Commitment to Quality and Safety
Accreditation
UC Davis Medical Center earned accreditation from the oldest and largest hospital health standards-setting organization in the U.S.
What Accreditation Means
UC Davis Medical Center is accredited by The Joint Commission, an independent not-for-profit organization dedicated to raising the level of safety and quality of health care. The health care industry considers accreditation a symbol of quality, and The Joint Commission the nation’s predominant health standards-setting body.
Accreditation is essentially an inventory of operational systems and procedures that the Joint Commission believes are critical to the safety and quality of patient care at a hospital. Joint Commission standards address a hospital’s performance in specific areas, and specify requirements to ensure that patient care is provided in a safe manner and in a secure environment.
The Joint Commission develops its standards in consultation with health care experts, providers, researchers, measurement experts, purchasers and consumers. Its governing board includes physicians, administrators, nurses, employers, quality experts, a consumer advocate and educators.
Accreditation is voluntary and supplements mandatory government licensure and certification.
How Accreditation Works
The Joint Commission uses a wide range of standards for hospital accreditation concerning a wide variety of topics, such as:
- Educating patients and upholding patient rights
- Controlling infections
- Managing medications
- Preventing medical errors
- Verifying staff qualifications and competency
- Emergency preparation
- Collecting performance data and using it to drive improvements
The commission issues a customized list of standards and systems for hospital staff to check their operations against. Hospitals submit reports to the commission for review and consideration, and undergo on-site surveys and inspections that may last a week.
How UC Davis Medical Center Maintains Accreditation
To keep its accreditation, UC Davis Medical Center must also:
- Perform focused standards assessment with action plans to address any compliance issues
- Submit data every three months about how it treats certain conditions, such as heart attack and pneumonia
- Submit to unannounced on-site surveys once every three years. During an accreditation survey, The Joint Commission evaluates an organization’s performance of functions and processes aimed at continuously improving patient outcomes. For instance, surveyors select patients based on established clinical service groups and conduct patient/unit tracers to review the services patients received. Surveyors also use on-site observations and interviews and review documents and information requested to evaluate compliance.
How to Report Problems or Concerns
As a patient, you can make your care safer by being an active and informed member of your health care team. Being involved and asking questions is the basis of The Joint Commission’s Speak Up campaign. It’s a national initiative to maintain and increase safety by encouraging patients to actively engage in their care plan.
Please tell us if you have care or safety concerns that we haven’t addressed to your satisfaction. Contact medical center management through UC Davis Medical Center’s Patient Relations department at 916-734-9777 or 800-305-6540. Additionally, you may also contact The Joint Commission directly to report a patient safety concern or file a complaint.