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The Growth Quality Score: Why Some Businesses Survive and Others Don’t

I've spent 27 years in marketing, much of it as a relentless operator, learning that having an idea and building a sustainable business around it are two very different things. Hilton, HCA Healthcare, Party City and Getty Images offer four very different lessons in competitive advantage, growth economics and organizational maturity. Two continued thriving as public companies, one collapsed, and another is restructuring. What separates them isn't simply the strength of their brands or relationships, but how effectively their operating models convert those advantages into economic value. That got me thinking about the Growth Quality Score, a framework for understanding whether a business is becoming stronger as it scales or simply more expensive to operate.

Cezanne Huq 36 min read
PE-Risks

What 27 years as a marketing operator, three private-equity-backed companies and decades of financial history tell us about competitive advantage, business maturity and the economics of sustainable growth.

The writing on the wall

Getty Images announced on October 12, 2026, that it had reached an agreement with its major financial stakeholders to restructure through a prepackaged Chapter 11 process, with the expectation of returning to private ownership. The proposed transaction includes an equity commitment of approximately $533 million from its principal shareholders, including the Getty family and Koch Equity Development, along with changes to its debt structure intended to improve its financial position. Getty expects to continue operating normally throughout the process, and the announcement shouldn’t be confused with a decision to liquidate the business.

Most of us will probably glance at the news and move on. Getty Images, stock photography, generative AI. The writing on the wall seems pretty obvious. After all, why pay for stock imagery when technology can generate seemingly limitless alternatives in seconds? But perhaps that’s precisely why we overlook what these developments mean for our own businesses. The explanation may appear straightforward, but the consequences for an established organization, its relationships, capabilities and operating economics are considerably more complicated.

Getty spent three decades building relationships with major publishers, advertisers, entertainment companies, sporting organizations and content creators. It accumulated extensive archives, exclusive access to certain events and content, commercial licensing capabilities and a distribution network that would be extraordinarily difficult to replicate. More than 70% of its booked revenue in 2025 came from customers with relationships spanning at least ten years. By most conventional measures, these are formidable competitive advantages, particularly when viewed through Michael Porter’s work on competitive strategy.

Yet those advantages don’t necessarily protect the economics of the products and services built around them. A publisher might retain its Getty relationship while reducing purchases of generic imagery. An advertiser may continue licensing exclusive editorial or entertainment photography while replacing other creative requirements with generated content. The relationship survives, but the revenue, pricing and contribution margin associated with it may change substantially. None of this establishes that Getty’s customers have universally reduced spending or that AI alone caused its restructuring. The point is that the economic value of a competitive advantage can change independently of whether the advantage itself still exists.

This raises a question I’ve become increasingly interested in: Can the relationships and capabilities that made a business successful continue to support the organization built around them? It’s a question about considerably more than Getty. It applies to businesses whose products are becoming increasingly substitutable, those whose distribution has shifted to powerful intermediaries, and those whose internal operating models were designed around market conditions that no longer exist.

I wanted to explore this through three businesses that went from private-equity ownership back to public markets: Hilton Worldwide, HCA Healthcare and Party City. Two continued operating successfully as public companies. The third filed for bankruptcy twice and ultimately wound down its corporate retail business. Their histories are very different, but they provide useful evidence of how growth, organizational design, capital requirements and competitive advantage interact over time.

Why I’m building the Growth Quality Score

I’ve spent 27 years in marketing, much of it as a relentless operator. I’ve worked across businesses at very different stages of maturity, with different growth expectations, customer dynamics, competitive pressures and organizational challenges. Over that time, I’ve developed a particular appreciation for the difference between having an idea, building something around it and establishing an operating system capable of producing sustainable results.

Years ago, I remember meeting with the Meatless Monday folks at the Yale Club in New York. During the conversation, one of their leaders described me, quite directly, as the “how” guy. I eventually extrapolated that into describing myself as a “blue-collar marketer.” I never considered it a slight, nor did I spend much time thinking about it. It was a reasonable description of how I approached the work, and in many respects it still is.

The world has no shortage of ideas. I certainly don’t. What I’ve found considerably less common is a clear-eyed understanding of how to execute those ideas, make the economics work and build a durable system that can withstand the challenges a business will inevitably face throughout its lifespan. An interesting concept might create the initial opportunity, and a compelling product or service might generate early demand, but translating that into a business capable of sustaining growth requires an entirely different level of operational discipline.

