Enhancing Equitable Access to Patient Accommodation: A Social Work–Led Systems Intervention in Urban Public Healthcare

Enhancing Equitable Access to Patient Accommodation: A Social Work–Led Systems Intervention in Urban Public Healthcare | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Equitable Access to Patient Accommodation: A Social Work–Led Systems Intervention in Urban Public Healthcare Kishor Howale, Dr Vinit Samant, Dr Sandeep Sawakare, Dr Naveen Chaturvedi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7019278/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: In urban public hospitals across India, socioeconomically disadvantaged patients frequently lack access to safe, affordable accommodation during treatment. This not only disrupts care continuity but also erodes patient dignity. Methods: This case study from a Tata Memorial Hospital in Mumbai, India, outlines a systems-level intervention that replaced administrative personnel with Medical Social Workers (MSWs) to coordinate with accommodation centers. Emphasis was placed on proactive communication, ethical oversight, and patient-centered follow-up. Results: The intervention resulted in a six fold increase in daily room availability—from 5–6 to over 30—and enabled patients to choose among options. Follow-up calls with both accommodated and non-accommodated patients informed continual refinement of the system and reinforced trust. Conclusion: The findings underscore the power of empathy-driven systems thinking in bridging operational gaps and promoting health equity through a low-cost, scalable model. health equity medical social work patient accommodation hospital systems ethical partnerships India 1. Introduction Health systems committed to equitable care are expected to address both clinical and non-clinical barriers that impact patient well-being. Among these, securing appropriate accommodation remains one of the most challenging barriers—particularly for critically ill and vulnerable patients, for whom it is essential to maintain dignity and ensure treatment adherence. Without access to dedicated accommodation facilities, countless patients in India’s urban hospitals are forced to endure treatment while sleeping in exposed, often hazardous outdoor conditions—an indignity that compromises both their safety and healing process Despite partnerships with multiple accommodation centers, the hospital in focus experienced significant underutilization of available rooms, typically averaging 5–6 vacancies per day. The passive, administrative coordination model led to delays, inefficiencies, and denied access for patients most in need. Recognizing this systemic gap, The department of Medical Social Services of Tata Memorial Hospital launched a proactive intervention built around Medical Social Workers (MSWs) who combined professional advocacy, real-time logistics, and ethical oversight to create a responsive and patient-centered system. This paper presents the design, outcomes, and policy relevance of that intervention—framed as a replicable, dignity-centered model for health systems facing similar challenges. 2. Methodology 2.1 Setting and Initial Conditions The hospital, located in Mumbai, serves a high volume of underprivileged patients requiring extended treatment stays. Accommodation partnerships existed with 21 private centers, but coordination relied on passive vacancy updates through administrative staff. 2.2 Identified Gaps Irregular vacancy reporting Minimal engagement with accommodation providers Lack of patient prioritization or needs assessment Exposure to overcharging and informal exploitation These shortcomings severely restricted equitable access to lodging and compromised the hospital’s ability to uphold comprehensive care. 2.3 Intervention Design The hospital deployed professionally trained Medical Social Workers (MSWs) to replace administrative staff in coordinating accommodation logistics. Key elements included: Daily Outreach: MSWs proactively called all centers each morning to confirm vacancies. Ethical Regulation: Centers were contractually bound to adhere to hospital tariffs, with zero tolerance for exploitative pricing. Rapport-Building: MSWs engaged regularly and empathetically with accommodation providers to foster trust. Live Vacancy Logs: Centralized tracking enabled real-time referral based on urgency and financial vulnerability. 2.4 Patient-Centered Refinement Post-allocation, MSWs conducted daily follow-up calls with: Patients who had accepted accommodation Patients who had refused available options The intent was to: Confirm service delivery and satisfaction Understand patient preferences and refusal reasons Inform iterative improvements to referral practices 3. Results 3.1 Vacancy Expansion Pre-intervention: 5–6 rooms/day Post-intervention: 30–35 rooms/day. This six fold increase significantly reduced patient exposure to unsafe living conditions. 