Developing the Next Generation of Physician Changemakers: "You Have to Love the People, and Love the Process".

INTRODUCTION: There is a growing consensus among patients, physicians, and policymakers that healthcare must undergo a massive transformation to promote healthcare worker well-being. The Institute for Health developed the Triple Aim framework for high-performing health organizations, which focused on reducing costs, improving individual patient experience, and population health. The move from the Triple to Quadruple Aim added a focus on the well-being of healthcare professionals, acknowledging growing literature and a movement that healthcare professionals' well-being is crucial to the quality of healthcare patients receive.  Objectives: This study sought to investigate the individual transformation and the organizational contributors that promote effective change. More specifically, how do attending physicians from various specialties construct their understanding and make sense of the individual and organizational factors that contribute to their development as changemakers? Given the exploratory nature of this topic and the limited existing literature, we employed a semi-structured interview format and an inductive analytic approach to allow unanticipated insights to emerge to determine the individual and organizational factors that support and enhance changemaking in attending physicians.

METHODS: Qualitative semi-structured interviews were conducted with 15 physician changemakers who have successfully implemented transformative healthcare initiatives. Data were analyzed using Braun and Clark's reflexive thematic analysis (RTA) to identify key themes and develop a comprehensive understanding of their experiences.

RESULTS: Analysis at the individual and organizational level illuminated a constellation of interconnected themes propelling these physician changemakers: Participants' insatiable appetite for learning, coupled with sustained inspiration and the capacity for embracing ambiguity and emotional regulation, drives changemakers' courage and resilience. Notably, while challenging, participants did not perceive changemaking as unduly burdensome. At the organizational level, changemakers perspicaciously report leveraging the system, engage in job crafting through protected time, and authentically take accountability and own the change.  Conclusions: With an increased focus on addressing the systems issues that impact quality healthcare, this study provides a roadmap for individual and organizational actions to expand and accelerate the number of physician changemakers.