Purpose: This review mainly aims to identify the lean practice conducted in hospitals, determining what problems lean practice can be helpful to solve in the hospitals. Data sources: Four electronic databases (Scopus, Web of science, Medline, and PubMed) were conducted for searching related literature in this review. Study selection: These studies in the hospitals that related lean healthcare practice and contained outcome variables were included. Data extraction: Related information such as research design, countries, lean tools, outcome variables, results were extracted. Results of data synthesis: 20 eligible articles were identified in this review. There was 20% lean practice being conducted in emergency department of hospitals in this review. Six cases have implemented lean in Brazilian hospitals. There were 12 cases implemented lean practice through Value Stream Mapping. Conclusion: Lean practices were highly valued in Brazilian hospitals, and it was frequently implemented in hospital emergency department. Value Stream Mapping and process mapping were the most commonly used lean tool. Waiting time, lead time and Length of Hospital Stay (LOS) were the primary indicators reflecting improvements in this review.

Al-hakim, L., & Sevdalis, N. (2021). A novel conceptual approach to lean: value, psychological conditions for engagement with work and perceived organizational support in hospital care. International Journal for Quality in Health Care, 33(4). https://doi.org/10.1093/intqhc/mzab148

Alkher, M., Radosevic, M., Čabarkapa, V., Toljaga-Nikolic, D. (2019). Case Study of Healthcare Organization Improvement with Lean Concept. Tehnicki Vjesnik—Technical Gazette, 26(3). https://doi.org/10.17559/tv-20180627080909

Almutairi, A. M., Almanei, M., Al-Ashaab, A., et al. (2021). Prioritized Solutions for Overcoming Barriers When Implementing Lean in the Healthcare Supply Chain: A Saudi Perspective. Logistics, 5(1), 9. https://doi.org/10.3390/logistics5010009

Almutairi, A. M., Salonitis, K., & Al-Ashaab, A. (2019). A framework for implementing lean principles in the supply chain management at health-care organizations. International Journal of Lean Six Sigma, 11(3), 463–492. https://doi.org/10.1108/ijlss-01-2019-0002

Alowad, A., Samaranayake, P., Ahsan, K., et al. (2020). Enhancing patient flow in emergency department (ED) using lean strategies—an integrated voice of customer and voice of process perspective. Business Process Management Journal, 27(1), 75–105. https://doi.org/10.1108/bpmj-11-2019-0457

Al-Saa’da, R. J., Abu Taleb, Y. K., Abdallat, M. E. A., et al. (2013). Supply Chain Management and Its Effect on Health Care Service Quality: Quantitative Evidence from Jordanian Private Hospitals. Journal of Management and Strategy, 4(2). https://doi.org/10.5430/jms.v4n2p42

Ankrum, A. L., Neogi, S., Morckel, M. A., et al. (2019). Reduced isolation room turnover time using Lean methodology. Infection Control & Hospital Epidemiology, 40(10), 1151–1156. https://doi.org/10.1017/ice.2019.199

Astiena, A. K., Hadiguna, R. A., Iswanto, A. H., et al. (2022). Digitalization of Outpatient Services Based on Lean Management to Reduce Waiting Time in Government Hospital. International Journal on Advanced Science, Engineering and Information Technology, 12(6), 2248–2257. https://doi.org/10.18517/ijaseit.12.6.17212

Borges, G. A., Tortorella, G. L., Martínez, F., et al. (2020). Simulation-based analysis of lean practices implementation on the supply chain of a public hospital. Production, 30. https://doi.org/10.1590/0103-6513.20190131

Cardoso, W. (2019). Value Stream Mapping as Lean Healthcare’s Tool to See Waste and Improvement Points: The Case of the Emergency Care Management of a University Hospital. Revista de Gestão em Sistemas de Saúde, 9(2), 360-380. https://doi.org/10.20396/jihm.v2i0.11805

Chbaly, H., & Brunet, M. (2022). Enhancing Healthcare Project Definition with Lean-Led Design. Sustainability, 14(3), 1588. https://doi.org/10.3390/su14031588

Dammand, J., Horlyck, M., Jacobsen, T. L., et al. (2014). Lean Management in Hospitals: Evidence from Denmark. Administratie Si Management Public, 23, 19-35. https://api.semanticscholar.org/CorpusID:30945224.

