Lily Sarafan is an innovative entrepreneur and leader whose impact spans healthcare and technology. As the co-founder and former CEO of TheKey, she transformed the startup into North America’s largest premium provider of in-home care for seniors. Now serving as executive chair, Lily continues to support the company’s mission to innovate and elevate aging at home.

She holds MS and BS degrees from Stanford University, and she serves on the Stanford University Board of Trustees. She is also a board member for several public and private companies, including Instacart and Thumbtack.

Recognized as a Fortune 40 Under 40 honoree, EY Entrepreneur of the Year, and one of the Top 100 Women CEOs, Lily’s accolades reflect her dedication to creating meaningful change.

Her mission to improve health, engagement, and quality of life continues to shape industries and inspire others. Learn more about Lily Sarafan’s remarkable journey.

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Q&A With Lily Sarafan

What inspired your journey with TheKey?

As with many entrepreneurial journeys, mine included a generous dose of serendipity. At 22, I met a brilliant couple who had started a Palo Alto-based senior care business that served as my gateway to a new landscape at the intersection of consumer services and healthcare. A deep dive illuminated the incredible opportunity for impact — 9 out of 10 seniors prefer to age in place; 4000 Americans turn 85 every day; a quarter of working adults, primarily women, provide care for an aging loved one; and the list goes on. This was also a starkly under-innovated space.

The overall concept of healthcare in the home had existed for centuries, but without consumer-focused infrastructure or an eye on operational excellence, scale, technology or service innovation. Every family we’ve had the privilege to serve over the past two decades provides continued inspiration to keep evolving and leading. We set out to create a paradigm shift for long-term aging at home, one of those breathtaking opportunities disguised as an insoluble challenge, and it has been deeply rewarding to see this vision come to life.

Throughout my upbringing, it was conventional wisdom that emotion is the opposite of logic. On personality tests, we assess whether someone is thinking or feeling. In reality, 99% of our neural processes power our intuition. Emotion and instinct are the undercurrents that logical reasoning later articulates and builds a narrative around.

In the absence of evidence, which doesn’t yet exist for a novel pursuit, it requires courage and conviction to advocate for unpopular positions based on an intuitive understanding of team, culture, and industry. Like most entrepreneurs, I had to do this many times in our foundational years with no guarantee of the outcome.

Great leaders are often distinguished by getting just a few high stakes decisions right; honed intuition and good judgment help us foresee the future and are as valuable in our decision-making as concrete data.

What are non-negotiables in your routine that keep you focused?

I prioritize sleep and notice a meaningful dip in cognitive function and aperture when I accumulate sleep debt. It’s remarkable how many facets of our physiology and neurology are primed for a lifestyle that is so distinct from the modern one so many of us live, marked by suboptimal sleep and chronic stress. In my younger years, I foolishly viewed the ability to operate on low sleep as a badge of honor, but now my sleep data is the only health data I’d be proud to show you.

I might add here that I hold a contrarian view on focus. I’ve never fit the classic narrative of the laser-focused, obsessive builder sprinting toward a single transcendent goal. While I bring deep focus to any task before me, I have actually found leverage in engaging with a wide set of pursuits at a time. This generalist approach has led me to think about progress at a systems level and over a longer arc, to draw on diverse and divergent perspectives, and to find unexpected connections across seemingly disparate fields.

What has been your biggest challenge while on this journey?

There is no consistent playbook for transitioning from chief executive to executive chair of a company. While I had been preparing for the hand-off for close to a year, it took time and intention to be engaged with the company I love from a different altitude. I remain steadfast in my commitment to our mission while our stellar management team executes masterfully day to day. Having experienced the boardroom as an operator and independent director has also helped me to harmonize goals across various stakeholders in various settings.

What advice would you give to other female entrepreneurs or CEOs?

If you can improve your expertise and insights in one topic, make it human nature. Books are a powerful and enduring technology — we can consume in a few hours what someone spent years if not decades synthesizing for our benefit. An elevated understanding of evolutionary neurobiology, neuropsychology and behavioral economics in non-fiction (and the human condition in fiction) will be forever relevant. Authors that come to mind are E.O. Wilson, Daniel Kahneman, Robert Sapolsky, Jonathan Haidt, Tali Sharot and Robert Wright.

On a more tactical level, take a segmented view of your business down to the smallest components. I once heard that if your head is in the oven and your feet are in an ice bucket, it doesn’t matter what your average body temperature is. Averages can be deceiving and outliers can provide an important signal.

Finally, thank you for taking a risk to improve a corner of the world. There is no shortage of grand challenges, and we need as many rigorous explorers as possible to navigate them.

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