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Robert Frist
Co-Founder, Chairman of the Board & Chief Executive Officer, HEALTHSTREAM INC

Nashville Business Breakfast Robert A Frist, Jr 12 11 13

🎥 Dec 16, 2013 📺 Lipscomb University ⏱ 57m 👁 397 views
Dwayne Dillard ...
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About Robert Frist

Robert A. Frist Jr., co-founder, chairman, and CEO of HealthStream, discussed the company's role in healthcare education and the broader Nashville business community. He stated that HealthStream focuses on training healthcare workers to reduce preventable errors, noting that ten percent of patient harms result from avoidable mistakes. He said the company delivers education to about 60% of U.S. hospitals, with over 3 million subscribers using its platform. Frist described simulation-based training as a significant part of healthcare's future, helping build confidence and maintain skills for nurses and physicians. Frist also reflected on HealthStream's initial public offering in April 2000, which occurred during the dot-com bubble burst. He said the company was fortunate to raise capital at the end of that period, which helped build the business over the next decade. He advised that companies should focus on building the business and ignore Wall Street's volatility. Frist emphasized the importance of building a network for business growth, and said diversity in the boardroom brings different perspectives and fosters good debate. He also noted Nashville's role in the globalization of healthcare, stating that HealthStream is beginning to deliver training internationally through partnerships and the internet.

Source: AI-verified profile updated from Robert Frist's recent appearances. Browse all interviews →

Transcript (31 segments)
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Bob0:12
Community, it's such a great place to be, such a great place to conduct business, and we're just grateful for mornings like this that we can get together and enjoy each other's company and hear from great speakers like we're going to hear from this morning. One of the things that I'm constantly reminded of about Nashville is that there's a lot of things about our community that the world still just doesn't fully get or fully realize. I have conversations frequently with lawyers, whether it's New York or Chicago or other major markets, and the things they know about Nashville, there are certain things they realize and know, whether it's the music brand or whatever it might be, but when we start talking about the significance of the healthcare industry in this community, people are blown away, and they should be. So one of the things we celebrate this morning is that industry and the role that it plays in our community, and we're grateful for that. I'm also grateful for a long partnership that we've had here at Lipscomb with the Nashville Business Journal in putting on this program. So I would ask you to join me in welcoming, as she greets you this morning, the publisher of the Business Journal, Kate Herman.
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Kate Herman1:33
Thank you to Bob and thanks to Lipscomb University. It's a pleasure to be here again this morning. We do these breakfasts quarterly and mix a little business with inspiration. I am pleased to be able to introduce you to the sponsors of this morning's program, and we appreciate their support. They are Crowe Horwath, Frost Brown Todd, Ingram Content Group, and PNC. And I would like to introduce you to Dwayne Dillard, audit partner at Crowe Horwath. He would like to welcome you this morning and say a few words.
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Dwayne Dillard2:09
Thanks, Kate. Good morning. Welcome to the Nashville Business Breakfast. Crowe Horwath is one of the largest public accounting and consulting firms in the United States. Crowe uses its deep industry expertise to provide audit services to public and private entities and also help clients reach their goals with tax advisory, risk, and performance services. With offices coast to coast and 3,000 personnel, Crowe is recognized by many organizations as one of the top places to work in the country. I would like to thank Lipscomb University and the Nashville Business Journal for their continued investment in the business community and also providing great events like the Nashville Business Breakfast. Thank you.
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Kate Herman2:55
Thank you, Dwayne. Thank you. Next, I'd like to introduce you to Grace Sasser, member at Frost Brown Todd. Grace would like to welcome you as well this morning.
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Grace Sasser3:10
Thanks, Kate. Good morning. Thanks for everyone for braving the day after Nashville's great storm. I'm Grace Sasser, member at Frost Brown Todd, and I'm pleased to be here. We are very pleased to sponsor this event, looking forward to hearing what Bobby Frist might have to tell us about the healthcare industry in Nashville. Quickly, Frost Brown Todd is a law firm, a full-service firm. We do just about anything. If you get in a car accident on the way home, you might want to call one of our friends, one of my colleagues. But other than that, we mostly work with companies in and around town and across middle America. We've got nine offices and about 450 attorneys. We are just pleased and tickled to death to sponsor this event and look forward to learning more today. Thank you.