I’ve also learned that businesses rarely evolve according to plan. We make deliberate decisions about products, pricing, customer acquisition, hiring, capital allocation and organizational design, each intended to produce a particular outcome. Those decisions create dependencies, some anticipated and others not. A promotional strategy might increase new customers while reducing the quality of the cohorts acquired. A new sales channel might improve distribution while gradually transferring the customer relationship to an intermediary. An organizational structure that worked brilliantly at $50 million in revenue may introduce unnecessary complexity at $500 million.

Meanwhile, the environment continues changing. Competitors introduce alternatives, suppliers renegotiate terms, customers change how they discover and evaluate products, and technological innovation changes what can be delivered and at what cost. Some of those developments are incremental. Others can undermine years of investment almost overnight. An organization may still be executing against its original plan when the market has already moved beyond the assumptions supporting that plan.

This is what led me to think about developing a more structured way to analyze the maturity of a business, the quality of its growth and its exposure to the environment in which it operates. I’d like to better understand the interaction between internal decisions, both planned and unplanned, external developments, and an organization’s response to those changes. Throughout that exercise, the customer, relationships and competition remain central because they ultimately determine demand, value creation and the economics a business can retain.

I don’t particularly want another framework that looks impressive in a presentation and does little to improve the business. I’m interested in whether we can develop something practical that helps us understand what’s working, what isn’t, why the economics are changing and how leadership can intervene before the consequences become difficult to reverse.

The Doomsday Score and the Growth Quality Score

I’ve started thinking about two related measures. The first, which I’m calling the Doomsday Score, evaluates the vulnerability of a category’s competitive advantages to changes in technology, competition, customer behavior and market economics. The second, the Growth Quality Score, or GQS, examines how effectively a business converts its market position, customer relationships and operating capabilities into sustainable economic value.

For the Doomsday Score, I’d begin with three interconnected vectors: relationships and market access, differentiated capabilities, and the competitive pressures that influence pricing power and substitutability. Porter’s Five Forces provide a useful foundation for the third vector, especially when examining the bargaining power of buyers and suppliers, threats from new entrants and substitutes, and the intensity of existing competition. I’d also want to understand how rapidly those pressures are changing, because their rate of change can be as consequential as their current severity.

The Growth Quality Score brings that assessment inside the business. A category could be experiencing substantial disruption while an individual company remains capable of adapting and generating attractive returns. Conversely, an industry might appear relatively stable while a business within it experiences deteriorating customer economics, excessive capital requirements or an operating structure that becomes progressively more expensive to maintain.

I’d propose six components for the GQS, with a combined weighting of 100 points.

DimensionWeightWhat I’d examine
Customer demand and durability20Acquisition quality, retention, repeat behavior, organic demand, customer value and concentration
Pricing power and differentiation15Realized pricing, discount dependency, competitive alternatives and willingness to pay
Incremental contribution economics20Fully loaded acquisition cost, marginal contribution, payback and returns from new business
Cash conversion and capital requirements20Operating cash, working capital, maintenance and growth investment
Financial resilience15Debt, interest obligations, liquidity, financing capacity and downside exposure
Operating-model adaptability10Organizational maturity, decision quality, experimentation and the ability to respond to change

The weights are an initial hypothesis rather than a statistically validated model. They would need to be calibrated by industry and tested against historical outcomes before being used to predict business distress. I also wouldn’t assume that the same measure means the same thing across different business models. Customer LTV and acquisition payback are highly relevant to subscription businesses, while hotel franchising, hospital operations and physical retailing require different definitions of the economic unit.

I would measure each dimension using a combination of current performance, historical trends and forward-looking indicators. Importantly, the score needs to account for the quality of the underlying data. A business with incomplete customer economics or inconsistent financial definitions shouldn’t receive a high-confidence assessment simply because its reported numbers look attractive.

And the score needs to connect to decisions. An organization that identifies weakening pricing power but continues allocating resources as though nothing has changed isn’t improving its position by measuring the problem. The value comes from understanding the consequences, testing alternatives and making changes that improve the underlying economics.

With that in mind, I wanted to examine three businesses whose financial histories provide unusually useful evidence of what happens when capabilities, capital and execution interact over time.

Hilton Worldwide: Making the operating model more valuable than the physical assets

In July 2007, Blackstone agreed to acquire Hilton Hotels Corporation in a transaction valued at approximately $26 billion, including debt. The acquisition closed on October 24, 2007, with shareholders receiving $47.50 per share. Hilton was already an established global hospitality business, with brands, distribution capabilities, hotel ownership interests, management contracts and a substantial presence across multiple lodging segments.