Demirli, K., Al Kaf, A., Simsekler, M. C. E., et al. (2021). Using lean techniques and discrete-event simulation for performance improvement in an outpatient clinic. International Journal of Lean Six Sigma, 12(6), 1260–1288. https://doi.org/10.1108/ijlss-09-2020-0138

Doğan, N. Ö., & Unutulmaz, O. (2014). Lean production in healthcare: a simulation-based value stream mapping in the physical therapy and rehabilitation department of a public hospital. Total Quality Management & Business Excellence, 27(1–2), 64–80. https://doi.org/10.1080/14783363.2014.945312

Fernandes, J. M., Reis, L. P., & Mansk, R. (2023). An adaptation of the SAE J4000/2021 standard for assessing lean maturity in Brazilian hospitals. The TQM Journal. https://doi.org/10.1108/tqm-01-2023-0023

Fiorillo, A., Sorrentino, A., Scala, A., et al. (2021). Improving performance of the hospitalization process by applying the principles of Lean Thinking. The TQM Journal, 33(7), 253–271. https://doi.org/10.1108/tqm-09-2020-0207

Fournier, P. L., Jobin, M. H., Lapointe, L., et al. (2021). Lean implementation in healthcare: offsetting Physicians’ resistance to change. Production Planning & Control, 34(6), 493–505. https://doi.org/10.1080/09537287.2021.1938730

Gadolin, C. (2019). The influence of policy makers over Lean implementations in healthcare. International Journal of Health Governance, 24(3), 222–229. https://doi.org/10.1108/ijhg-02-2019-0016

Henrique, D. B., Filho, M. G., Marodin, G., et al. (2020). A framework to assess sustaining continuous improvement in lean healthcare. International Journal of Production Research, 59(10), 2885–2904. https://doi.org/10.1080/00207543.2020.1743892

Kahm, T., & Ingelsson, P. (2020). “Stuck in the middle” first-line healthcare managers’ responsibilities and needs of support when applying Lean. International Journal of Quality and Service Sciences, 12(2), 173–186. https://doi.org/10.1108/ijqss-06-2019-0088

Khan, S. (2020). Meta-Analysis. Springer Singapore. https://doi.org/10.1007/978-981-15-5032-4

Kitchenham, B. A., Sjøberg, D. I. K., Dybå, T., et al. (2012). Three empirical studies on the agreement of reviewers about the quality of software engineering experiments. Information and Software Technology, 54(8), 804–819. https://doi.org/10.1016/j.infsof.2011.11.008

Le, D. X., Do, H. T., Bui, K. T., et al. (2021). Lean management for improving hospital waiting times—Case study of a Vietnamese public/general hospital emergency department. The International Journal of Health Planning and Management, 37(1), 156–170. https://doi.org/10.1002/hpm.3310

Liker, J. K. (2004). The Toyota Way: 14 Management Principles from the World’s Greatest Manufacturer. McGraw Hill.

Lukrafka, T. O., Silva, D. S., & Echeveste, M. (2020). A geographic picture of Lean adoption in the public sector: Cases, approaches, and a refreshed agenda. European Management Journal, 38(3), 506–517. https://doi.org/10.1016/j.emj.2020.02.004

Martins Drei, S., & Sérgio de Arruda Ignácio, P. (2022). Lean healthcare applied systematically in a medium-sized medical clinic hospitalization. Journal of Health Organization and Management, 36(5), 666–689. https://doi.org/10.1108/jhom-05-2021-0194

Menachemi, N., Tinsley, T., Johnston, A., et al. (2020). Implementation of Lean in a Health System: Lessons Learned from a Meta-Analysis of Rapid Improvement Events, 2013–2017. Journal of Healthcare Management, 65(6), 407–417. https://doi.org/10.1097/jhm-d-19-00097

Moher, D., Liberati, A., Tetzlaff, J., et al. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097

Morales-Contreras, M. F., Chana-Valero, P., Suárez-Barraza, M. F., et al. (2020). Applying Lean in Process Innovation in Healthcare: The Case of Hip Fracture. International Journal of Environmental Research and Public Health, 17(15), 5273. https://doi.org/10.3390/ijerph17155273

Peimbert-García, R. E., Gutiérrez-Mendoza, L. M., & García-Reyes, H. (2021). Applying Lean Healthcare to Improve the Discharge Process in a Mexican Academic Medical Center. Sustainability, 13(19), 10911. https://doi.org/10.3390/su131910911