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Kate Herman3:57
Thank you for being here. We appreciate you. And next, I'd like to introduce you to Ed Black, senior vice president of PNC. Ed, could you please join me? Thanks for being here.
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Ed Black4:12
Good morning. On behalf of PNC, I want to welcome you all here. It has certainly been a great year of programs, and I know this morning will be no different. PNC is certainly proud to be able to be a part of the team that puts on these events. Kate and her team at the NBJ do a great job. And full disclosure, I'm a Lipscomb graduate, so this won't be a biased comment, but I can't think of any place in the world that would be a better place to be hosting this event than here. So we thank you all for being here. I would echo earlier comments that Nashville is a special place. PNC is honored to be here. We thank you for your attendance, and we know you're in for a great program this morning. Thank you.
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Kate Herman5:02
Thank you, Ed. And another thank you as well to Ingram Content Group. So thank you to all of our sponsors. We appreciate you being here this morning. Well, now we're going to give you a few minutes just to enjoy your breakfast and conversation at your table, and we'll be back shortly with Bobby Frist. Enjoy. We're grateful that you're here with us this morning. One thing I want to mention to you as we get into the program, and for those of you who have been with us, you know we have a Q&A session with our speaker. At the bottom of the front page of the program, you will see information that gives you the number to text if you have questions for our speaker this morning. We'll have a few minutes at the end that we can hopefully share some of those, but please feel free to text in your questions for Mr. Frist if you have any. But again, we're glad you're with us this morning. We traditionally begin our mornings with an invocation and a prayer blessing. So this morning, we've asked our dean of the pharmacy school at Lipscomb University to offer that prayer. Lipscomb is beginning its eighth year in the pharmacy program, and Roger Davis has been the dean of that program since its inception. And much like our speaker this morning, Roger's business is about training people in the healthcare profession to be better servants of those who need their care and their safe keeping. We're grateful for the program that has developed here at Lipscomb, and so we'll ask Roger to offer our prayer this morning. Roger.
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Roger Davis7:00
Almighty God, we pause before you this morning to acknowledge your presence in our lives, to give you thanks for the blessings that you have shared upon each one of us. We're grateful for the way you look after and care for each individual, for this university, and for this great community that we live in. Father, we are aware that we are a blessed people among all the nations and cities of this country and world. We thank you for the spirit of partnership and care and concern that exists in this community, for the leadership that you've provided us with, whether it be in the arena of politics or business or religion, or simply in the way that we live our lives. We're grateful to be in a community where the quality of life is important and where we are built up by each other's presence and by your presence. We thank you, Father, for giving us a compassionate and an inspiring community to live and work in. We're grateful for people who have the sense to create jobs and to create opportunities and to lead in the quality of life that we share. We thank you particularly at this time of the year for these blessings. We thank you for the opportunity to learn, as we will this morning, from people who have made great contributions to improving life and sharing faith with each other. We pray, Father, that at this time you will give us an extra measure of peace and hope and well-being. In the name of Christ, amen.
