Starting and scaling a business is never easy, particularly in healthcare. BrightStar Care Founder Shelly Sun Berkowitz turned a personal family challenge into a nationwide healthcare franchise empire. On today’s episode of The Small Business Show, she shares her insights on building and growing a business and how she now helps other founders succeed through her company, Founder 2 Founder.
In late 2001, Berkowitz was searching for a company that could provide comprehensive homecare for her grandmother, who required both medical and non-medical services. She became frustrated managing two separate service providers because no single company offered the full continuum of care.
Recognizing a significant market need, Berkowitz launched BrightStar Care in October 2002. Although she had no background in healthcare, she was determined to provide families with a reliable, all-in-one source of care. Today, the company operates over 400 franchises nationwide.
Accessing capital is one of the most daunting challenges when building a business. To scale BrightStar Care, Berkowitz chose franchising—a strategy not commonly used in healthcare at the time. Her first exposure to franchising came in 2004 when she invested in Choice Hotels.
Franchising offered a low-cost path to expansion and allowed her to maintain company culture without early dilution from outside investors. It also gave aspiring entrepreneurs the opportunity to own a business by replicating BrightStar Care’s model in local markets.
Operating a franchise model can simplify scaling, but challenges remain. Founders often become attached to early employees, blurring the line between business and friendship. As a business grows, it requires individuals with stronger skill sets. Berkowitz advises leaders to prioritize the business first, gracefully exit employees who have reached their growth ceiling, and help them find new opportunities. Over time, she reshuffled her senior leadership team five times to scale successfully.
For companies with 25 to 50 units, a generalist team can work effectively. Beyond that, hiring specialists is critical to scale efficiently. Founders must bring in people with greater expertise than themselves in key areas to ensure long-term success and profitable growth.
Berkowitz launched Founder2Founder after identifying a gap in founder-focused advisory during the sale of BrightStar Care. The company provides strategic guidance for scaling or exit decisions, cultural alignment, and practical tools—all without conflicting financial incentives.
"Anchoring to the 'why' you started gets you through the hard days."
Managing employees and company growth can be stressful, especially when the team presents every problem to the founder. Berkowitz recommends the 1-3-1 framework: for every problem, employees propose three possible solutions, and the leader makes a final recommendation. This approach fosters autonomy, empowers the team, and frees the founder’s bandwidth as the company grows.
Founder2Founder also provides a large library of free resources, including Berkowitz’s book “Grow Smart, Risk Less.” She also funds a free franchise education program for aspiring entrepreneurs through the University of Tennessee. To learn more about the program, click here.
Franchise, The Small Business Show