3.2 Empowerment Through Choice Patients moved from accepting limited options out of desperation to making informed choices. Instances of refusal indicated not failure—but improved agency and range of options. 3.3 Ethical Safeguards All accommodation centers within the partnership network complied with transparent and standardized tariff structures, ensuring affordability and minimizing the risk of patient exploitation. MSWs monitored adherence. Centers failing to meet these ethical criteria were delisted from the referral network. 3.4 Collaborative Relationships MSWs built trust and goodwill with center operators, resulting in increased willingness to reserve space for vulnerable patients and sustained cooperation. 3.5 Feedback-Driven Adaptability Patient feedback—especially from follow-up calls—was consistently used to refine matching strategies and improve outcomes, embedding a real-time ethical feedback loop into the process. 4. Discussion This intervention redefined logistical coordination as a site for equity advancement. By replacing task-based administrative roles with socially conscious professionals, the hospital addressed an invisible but critical determinant of care access. The six fold increase in vacancy utilization was not merely logistical—it was moral. It reflected the latent capacity of compassionate systems design to resolve long-standing gaps in care for the underserved. Embedding a feedback mechanism further established that patient voices matter—not just at the bedside but at every operational junction of the health system. More broadly, this model challenges common assumptions: transformative impact does not always require new infrastructure or technologies. It can begin with institutional empathy, ethical clarity, and a willingness to shift from passive service to active advocacy. 5. Conclusion and Policy Recommendations This initiative demonstrates that: Social workers are vital systems actors , not just support roles—they enhance ethical sensitivity and relational fluency in operational domains. Trust, communication, and ethics are infrastructure. Their absence is costly; their presence is transformative. Equity is operational , not rhetorical. Health systems can promote it with the right interventions—starting with logistics, language, and leadership. Policy Recommendations : Scale MSW engagement across non-clinical patient support pathways Establish ethical compliance protocols with third-party partners Create closed-loop systems where patient feedback informs continuous improvement Declarations Ethics Approval and Consent to Participate: Not applicable—no individual patient-identifiable data were collected. Consent for Publication: All individuals and centers described agreed to anonymous reporting and disclosure of aggregated outcomes. Competing Interests: None declared. Funding: This study received no specific grant or external funding. Author Contribution Mr Kishor Howale(OIC) Wrote the main manuscriptDr Vinit Samant (MS) Approved the policy Dr. Sandeep, Sawakare (MS) Approved the conceptDr Naveen Chaturvedi (Addl MS) reviewed the manuscript Acknowledgement Mrs. Sushmita Katkar (MSW) is the frontline worker References World Health Organization. Social determinants of health . Geneva: WHO; 2021. Available from: https://www.who.int/health-topics/social-determinants-of-health Marmot M. The Health Gap: The Challenge of an Unequal World . London: Bloomsbury; 2015. Gopichandran V, Chetlapalli SK. Advocacy for social accountability in the Indian health system: a conceptual framework. Indian J Med Ethics . 2013;10(2):94–9. Rawat J, Mehra A, Panwar V, et al. Leveraging patient feedback for quality improvement in public hospitals: a systems approach. BMC Health Serv Res . 2020;20(1):963. Bhattacharya S, Sharma N. Community-based interventions for improving equity in healthcare in urban India: A scoping review. Int J Equity Health . 2022;21(1):145. Lehmann U, Sanders D. Community health workers: What do we know about them? Geneva: WHO; 2007. Available from: https://www.who.int/hrh/documents/community_health_workers.pdf Singh R, Purohit B. Limitations of administrative coordination in public health infrastructure. Indian J Public Adm . 2021;67(4):643–56. Duffy M, Baldwin M. Social work and systems thinking: Interventions for ethical service design. Soc Work Health Care . 2019;58(7):690–704. Kundu A. Access to affordable housing in Indian cities: Challenges and interventions. Urban Stud . 2015;52(10):1902–15. Mitra A, Mehta K. Transforming public service delivery through relational models: Lessons from Indian health settings. J Health Manage . 