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Bob9:01
It's always my pleasure to welcome you as well to this breakfast and appreciate your getting up and joining us for what we hope will be a stimulating time together. We especially appreciate a group of you that have come this morning from Williamson County. Lipscomb's idea center, called Spark in Williamson County, is now coordinating a shuttle along with Grand Avenue. If you live in that part of our area, you can meet there at 6:15, and they'll serve you coffee as you sit on the bus with colleagues, and you can get another hour of networking in. So keep that in mind if you're from that area. I always try to say something about the university just because this is the setting. Tomorrow night in this arena, we have sold it out for the Gaither Christmas Homecoming. Some of you may know what that is, some of you may not, but it'll be an exciting time of Christmas music tomorrow night. On Saturday, the arena will be sold out, I guess in a sense, for graduation. We will graduate between three and four hundred students mid-year, the majority of whom will be graduate students, which is a little unusual for this university. We will also have an event on Friday that I can't invite you to. While I'd love to have you celebrate most all of these events, this is one where frankly you're not invited. But I want to tell you about it because it is a very special moment in our institution's service. We will have for the first time a second graduation during December. The one on Saturday is public. We will have several thousand people here to celebrate the success of those graduates. But the one on Friday is actually a private ceremony. It will only include nine graduates, but it will be just like graduation in the sense that they will march down an aisle, they'll be dressed in caps and gowns, faculty will be there in their 12th century garb, and there will be speeches and there will be music. The difference is that particular graduation ceremony will take place inside the Tennessee Prison for Women. Seven years ago, one of our faculty members had on his heart a sense of passion to go inside the prison and offer the only higher education that is offered to the women who reside there. It's a bit of a unique program because as he goes in and faculty go in every Wednesday night to teach, they also have as members of the class other regular Lipscomb students. So we have what we call insiders and outsiders, and the outsiders go through all the security each week and join their classmates in a Lipscomb University class completely accredited by our accrediting body. And Friday, we will offer the very first associate degrees. Now you've got to understand, these are women many of whom are there for the rest of their lives. There's no pretense that things have gone well for them and that they've made good decisions or that justice isn't being done. But there are also women for whom we have taken a great interest. So our students join them in their class each week. One of them said that it's really her window to the world. And after seven years, they will be getting an associate's degree on Friday. I was talking at the prison with one the other day, and I was just sitting there talking to her. I said, tell me, what does this mean? And she said, well, you know, all of my life I was told I would never amount to anything. And for most of my life, I confirmed it. For most of my life, I didn't amount to anything. I made horrible decisions, I had horrible friends, I did illegal things, and that's why I'm here. She said, what it means to me is that I am someone. And she talked about how exciting it was for her to see that contrast between the voices in her life growing up and this moment of her achievement. Seven years to get an associate's degree. And it's ironic because on Friday, she said, I'm going to get that degree. She said, every semester I get my transcript, and it reminds me that I am somebody. And when I get that degree on Friday, and then she started crying. She said, I realized it's my dad's day, the day that he died, the anniversary of his death. And she said, when I get that degree, I'm gonna hold it up. I'm gonna say, Daddy, Daddy, I did amount to something. It's just so significant that every once in a while we look out in the world that we live in and perhaps engage differently in the lives of those that are so close around us. So I can't invite you there, but we will have a very special ceremony celebrating this university's effort in the Tennessee Prison for Women. This morning we're privileged to have a wonderful speaker, and because he has been in this community a long time, many of you know Bobby Frist Jr. He is the CEO, the President, and the Chairman of HealthStream. He has been involved in that company almost since his graduation from college in 1990. He's a graduate of Trinity University, and our family knows a little bit about Trinity because, if I'm right, Trinity was the school that defeated Wheaton in the finals of the national finals of soccer the year my son played. So we're going to be nice to you, Bobby, but we do know your school and know it by reputation in San Antonio. Obviously, this is someone before us today who is distinguished in the business that he has developed. He's also someone who's been a great contributor to our community. He has recognitions that you don't need to hear all about, but you would quickly acknowledge would be true. Certainly on the local level, we recognized HealthStream. On the national level, that has been done through Forbes and a number of other publications. Bobby has four daughters, and this is an exciting time in life. All four of his daughters are under 12 years old, and he said it's been a really busy and challenging time. I said, nothing like it's going to be. They're all under 12. But there also will be great joy in those moments. Just last week, I joined him at a dinner where the Nashville Business Journal recognized him as one of the three most admired CEOs in his category. Would you please welcome our speaker this morning, Bobby Frist?
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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.
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Bob35:20
Bobby, it's great to have you back on the Lipscomb campus. Thanks for being here today. I want to take you back to the alpha omega story for just a second, but I want to flash forward to last year. I did a little research, and the cumulative total return on your stock last year was seven times the Nasdaq Composite Index and seven times the Computer and Technology Index, which is incredible. From a leadership standpoint, tell us a little bit, how do you do that? How did you do that?