The timing of the acquisition was hardly ideal. Within a year, the global financial crisis would severely affect credit markets, consumer spending, corporate travel and hotel operating performance. For a business involving substantial hotel property ownership and financing obligations, those were particularly challenging conditions. A transaction that might have looked attractive under more favorable market assumptions faced a very different economic reality shortly after closing.

Blackstone appointed Christopher Nassetta president and CEO in October 2007. Nassetta came from Host Hotels & Resorts, where he had extensive experience with hotel ownership and the economics of lodging assets. His appointment matters because Hilton’s challenge wasn’t simply generating more demand for hotel rooms. It needed to examine the organization, its portfolio of activities and the way its brands and commercial capabilities could generate value across a larger network.

Hilton’s 2013 IPO prospectus described a transformation that included organizational alignment, brand development, operating performance and expansion of its management and franchise business. Those changes weren’t independent workstreams. They affected the economics of how Hilton could grow, where capital needed to be invested and which capabilities would become increasingly important to the organization.

What changed between the buyout and the IPO

Before the transformation, Hilton operated three major business segments: management and franchising, owned and leased hotels, and timeshare. Each benefited from hotel demand and the company’s brands, but the capital required to expand them differed considerably. Owning an additional hotel involves real estate, equipment, renovation, maintenance and financing. Franchising an additional hotel involves a different set of investments in distribution, reservations, brand standards, owner relationships, technology and commercial support.

That distinction became central to Hilton’s growth strategy. Between June 2007 and September 2013, Hilton expanded its open room count by approximately 176,000 rooms, or 36%. Its management and franchise segment grew room count by approximately 40%, accounting for 98% of the company’s overall room growth, with virtually no corporate capital investment in those additions. Hilton’s development pipeline also increased 60% to roughly 185,700 rooms, with more than 99% of those rooms in the management and franchise segment.

The company was expanding its economic reach without needing to finance the same proportion of additional physical infrastructure. Its brands, distribution, reservation capabilities and management expertise could be extended across properties owned by other parties, with Hilton earning management, franchise and licensing fees associated with those relationships.

The geographic component was equally important. Rooms in the development pipeline outside the United States increased from less than 20% to more than 60%, while international rooms under construction increased from less than 15% to nearly 80%. Hilton was expanding into markets where its brands had historically been less represented, using commercial capabilities that could support a larger network without requiring the company to become the principal real estate investor in every market.

Hilton returned to public markets in December 2013 at $20 per share. Blackstone retained substantial ownership following the IPO, so the listing wasn’t the end of the sponsor’s involvement. In fact, the more revealing step came several years later, when Hilton completed the separation of Park Hotels & Resorts and Hilton Grand Vacations in January 2017.

That transaction created three separately traded businesses. Park held substantial hotel real estate, Hilton Grand Vacations operated the timeshare business, and Hilton Worldwide became more concentrated around its management, franchise and commercial services operations. In its 2016 investor presentation, Hilton described a post-separation business expected to generate approximately 90% of adjusted EBITDA from fees.

The transaction changed more than the capital structure. It helped clarify which capabilities Hilton intended to monetize and how the organization would expand. The commercial proposition increasingly centered on brands, distribution, customer relationships, reservation infrastructure and operating expertise, rather than requiring direct ownership of a proportionate share of the hotel network.

What the 2025 numbers tell us

Hilton’s 2025 results demonstrate how far this model has developed. At year-end, the company reported 9,158 properties and 1,351,351 rooms across 143 countries and territories, with approximately 243 million Hilton Honors members. During the year, it opened approximately 97,000 rooms, added a net 81,100 rooms and achieved 6.7% net unit growth. The development pipeline reached approximately 520,500 rooms.

The financial reporting requires careful interpretation because Hilton’s consolidated revenue includes substantial cost reimbursements collected and spent on programs operated for hotel owners. Simply dividing adjusted EBITDA by headline GAAP revenue can therefore obscure the economics of its fee-based operations.

Hilton metric20242025
Franchise and licensing fees$2.60B$2.78B
Management fees$659M$689M
GAAP consolidated revenue$11.17B$12.04B
Cost reimbursement revenue$6.43B$7.09B
Adjusted EBITDA$3.43B$3.73B
Operating cash flow$2.01B$2.13B
Comparable system-wide RevPAR growth—0.4%

Hilton’s management and franchise segment comprised 873 managed properties and 8,239 franchised or licensed properties at the end of 2025. Its ownership segment contained only 46 hotels, representing 15,287 rooms. That is a very different business mix from the organization Blackstone acquired in 2007.

