our employees, and the journey they've taken us on. The 23-year journey and the little predecessor company of a car wash, the principles embodied have kind of carried us that whole way. It's been an exciting thing to be a part of, and I'm grateful for the teams that have helped get us there. I turn it back over to the program. I'm looking forward to Q&A. Again, if you don't ask me questions, I may ask you questions because I've got to take some advice back to my wife who's dealing with four pre-teen daughters.