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Robert Frist35:54
Well, that's fascinating because you can't, I don't believe you can take any credit, and sometimes you try to take no blame for what the market does with your currency and your stock. I think what I try to do with our employees is just focus on the baseline, trying to build the company, stick to the values, and keep incrementing the wheel forward. We try, it's hard to do, to as best we can ignore Wall Street. It's one thing to say that, another thing to try to do it. Every time we have a spike or something moves up or down, if it's up, I tell them to remember it can be down. If it's down, I remember to tell them that it can only go up. So we try to keep a level head and keep focused on just building the base of the business. How Wall Street treats your stock and your company, we've been through periods of time where it's just inexplicable on either side of the equation. When the business is growing quarter after quarter, showing steady progress, and no one will listen to our story, that happened for almost seven years. Then on the other end, when things start to go a little bit right, they decide that everything's going right and nothing can go wrong. There's really not a lot of truth to that either, as we all know life has a lot of cycles and companies go through cycles. So we just try to push ahead and maintain an even keel. I don't really know how to explain that. This is on the fun side of the curve. There are other sides of the curve when things don't go quite as well and you're just trying to push your business forward. I will neither take credit nor give advice on how to achieve that result, but we do continue to stay focused on our core business.
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Bob37:23
Well, and it is interesting because you're touching on two industries that are kind of volatile, especially right now, obviously with the uncertainty of healthcare and then technology with the lack of workers. So I'm curious, what at this moment really keeps you up at night? What are you most concerned about?
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Robert Frist37:41
Oh, well, there's so much besides your daughters. No, the family and the daughters are wonderful. But the business, there are so many things. Anytime you run a business at any level, back to vintage auto detailing, it's just finding the next customer keeps you up at night. How do you find the next customer just so you can have a little bit of revenue, $65 per car, to pay your workers the next day? And you don't have to pay them and show these gift certificates from your grandmother because you don't have any revenue, which is a true story. Today, though, the problems are bigger. Technology moves much faster. No matter what you do, you can find, if you read a little blog called TechCrunch, if you get in there, you can almost have a heart attack as a CEO because there's always some emerging company that is completely disruptive to whatever it is that you're trying to do. The rate that they're coming at you is even faster. So you can be worried about giants like Oracle that are also in our business, or you can read TechCrunch and be worried about a little two-person startup down at the Nashville Entrepreneur Center that has an idea that you didn't think of that's better than yours. So you're in a constant state of concern about how to keep up in today's speed with which things evolve.
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Bob38:51
In your business, you must think a lot about the future of U.S. healthcare. So I wonder if we could flash forward now five or ten years and could you describe for us what you think the landscape will look like in U.S. healthcare in a few years?
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Robert Frist39:03
I'll probably be better at projecting it relative to our business. There are other experts, I've seen you had up here, that could talk more about the nature of delivery and how that's going to change. We all experienced that. I mean, we already run our children down to Walgreens to get their strep test instead of our primary care doctor. So we all know the shifting landscape and the speed at which it's coming. With regard to our business, we feel the shifts. We're trying to be a part of them. We were just talking about this over here a few minutes ago about the need for the shift in how we train and certify in healthcare. The airline industry has already adopted a model that I think needs to happen in healthcare, which is this kind of risk-free environment of virtual and physical simulation on a recurring basis that's role-based, where you're practicing what you're going to encounter in your work job. Today, sometimes the last time our physicians and nurses have been through simulation-based training environments is when they're in their academic programs like here at Lipscomb. I think that has to change. I have a good friend who's a pilot for American Airlines, and every six months he goes to Dallas and he sits for two days in simulators, and they practice everything possible. That is a recurring training model. That's how you keep your skills sharp, and then retesting and reevaluating. I think today we have a process that has to be enhanced around continuing education and maintenance of skills and maintenance of competence. In our industry, we expect to see continued shifts in how people certify, train, and retrain, and are constantly developed. I think moving towards risk-free simulation-based testing and assessments is a way that can really help reduce the errors that we talked about.