Prado-Prado, J. C., García-Arca, J., Fernández-González, A. J., et al. (2020). Increasing Competitiveness through the Implementation of Lean Management in Healthcare. International Journal of Environmental Research and Public Health, 17(14), 4981. https://doi.org/10.3390/ijerph17144981

Reis, L. P., Fernandes, J. M., Silva, S. E., et al. (2023). Managing inpatient bed setup: an action-research approach using lean technical practices and lean social practices. Journal of Health Organization and Management, 37(2), 213–235. https://doi.org/10.1108/jhom-09-2021-0365

Rocha, Í. J. A., & Vasconcelos, C. R. d. (2021). Lean healthcare implications in an occupational medicine clinic. International Journal of Lean Six Sigma, 12(5), 973–991. https://doi.org/10.1108/ijlss-05-2020-0056

Rollinson, T. J., Furnival, J., Goldberg, S., et al. (2021). Learning from Lean: a quality improvement project using a Lean-based improvement approach to improve discharge for patients with frailty in an acute care hospital. BMJ Open Quality, 10(4), e001393. https://doi.org/10.1136/bmjoq-2021-001393

Saavedra Bravo, M. A., Santos, G. C. S. D., Petenate, A. J., et al. (2023). Adapting Lean Management to Prevent Healthcare-Associated Infections: A Low-Cost Strategy Involving Kamishibai Cards to Sustain Bundles’ Compliance. journal of the International Society for Quality in Health Care, 35(4). https://doi.org/10.1093/intqhc/mzad10

Sales Coll, M., De Castro, R., Ochoa de Echagüen, A., et al. (2024). Economic Impact of Lean Healthcare Implementation on the Surgical Process. Healthcare, 12(5), 512. https://doi.org/10.3390/healthcare12050512

Sales-Coll, M., de Castro, R., & Hueto-Madrid, J. A. (2021). Improving operating room efficiency using lean management tools. Production Planning & Control, 34(13), 1261–1274. https://doi.org/10.1080/09537287.2021.1998932

Santos, A. C. de S. G. dos., Reis, A. da C., Souza, C. G. de., et al. (2020). The first evidence about conceptual vs analytical lean healthcare research studies. Journal of Health Organization and Management, 34(7), 789–806. https://doi.org/10.1108/jhom-01-2020-0021

Shah, R., & Ward, P. T. (2003). Lean Manufacturing: Context, Practice Bundles, and Performance. Journal of Operations Management, 21, 129-149. https://doi.org/10.1016/S0272-6963(02)00108-0

Shortell, S. M., Blodgett, J. C., Rundall, T. G., et al. (2018). Use of Lean and Related Transformational Performance Improvement Systems in Hospitals in the United States: Results from a National Survey. The Joint Commission Journal on Quality and Patient Safety, 44(10), 574–582. https://doi.org/10.1016/j.jcjq.2018.03.002

Tlapa, D., Zepeda-Lugo, C. A., Tortorella, G. L., et al. (2020). Effects of Lean Healthcare on Patient Flow: A Systematic Review. Value in Health, 23(2), 260–273. https://doi.org/10.1016/j.jval.2019.11.002

Vendramini, M. P., Cagnin, F., Oliveira, M. C., et al. (2016). Simulation and Lean Principles: A Case Study in a Public Service in Brazil. International Journal of Performability Engineering, 12, 103-113.

Verbano, C., & Crema, M. (2019). Applying lean management to reduce radiology turnaround times for emergency department. The International Journal of Health Planning and Management, 34(4). https://doi.org/10.1002/hpm.2884

Vidal-Carreras, P. I., Garcia-Sabater, J. J., & Marin-Garcia, J. A. (2022). Applying Value Stream Mapping to Improve the Delivery of Patient Care in the Oncology Day Hospital. International journal of environmental research and public health, 19(7), 4265. https://doi.org/10.3390/ijerph1907426

Zdęba-Mozoła, A., Rybarczyk-Szwajkowska, A., Czapla, T., et al. (2022). Implementation of Lean Management in a Multi-Specialist Hospital in Poland and the Analysis of Waste. International Journal of Environmental Research and Public Health, 19(2), 800. https://doi.org/10.3390/ijerph19020800