2021;23(3):347–65 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7019278","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":478995612,"identity":"f84cff82-29d5-4746-91cf-2980a5bdef6f","order_by":0,"name":"Kishor Howale","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACAxDxgCGBgR8uxEyMlgQglGwjWYvBMWIdZs7eY/ghoSLN3vh+d+IHhl82iQ3svAfwarHsOWMskXAmJ3HbMd7NEox9aYkNzHwJ+B12I3eDRGJbRYLZMd5tDIw9h40ZmHkMCGnZ/CPxX4W9cRsJWrZJJDbkMG5gA2ph+HFYjrCWM+e/WSQcS0uccSx3M1BvmhwbQS3H25JvfKhJtudvPrvxw4c/Njz8/Gfwa0EFicD4ZCNBPQj8IVH9KBgFo2AUjAgAAEiIQ+JQdrW+AAAAAElFTkSuQmCC","orcid":"","institution":"Tata Memorial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kishor","middleName":"","lastName":"Howale","suffix":""},{"id":478995613,"identity":"04fea165-3f15-4782-8670-6bcc1193a224","order_by":1,"name":"Dr Vinit Samant","email":"","orcid":"","institution":"Tata Memorial Hospital","correspondingAuthor":false,"prefix":"Dr","firstName":"Vinit","middleName":"","lastName":"Samant","suffix":""},{"id":478995614,"identity":"6a686493-fee7-455c-af0e-c28c4e7a74eb","order_by":2,"name":"Dr Sandeep Sawakare","email":"","orcid":"","institution":"Tata Memorial Hospital","correspondingAuthor":false,"prefix":"Dr","firstName":"Sandeep","middleName":"","lastName":"Sawakare","suffix":""},{"id":478995615,"identity":"329aeff1-232b-4df7-9235-dc81a6c439e2","order_by":3,"name":"Dr Naveen Chaturvedi","email":"","orcid":"","institution":"Tata Memorial Hospital","correspondingAuthor":false,"prefix":"Dr","firstName":"Naveen","middleName":"","lastName":"Chaturvedi","suffix":""}],"badges":[],"createdAt":"2025-07-01 10:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7019278/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7019278/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89972241,"identity":"792bd1e2-63c3-4ade-9206-cc9eee79ad5d","added_by":"auto","created_at":"2025-08-27 05:39:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":558213,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7019278/v1/0c982d32-fe24-473f-b65d-a063963b16a4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhancing Equitable Access to Patient Accommodation: A Social Work–Led Systems Intervention in Urban Public Healthcare","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHealth systems committed to equitable care are expected to address both clinical and non-clinical barriers that impact patient well-being. Among these, securing appropriate accommodation remains one of the most challenging barriers\u0026mdash;particularly for critically ill and vulnerable patients, for whom it is essential to maintain dignity and ensure treatment adherence. Without access to dedicated accommodation facilities, countless patients in India\u0026rsquo;s urban hospitals are forced to endure treatment while sleeping in exposed, often hazardous outdoor conditions\u0026mdash;an indignity that compromises both their safety and healing process Despite partnerships with multiple accommodation centers, the hospital in focus experienced significant underutilization of available rooms, typically averaging 5\u0026ndash;6 vacancies per day. The passive, administrative coordination model led to delays, inefficiencies, and denied access for patients most in need. Recognizing this systemic gap, The department of Medical Social Services of Tata Memorial Hospital launched a proactive intervention built around Medical Social Workers (MSWs) who combined professional advocacy, real-time logistics, and ethical oversight to create a responsive and patient-centered system.\u003c/p\u003e \u003cp\u003eThis paper presents the design, outcomes, and policy relevance of that intervention\u0026mdash;framed as a replicable, dignity-centered model for health systems facing similar challenges.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cp\u003e\u003cstrong\u003e2.1 Setting and Initial Conditions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe hospital, located in Mumbai, serves a high volume of underprivileged patients requiring extended treatment stays. Accommodation partnerships existed with 21 private centers, but coordination relied on passive vacancy updates through administrative staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Identified Gaps\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eIrregular vacancy reporting\u003c/li\u003e\n \u003cli\u003eMinimal engagement with accommodation providers\u003c/li\u003e\n \u003cli\u003eLack of patient prioritization or needs assessment\u003c/li\u003e\n \u003cli\u003eExposure to overcharging and informal exploitation\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese shortcomings severely restricted equitable access to lodging and compromised the hospital’s ability to uphold comprehensive care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Intervention Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe hospital deployed professionally trained \u003cstrong\u003eMedical Social Workers (MSWs)\u003c/strong\u003e to replace administrative staff in coordinating accommodation logistics.\u003c/p\u003e\n\u003cp\u003eKey elements included:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eDaily Outreach:\u003c/strong\u003e MSWs proactively called all centers each morning to confirm vacancies.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEthical Regulation:\u003c/strong\u003e Centers were contractually bound to adhere to hospital tariffs, with zero tolerance for exploitative pricing.