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Bob40:39
Can you tell us a little bit about what you're finding? There's been a big push in the city about finding tech talent and having more people attracted to Nashville in the technology industry. How is that going for you? How do you keep your talent that you currently have? Are you seeing that there's an issue that they're picking other cities to live in?
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Robert Frist40:57
Nashville, we all know this because we're here, we're part of it, but Nashville is definitely on the upswing. I look back a decade, you look at the small decisions made by our great and progressive leadership, the focus on greenways and our prior mayors and building up infrastructure for our city that's attractive, the focus on business development from our current mayors, and then state government very supportive and tax environment very favorable. So the state and the city are doing amazing things to encourage this. By the way, it's not just the last two years. Ralph Schultz at the Chamber, we're the top chamber in the country. We've got programs that keep us current on news like the Business Journal, and I read that every morning on my blog. So the city is now viewed as very progressive. But you think back a decade to the things that were done to make us progressive, and it's a lot of small decisions that go back over a decade ago that are resulting in success. So the city is a great attractor for our employees. We're finding that we can bring transplants in a lot easier than say five or seven years ago. We still have shortages in technology. Tech workers are obviously very understanding of their situation. Pretty much there are 800 to a thousand open jobs, and they can go across the street and make more. So then you have to focus on culture. Our culture, like every company, has its ebbs and flows. We're definitely on an uptick. We're building a culture of empowerment. We've been through times where we went through such rapid growth, and we're still there now a little bit, you don't know everybody in the hallways, and it can create an awkwardness in the culture. So you have to get back to your roots and build a great culture to attract. I think our city attracts people, and now we're trying to focus on our company to make sure the company is attractive because all these employees have so many great options. It can't be all about the money. I mean, you have to pay competitively, but if it turns into something about the money, the smaller companies can't win against the bigger companies in that. So you have to focus on culture.
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Bob42:51
Other members of your family are making a big investment in a hospital in Shanghai, China, if I'm not mistaken. So two questions: one, do you see globalization in the future of HealthStream? Big world out there. Are you going to expand beyond the United States in training? And two, do you see globalization in the future for the Nashville healthcare industry?
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Robert Frist43:15
For the latter, certainly globalization is a key role. More than any city on the planet, Nashville has a role to play in globalization and teaching best practices and how to run and operate efficiently. The lessons are all here. People are all here that know how to improve healthcare delivery systems. So Nashville should play a centerpiece in our companies and their thought leadership and how to go about delivering quality care across the globe. From HealthStream's perspective, I've always had ambition to be international. The problem is at our current size and scale, I don't feel equipped to deal with all the international law, the currency exchange rates. I really feel like we're too small of a company yet to focus on globalization. That said, one of our core partners is a company called Laerdal Medical, and they're in Stavanger, Norway. They operate in 23 countries. I said earlier that a big part of the future of healthcare delivery is this simulation-based education and training. Well, they're the world leader in that. Every month, their CEO, Clive Patterson, pushes me and says we're going to go global because Laerdal is already in 23 countries, and their mannequins are tens of thousands of them across the globe. In small ways, we've started to go global through the internet. We're now delivering a curriculum to simulation centers that's built in Japan and in Israel. Through the internet, almost like an internet store, you can create a scenario to run on this mannequin, upload it to a HealthStream-built internet site, and then download it and run it on your mannequin here at the Lipscomb sim lab. HealthStream is facilitating the transfer of intellectual property that runs these high-tech simulators globally already. We'd like to play a role, but I think our company needs to grow up a little more and be a little bigger in order to play on the global stage.
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Bob45:06
So you're sitting in a room full of business people who day in and day out are looking to grow their business and do things in the community. You've given your story, it's just so inspiring. But what one piece of advice do you have as they're trying to go about their day growing their business? What would you leave them?
