The nation's "best" hospitals aren't even in the top 400 list of safest hospitals.

In the latest advance for health care accountability, the country’s leading hospital accreditation board, the Joint Commission, released a list on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like heart attack and pneumonia. Almost without exception, most highly regarded hospitals in the United States, from Johns Hopkins in Baltimore to the Mayo Clinic in Rochester, Minn., did not make the list.

The Joint Commission list omitted the Cleveland Clinic; Massachusetts General Hospital in Boston; Duke University Medical Center in Durham, N.C.; Ronald Reagan U.C.L.A. Medical Center; and the University of California San Francisco Medical Center, among others. It did not include a single hospital in New York City, or the most prominent centers in Chicago and Houston.

The safest and most effective hospitals aren’t always what you think. Many of the nation’s “top” hospitals think their reputation allows them to do whatever they want, when, in the end, the evidence now suggests you’ll get higher quality, safer care at your local no-name hospital.