The distinction between 6.7% net unit growth and 0.4% comparable RevPAR growth is worth examining. Hilton’s existing hotel base wasn’t generating exceptional comparable revenue growth, but the business continued increasing its fee-generating network. The economics of expansion therefore depended substantially on adding properties, retaining hotel owners, maintaining franchise economics and making the Hilton commercial proposition valuable to both owners and guests.

Hilton’s disclosed franchise and licensing revenue increased approximately 6.9% in 2025, while management fees grew approximately 4.6%. That growth came from multiple sources, including network expansion, contractual fees and partnerships. Revenue from co-branded credit cards and other licensing arrangements also contributed, demonstrating that Hilton could monetize its customer relationships and commercial ecosystem beyond the hotel stay itself.

For Growth, there’s an important implication. The customer relationship isn’t simply the hotel guest. Hilton also needs property owners and developers who view its brands, reservations, loyalty program and operating support as economically attractive. If the guest proposition weakens, the owner proposition can eventually weaken with it. If Hilton maintains strong customer demand and distribution, owners have a reason to enter or renew long-term agreements, creating further network expansion opportunities.

This is a system of interconnected economics. Additional properties increase availability and opportunities for customers to stay within Hilton’s portfolio. More guest engagement can improve the attractiveness of the platform to hotel owners. The expanded network can then generate more franchise and management fees, subject to contractual terms and operating performance.

Where I’d challenge Hilton’s growth quality

Hilton’s operating model is attractive, but it shouldn’t be presented as indestructible. The company reported approximately $12.5 billion in debt at the end of 2025, and its 2025 financial statements show that it repurchased approximately $3.2 billion in shares while generating $2.13 billion in operating cash. Buybacks, financing and capital allocation therefore need to be assessed alongside operational growth.

I’d also examine the economics from the hotel owner’s perspective. A franchise fee can be attractive to Hilton while becoming less attractive to an owner facing higher financing costs, labor expenses, renovation requirements or declining property-level profitability. Hilton’s distribution and brand capabilities have value only while they continue producing appropriate returns for both parties.

My GQS assessment would therefore look beyond Hilton’s own revenue and margin. I’d want to understand owner retention, new development economics, franchise fee realization, the customer demand generated by Hilton’s distribution network, loyalty behavior, direct versus intermediary bookings and the cost of maintaining brand standards and commercial infrastructure.

The larger lesson is that Hilton didn’t simply retain valuable relationships and brands. It developed an operating model that allowed those capabilities to support expansion with comparatively limited direct property investment. Its growth system became more scalable because the organization changed how it captured economic value.

HCA Healthcare: Making a capital-intensive business generate the cash to keep growing

HCA Healthcare offers a different lesson because the operating model cannot be made asset-light in the same way. Hospitals require substantial physical infrastructure, clinical equipment, highly trained professionals, regulatory compliance and continuous reinvestment. The business also depends on complicated relationships with physicians, payers, government programs and the communities it serves.

HCA was founded in 1968 by Dr. Thomas Frist Sr., Dr. Thomas Frist Jr. and Jack Massey. By 2006, it had become one of the largest hospital operators in the United States. In July of that year, an investor group led by Bain Capital, Kohlberg Kravis Roberts, Merrill Lynch Global Private Equity and founder Thomas Frist Jr. agreed to acquire the company. The transaction closed in November 2006 at approximately $33 billion, including the assumption or repayment of $11.7 billion in debt.

Jack Bovender was chairman and CEO at the time of the transaction, and Richard Bracken subsequently led the company through its return to public markets. The buyout introduced a substantial financial burden into a business that already required significant operating and capital investment. Unlike Hilton, HCA couldn’t fundamentally separate itself from the cost of delivering its core service.

There was also a major shareholder distribution before the IPO. HCA’s 2010 Form 10-K records distributions totaling approximately $4.33 billion, financed through available credit facilities, debt issuance and cash. Those payments created liquidity for shareholders but also illustrate the importance of examining the relationship between financing decisions and the capital requirements of the underlying operation.

HCA returned to public markets in March 2011 through an offering of approximately 126.2 million shares at $30 per share. The company sold approximately 87.7 million new shares, generating roughly $2.51 billion in net proceeds, while existing shareholders sold additional stock. HCA intended to use its proceeds primarily to reduce indebtedness and for general corporate purposes.

At the end of 2011, HCA reported $29.68 billion in annual revenue, $6.06 billion in adjusted EBITDA and approximately $27.05 billion in total debt. Its reported debt-to-adjusted-EBITDA ratio was 4.46 times. There was meaningful operating profitability, but leverage remained substantial, as did the capital needed to maintain and develop its facilities.