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Robert Frist45:22
I think it does come back to building a network. I know I've personally had great advantages in building my network, and that's a huge step up for anybody starting a business. But you just have to go about the process of building a network and take advantage of the friendliness of the city and the openness of it. Don't be afraid to put your foot in and ask for that meeting you don't think you're going to get because you probably will get it in this city. I think that's the thing that you just have to push a little bit and get your seat at the table. I always come back to just things happen through people. People take attachment to you and your journey. They want you to be successful. So the more people you can engage in that dialogue, make them either an investor in your idea or a supporter of you both emotionally and as a person, they tend to stay by you in this city. So I always say build your network. Pick up the phone and call someone. Get the meeting you didn't think you could get, and then go to the next one. The great thing about our city is we're formalizing that structure now down at our Entrepreneur Center. There are over a hundred volunteer mentors that are successful business people themselves that are giving back a minimum number of hours of consulting and advising service to startup companies. Our city is turning that experience outward directly and giving people even better models for accessing talent. Entrepreneurship programs like here at Lipscomb are pushing out availability and building programs like this. So our city is being very progressive in helping people start businesses and build their personal networks, which is probably my number one piece of advice.
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Bob46:48
Bobby, we've tried to be very supportive here of the concept of diversity in the boardroom through our Dean Institute and our College of Business. You have two females on your board. You're one of the few companies in the state of Tennessee that have two females. Linda Rebrovic and Debbie Tate are both here this morning. Why have you done that? What value has that brought? And what advice would you give other CEOs about the value of diversity in the boardroom?
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Robert Frist47:12
Well, it's certainly invaluable. All the statistics and the performance of companies shows that building diversity at that leadership level is important. It's inspiring to the people inside of your company that leadership roles can be attained by everyone. It's proven a key element in the dynamics of how our board operates. Each person has their own relative strengths and weaknesses. Creating that diversity creates that diversity of thought, which creates a diversity of opinion and sets up for good debate and great discussion. We've been fortunate. If Linda and Debbie are here, their contributions have been consistent and steady in shaping the company and who we are. The dynamic of the boardroom shifts when it's a well-balanced and thoughtful and different perspectives are brought to the table. There's the gender perspectives potentially, and there's the thought perspectives and experience, the different experiences everyone brings to the table. We couldn't be more grateful for achieving some diversity of thought at the board and leadership levels of our company.
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Bob48:10
You've been gracious enough to be on panels that we've had regarding entrepreneurism. I know that the beginning of your story you had to be really flexible with your business idea and what you were doing. Can you tell us a little bit about that and the flexibility you need to have when you're growing a business to maybe move into another direction and just to adapt to what's going on?
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Robert Frist48:34
I was trying to think about what's the same from the first founding of HealthStream, day one, that's the same today 23 years later, and what's different. The thing that's the same is the interest and the use of technology to educate and develop. The thing that's different is everything else. I was thinking about the journey. People say, been at one company for 23 years, but that company is a different company every five years. The first five years, we were pretty much a service-oriented company. We were quote advisors, 23-year-old technology advisors to other companies on how to use technology to train and educate. We mostly worked for medical publishers to help them take their books and put them on CD-ROMs. So we were kind of a high-tech service bureau. Today, we're an internet-based subscription-driven content delivered over the internet. The internet really emerged around '96, and we didn't have our first internet applications until really '98. So that first eight years was really learning the ropes of the industry, how it worked. Everything, the delivery, the technology, the business model, has been different every five years, making the journey both interesting and challenging. To your question, I think the flexibility comes from just a constant surveillance of the movement of the market. If you stay something in long enough, and I don't claim a lot of great traits. My best thing is we hire people smarter. That's true. I know that I'm a pretty average student. There are people definitely that can outthink me. There are people that have deeper domain knowledge in healthcare. I'm fortunate to hire and have those people around me. But the one trait that I try to claim is just persistence. I'm going to stay at this game and orchestrate and push to get an outcome. I think persistence is a trait that drives me forward. It's the people that I've been able to bring around me that get me to the end result.
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Bob50:26
We probably only have time for one more question. So let me ask a personal question here to close. You could maybe make the case that the Frist family in Nashville is the 21st century version of the Kennedy family. Incredible accomplishments by so many different family members. I hope not because we all want to be around a little more. But with that having been said, a lot of accomplishments in business, government. I'm sure all of us would like to know, what's it like to be a Frist? What sort of burden does that bring, and what privileges does that bring?