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRapport-Building:\u003c/strong\u003e MSWs engaged regularly and empathetically with accommodation providers to foster trust.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLive Vacancy Logs:\u003c/strong\u003e Centralized tracking enabled real-time referral based on urgency and financial vulnerability.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Patient-Centered Refinement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost-allocation, MSWs conducted daily follow-up calls with:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePatients who had accepted accommodation\u003c/li\u003e\n \u003cli\u003ePatients who had refused available options\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe intent was to:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eConfirm service delivery and satisfaction\u003c/li\u003e\n \u003cli\u003eUnderstand patient preferences and refusal reasons\u003c/li\u003e\n \u003cli\u003eInform iterative improvements to referral practices\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Vacancy Expansion\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003ePre-intervention:\u003c/strong\u003e 5–6 rooms/day\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePost-intervention:\u003c/strong\u003e 30–35 rooms/day. \u0026nbsp;This six fold increase significantly reduced patient exposure to unsafe living conditions.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Empowerment Through Choice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients moved from accepting limited options out of desperation to making informed choices. Instances of refusal indicated not failure—but improved agency and range of options.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Ethical Safeguards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll accommodation centers within the partnership network complied with transparent and standardized tariff structures, ensuring affordability and minimizing the risk of patient exploitation. MSWs monitored adherence. Centers failing to meet these ethical criteria were delisted from the referral network.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Collaborative Relationships\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMSWs built trust and goodwill with center operators, resulting in increased willingness to reserve space for vulnerable patients and sustained cooperation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Feedback-Driven Adaptability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient feedback—especially from follow-up calls—was consistently used to refine matching strategies and improve outcomes, embedding a real-time ethical feedback loop into the process.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis intervention redefined logistical coordination as a site for equity advancement. By replacing task-based administrative roles with socially conscious professionals, the hospital addressed an invisible but critical determinant of care access.\u003c/p\u003e \u003cp\u003eThe six fold increase in vacancy utilization was not merely logistical\u0026mdash;it was moral. It reflected the latent capacity of compassionate systems design to resolve long-standing gaps in care for the underserved. Embedding a feedback mechanism further established that patient voices matter\u0026mdash;not just at the bedside but at every operational junction of the health system.\u003c/p\u003e \u003cp\u003eMore broadly, this model challenges common assumptions: transformative impact does not always require new infrastructure or technologies. It can begin with institutional empathy, ethical clarity, and a willingness to shift from passive service to active advocacy.\u003c/p\u003e"},{"header":"5. Conclusion and Policy Recommendations","content":"\u003cp\u003eThis initiative demonstrates that:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSocial workers are vital systems actors\u003c/b\u003e, not just support roles\u0026mdash;they enhance ethical sensitivity and relational fluency in operational domains.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTrust, communication, and ethics\u003c/b\u003e are infrastructure. Their absence is costly; their presence is transformative.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eEquity is operational\u003c/b\u003e, not rhetorical. Health systems can promote it with the right interventions\u0026mdash;starting with logistics, language, and leadership.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePolicy Recommendations\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eScale MSW engagement across non-clinical patient support pathways\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEstablish ethical compliance protocols with third-party partners\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCreate closed-loop systems where patient feedback informs continuous improvement\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e \u003cp\u003eNot applicable\u0026mdash;no individual patient-identifiable data were collected.