CHICAGO — Chris Van Gorder might be the closest thing I've seen to a rock star during these first few days at the American College of Healthcare Executives' annual gathering of leaders this week.

Every session I've seen him in (OK, two) has been packed; every joke garners a laugh; every answer is seemingly on point. But beyond his way of commanding a room, the former cop and current CEO of Scripps Health in San Diego has done inspiring things when it comes to rooting out variation and taking costs out of the five-hospital system. Three years ago, the system eliminated $77 million in operating costs by cutting non-value-added variation. It cut another $66 million last year, and expects to match that figure in 2013.

One of the key ingredients in that mix has been physician engagement and alignment, Van Gorder told attendees during a session on Tuesday. Scripps was losing about $15 million a year back in the late 1990s, physician dissatisfaction grew and they voted "no confidence” in the previous CEO. Scripps' strategy at the time didn't embrace partnering with physicians to make decisions, and docs, in turn, felt threatened.

So Scripps formed a physician leadership council, giving doctors a forum to chew over important issues and speak their mind. The group is completely informal and isn't any part of the providers' bylaws, but Van Gorder says that hasn't mattered.

"In 14 years, we've accepted 100 percent of the recommendations from that group, and only one vote has been less than unanimous," he says. "It's the most formal and powerful nonexistent entity in the organization."

Scripps has moved toward a similar approach for its independent medical groups (the system has 2,000 physicians in independent practice to go with 600 employed), carefully adhering to legal requirements. As with the employed docs, 100 percent of the independent medical groups' recommendations have received the stamp of approval.

Iowa Health System also invites physicians to help drive change, says President and CEO William Leaver, who also took part in ACHE's Tuesday session. He believes that hospitals that don't engage their physicians now and, instead, hang on to the cantankerous relations of the past will get burned in the long run.

"It's very important to being successful that you understand this is a multiyear task, and this begins with what credibility and trust physicians have in you as leaders," Leaver says. "Are you willing to invite them to be at the table? Are you willing to have them be a part of it? Are you willing to accept their influence in terms of what really matters for the patient?"

At Scripps, that's meant partnering with doctors in the management of clinical protocols at every site of care and across the entire care continuum, Van Gorder says. Scripps cultivates physician leadership talent from within; it launched its Physician Leadership Academy in 2011 to target rising leaders and to give doctors the necessary experience to rise through the ranks.

"I know there are some physicians out there who believe, 'I'm an M.D. and I can take a six-week class and be a CEO,' Van Gorder says. "But I didn't learn how to be a CEO in graduate school. I learned after 25-plus years of experience. It's our job to give those doctors experience."