The economics behind HCA’s growth

HCA’s competitive advantage is built around operating facilities in markets where it has established clinical capabilities, physician relationships, payer contracts, local presence and infrastructure. Those capabilities require time and capital to replicate, making market entry considerably more complicated than launching a new consumer product or e-commerce business.

But healthcare introduces constraints that make conventional marketing growth measures inadequate. HCA can’t simply stimulate demand without considering medical necessity, quality, capacity and clinical outcomes. Nor can the organization maximize contribution margin without accounting for the requirements of patient care, regulatory obligations and access.

A useful economic unit might be a hospital, a service line, an outpatient facility or additional clinical capacity. Growth quality then depends on the demand served, reimbursement rates, service complexity, utilization, labor requirements, capital investment and the clinical and financial outcomes produced.

At the end of 2025, HCA operated 190 hospitals, 121 freestanding ambulatory surgery centers and 31 freestanding endoscopy centers. Its reported revenue reached $75.60 billion, compared with $70.60 billion in 2024 and approximately $65.0 billion in 2023. That represents substantial growth from the $29.68 billion reported in 2011, although the historical increase reflects many years of acquisitions, market development, pricing, reimbursement changes and operating activity.

HCA metric202320242025
Revenue~$65.0B$70.60B$75.60B
Operating cash flow$9.43B$10.51B$12.64B
Capital expenditures$4.74B$4.88B$4.94B
Operating cash less capex$4.69B$5.64B$7.69B
Share repurchases$3.81B$6.04B$10.07B

The operating cash numbers are particularly important because they show that HCA continued generating substantial cash after funding its reported capital expenditures. In 2025, operating cash exceeded capital expenditure by approximately $7.69 billion, before acquisitions, dividends and other financing uses.

That provides a meaningful degree of operating flexibility. But the company also repurchased approximately $10.07 billion in stock during 2025, while indebtedness increased by approximately $3.29 billion. Total debt reached $46.49 billion, and interest expense was approximately $2.25 billion. A business can be operationally strong while still making aggressive financial decisions that deserve scrutiny.

I’d also examine what’s driving the revenue increase. HCA reported 6.6% same-facility revenue growth in 2025, reflecting the combined effect of a 2.4% increase in equivalent admissions and a 4.1% increase in revenue per equivalent admission. The distinction matters because revenue per admission is influenced by service complexity, payer mix and reimbursement arrangements, not simply the company’s ability to increase prices.

Another important consideration is the role of government reimbursement. HCA reported approximately $6.2 billion in revenue from Medicaid state-directed and supplemental payment programs during 2025, compared with $5.5 billion in 2024. These programs are subject to policy and regulatory changes. A business that depends on them needs to understand how changes in government financing could affect the economics of its facilities and services.

The company’s geographical concentration adds another dimension. HCA’s June 2026 filing reported that hospitals in Texas and Florida accounted for approximately 55% of quarterly revenue and 58% of admissions. Concentration can produce operating advantages through local scale, physician relationships and resource allocation, but it also increases exposure to the regulatory, reimbursement and competitive conditions of those markets.

Why HCA’s model has endured

HCA has sustained a business that generates sufficient operating cash to support substantial ongoing investment, despite its high capital requirements. Its physical presence, established clinical services and market relationships create meaningful barriers to entry, while the operating network provides opportunities for scale in technology, procurement, administrative support and specialized services.

That doesn’t mean each hospital or service line is equally profitable, nor does company-wide operating cash establish that every capital investment produces an attractive return. I’d want to see the economics by market and service line, including patient volumes, payer mix, clinical labor, utilization, cost per case, reimbursement, capital requirements and quality outcomes.

I’d also distinguish between investment that preserves current operating capacity and investment intended to produce incremental growth. Both are necessary, but their economic implications differ. A new surgical facility may create additional capacity and revenue, while replacing aging equipment may be necessary simply to maintain the existing service proposition. Treating both as equivalent growth investment can obscure the actual return on incremental capital.

For a growth executive, HCA demonstrates that sustainable growth isn’t exclusively about reducing capital intensity. A company can operate with substantial fixed assets, labor requirements and debt if its demand, margins, cash generation and reinvestment obligations remain sufficiently aligned. The question is whether management can maintain that alignment as market conditions, reimbursement structures and service requirements change.

HCA also illustrates why financial measures need to be supplemented by operating and service-quality indicators. In healthcare, profitability cannot be evaluated independently of patient safety, clinical outcomes, access and regulatory compliance. Any framework that rewards financial performance while ignoring those obligations would be incomplete.

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