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication:\u003c/strong\u003e \u003cp\u003eAll individuals and centers described agreed to anonymous reporting and disclosure of aggregated outcomes.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests:\u003c/strong\u003e \u003cp\u003eNone declared.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study received no specific grant or external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMr Kishor Howale(OIC) Wrote the main manuscriptDr Vinit Samant (MS) Approved the policy Dr. Sandeep, Sawakare (MS) Approved the conceptDr Naveen Chaturvedi (Addl MS) reviewed the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eMrs. Sushmita Katkar (MSW) is the frontline worker\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eSocial determinants of health\u003c/em\u003e. Geneva: WHO; 2021. Available from: https://www.who.int/health-topics/social-determinants-of-health\u003c/li\u003e\n\u003cli\u003eMarmot M. \u003cem\u003eThe Health Gap: The Challenge of an Unequal World\u003c/em\u003e. London: Bloomsbury; 2015.\u003c/li\u003e\n\u003cli\u003eGopichandran V, Chetlapalli SK. Advocacy for social accountability in the Indian health system: a conceptual framework. \u003cem\u003eIndian J Med Ethics\u003c/em\u003e. 2013;10(2):94\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eRawat J, Mehra A, Panwar V, et al. Leveraging patient feedback for quality improvement in public hospitals: a systems approach. \u003cem\u003eBMC Health Serv Res\u003c/em\u003e. 2020;20(1):963.\u003c/li\u003e\n\u003cli\u003eBhattacharya S, Sharma N. Community-based interventions for improving equity in healthcare in urban India: A scoping review. \u003cem\u003eInt J Equity Health\u003c/em\u003e. 2022;21(1):145.\u003c/li\u003e\n\u003cli\u003eLehmann U, Sanders D. \u003cem\u003eCommunity health workers: What do we know about them?\u003c/em\u003e Geneva: WHO; 2007. Available from: https://www.who.int/hrh/documents/community_health_workers.pdf\u003c/li\u003e\n\u003cli\u003eSingh R, Purohit B. Limitations of administrative coordination in public health infrastructure. \u003cem\u003eIndian J Public Adm\u003c/em\u003e. 2021;67(4):643\u0026ndash;56.\u003c/li\u003e\n\u003cli\u003eDuffy M, Baldwin M. Social work and systems thinking: Interventions for ethical service design. \u003cem\u003eSoc Work Health Care\u003c/em\u003e. 2019;58(7):690\u0026ndash;704.\u003c/li\u003e\n\u003cli\u003eKundu A. Access to affordable housing in Indian cities: Challenges and interventions. \u003cem\u003eUrban Stud\u003c/em\u003e. 2015;52(10):1902\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eMitra A, Mehta K. Transforming public service delivery through relational models: Lessons from Indian health settings. \u003cem\u003eJ Health Manage\u003c/em\u003e. 2021;23(3):347\u0026ndash;65\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"health equity, medical social work, patient accommodation, hospital systems, ethical partnerships, India","lastPublishedDoi":"10.21203/rs.3.rs-7019278/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7019278/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e In urban public hospitals across India, socioeconomically disadvantaged patients frequently lack access to safe, affordable accommodation during treatment. This not only disrupts care continuity but also erodes patient dignity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This case study from a Tata Memorial Hospital in Mumbai, India, outlines a systems-level intervention that replaced administrative personnel with Medical Social Workers (MSWs) to coordinate with accommodation centers. Emphasis was placed on proactive communication, ethical oversight, and patient-centered follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe intervention resulted in a six fold increase in daily room availability—from 5–6 to over 30—and enabled patients to choose among options. Follow-up calls with both accommodated and non-accommodated patients informed continual refinement of the system and reinforced trust.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The findings underscore the power of empathy-driven systems thinking in bridging operational gaps and promoting health equity through a low-cost, scalable model.\u003c/p\u003e","manuscriptTitle":"Enhancing Equitable Access to Patient Accommodation: A Social Work–Led Systems Intervention in Urban Public Healthcare","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 07:02:50","doi":"10.21203/rs.3.rs-7019278/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e2245559-ae62-41ff-8c90-07e115f7f422","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-27T05:23:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-02 07:02:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7019278","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7019278","identity":"rs-7019278","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}