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Robert Frist51:03
It certainly brings a little bit of both psychologically. I went to the same high school as my father, where I was a very average athlete and he was the quarterback and the head of the honor council and the quarterback of the football team. You know how you internalize and personalize those things. I had the same English teacher that he had, which was kind of strange. She could remember things that he had done. So you're constantly trying to measure up to those shoes, and that creates that burden, a little bit of pressure. But it also drives you. The great thing about our family is that, and I've thought about this often as well, like why didn't I become a doctor? Well, maybe because I wasn't quite good enough to get the grades and get into it. But also it's because our family encourages individual pathways for each child and person in it. They never oversteer anybody. They let us truly go down our own path. At one point, I actually got saddened by that because I realized I'd never gone down to see my father operate, and he'd never made me like, you're going to come down and see what it's like to be a doctor. I should have probably gone down and seen him operate, and I may have taken a greater interest in medicine that way and maybe become a doctor. So you reflect on things like that. But the great thing about our family was it didn't matter what we did, whether we polished the paint off my grandfather's car or whether we took an interest in a non-traditional sport like I did martial arts instead of football and basketball, they were always right there for me and helped me develop my own path. So you kind of go this winding path. Certainly there's a bit of that pressure. You want to do well and push forward. They always led by example. So the more I could be around family members like my grandfather, who was always so humble and very reinforcing, you try to learn and be the best you can to be like them. That's what it's like. It's this mixture of pressure but support and pushing you forward to do better and encouraging you when you do poorly. It's been an amazing thing to have this supportive and big family all around Nashville. We gather. I only know one other family that has to rent out a gym to get their family together, and that's the Pearson family. I don't know if Eddie's here. When we all get together, it's a big family thing, and you can feel the support that they provided over time.
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Bob53:17
It's been great to have you this morning, Bobby. Thank you for being here.
Well, certainly stories are powerful, and we appreciate Bobby sharing personal stories and professional stories and the story of his company with us this morning. Stories we remember a lot more than just lectures. Thank you for bringing life to what you have done. I want to share just one comment as we get ready to leave today. Obviously, it's a special time of the year. It's a time where we think about both receiving and also giving. College presidents like to listen to other college presidents. A number of years ago, I heard a college president describe something that's profound as we think about this season. He was speaking to a soccer team at his college that had just won the national championship. My daughter was on that team, and you can imagine the energy there with a bunch of young women who have gone and navigated 400 and some colleges to become number one in the nation. He knew that they had that energy, and he knew they were feeling pretty good about themselves. So he asked this question. He looked at this banquet where students and parents were all sitting and the celebration for this achievement was taking place, and he looked at the students and asked this question. He said, what do you have that you have not been given? What do you have that you have not been given? He kind of walked them through their lives. He said, you had nothing to do with the life that you have. The fact that life was given to you by your parents. He said, you really had little to do with the years and years of nurturing that they offered and gave you. You went to school and probably in many cases didn't pay a thing for the teachers that instilled knowledge and informed you. He said, and then after school, you will be given opportunities by organizations to take that knowledge and to flourish. Frankly, you won't pay for that. That will be offered to you. He just continued with that line of thinking, trying to help them understand that no matter how much they had achieved, there was a reason to be tremendously grateful for what they had been given. I thought of the Gospel of Matthew and thought about the story of the Christ child that we will celebrate this season. I thought about one little passage where Jesus is sending his apostles out to share that story, and he used this phrase: freely ye have received, freely give. That's actually the motto of my alma mater, Pepperdine University. As students, we never really believed it because it was far from free. We borrowed thousands and thousands of dollars. But nevertheless, the spirit was there. Freely you have received, freely give. My hope for you is that as you leave today and enter the season, that you will have moments to reflect on the gratitude that you have for all that you have been given. Then perhaps even more important, you will realize you have an obligation, as all of us do, to give as well. May God bless you in this wonderful season. See you in February.