Lean Healthcare for financial management in accredited hospitals: a bibliometric study of scientific production

Authors

  • Tatiane Lemes Moreira Ribeiro

    Universidade Federal de Goiás (UFG)

    https://orcid.org/0009-0006-8024-1024

    Author

  • Isabela Crisóstomo Melo

    Universidade Federal de Goiás (UFG)

    Author

  • Cynara Mendonça Moreira Tinoco

    Universidade Federal de Goiás (UFG) - Faculdade de Ciências e Tecnologia (FCT)

    https://orcid.org/0000-0002-6493-2451

    Author

DOI:
https://doi.org/10.47456/bjpe.v12i5.53090
Keywords:
Accreditation, financial indicators, stantard
Abstract

The healthcare system faces chronic challenges related to overcrowding in hospitals, as well as long waiting times for care and growing pressure for greater efficiency in resource management. In this scenario, Lean Healthcare emerges with the goal of eliminating waste, standardising processes, and adding value to the patient. Despite the expansion of literature on the subject, there are still gaps in understanding research trends, the tools most used in accreditation processes, and the specific contexts for applying Lean methodology in hospital environments with a view to sustainability of results. This study aimed to conduct a systematic review of the literature to map scientific production based on the keywords “Lean Healthcare,” hospital, and standard*. The research is exploratory and descriptive in nature, with a qualitative and quantitative approach. The Web of Science and Scopus databases were used, first without filters and then with a time frame from 2010 to 2025. Data analysis was conducted in RStudio, with Bibliometrix, revealing progressive growth in publications over the last ten years and identifying a lack of studies relating Lean to financial indicators, pointing to an opportunity for research that integrates the Lean Healthcare methodology with hospital economic and financial management.

Author Biographies
  1. Tatiane Lemes Moreira Ribeiro, Universidade Federal de Goiás (UFG)

    FIOCRUZ: Rio de Janeiro, Rio de Janeiro, BR. 2024-04 to present | Bolsista de pesquisa. Employment. UFG: Goiânia, Goiás, BR. 2025 to present | MESTRADO (PPGEP)
    Education. https://orcid.org/0009-0006-8024-1024.

  2. Isabela Crisóstomo Melo, Universidade Federal de Goiás (UFG)

    Natural de Goiás, atualmente cursa Engenharia de Produção na Universidade Federal de Goiás. Preferência nas áreas de logística, pesquisa operacional, planejamento e controle da produção e lean healthcare. E por isso, hodiernamente, ocupa-se com a IMPLANTAÇÃO DE LEAN HEALTHCARE COM VIAS A SAÚDE 4.0 (2024 - ATUALIDADE) - Projeto de Pesquisa ligado ao Hospital Universitário, a pesquisa objetiva reduzir o Lead Time dos Pacientes da ala cirúrgica utilizando a inteligência emocional, metodologia PCDA e outros recursos. https://orcid.org/0009-0006-5471-086X

  3. Cynara Mendonça Moreira Tinoco, Universidade Federal de Goiás (UFG) - Faculdade de Ciências e Tecnologia (FCT)

    Possui graduação em engenharia civil pela Universidade Federal do Rio Grande do Sul (1996), mestrado em Engenharia de Produção pela Universidade Federal de Santa Catarina (2001) e doutorado em Doutorado em Engenharia Elétrica pela Universidade Estadual de Campinas (2017) e Pós Doutorado na Universidade de Aveiro (Portugal) em Lean Healthcare (2023). Atualmente é professor do magistério superior da Universidade Federal de Goiás, Professor Permanente no Mestrado Profissional em Administração Pública (PROFIAP) e Docente colaborador no Mestrado Profissional em Engenharia de Produção UFG. Tem experiência na área de Engenharia de Produção, com ênfase em Lean Healthcare Six sigma, atuando principalmente nos seguintes temas: segurança no trabalho, melhoria de processos, cadeia do leite, prevenção de riscos ocupacionais e boas práticas na ordenha e lean healhcare em hospitais. http://lattes.cnpq.br/9100166866914614 https://orcid.org/0000-0002-6493-2451

References

Al-Balushi, M. M. & Al-Mandhari, Z. (2018). Implementing lean management techniques at a radiation oncology deartment. Sultan Qaboos University Medical Journal, 18(3), e325-e331. https://doi.org/10.18295/squmj.2018.18.03.014

Alvi, S. S., Hamid, Z., Riaz, S., Alvi, M. S., & Azam, N. (2020). Effect of lean daily management (ldm) system on quality of healthcare delivery in indoor setting - a pilot study. Pakistan Armed Forces Medical Journal, 70(3), 842-48.

Amati, M., Valnegri, A., Bressan, A., La Regina, D., Tassone, C., Lo Piccolo, A., Mongelli, F., & Saporito, A. (2022). Reducing changeover time between surgeries through lean thinking: an action research project. frontiers in medicine, 9. https://doi.org/10.3389/fmed.2022.822964

Boronat, F., Budia, A., Broseta, E., Ruiz-Cerda, J. L., & Vivas-Consuelo, D. (2018). Application of lean healthcare methodology in a urology department of a tertiary hospital as a tool for improving efficiency. Actas Urologicas Espanolas, 42(1), 42-8. https://doi.org/10.1016/j.acuro.2017.03.009

Zattar, I. C., Silva, R. R. L., da, & Boschetto, J. W. (2017). Aplicações das ferramentas lean na área da saúde: revisão bibliográfica. Journal of Lean Systems, 2(2), 68-86. Recuperado de http://leansystem.ufsc.br/

Dermindo, M. P. (2019). Gestão eficiente na saúde pública brasileira. JMPHC. Journal of Management & Primary Health Care. ISSN 2179-6750, 11. https://doi.org/10.14295/jmphc.v11iSup.933

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372(71). https://doi.org/10.1136/bmj.n71

Morales-Contreras, M. F., Chana-Valero, P., Suarez-Barraza, M. F., Diaz, A. S., & Garcia, E. G. (2020). Applying lean in process innovation in healthcare: the case of hip fracture. International Journal of Environmental ResearchaAnd Public Health, 17(15). https://doi.org/10.3390/ijerph17155273

Gayer, B. D., Marcon, É., Bueno, W. P., Wachs, P., Saurin, T. A., & Ghinato, P. (2020). Analysis of hospital flow management: the 3 R’s approach. Production, 30. https://doi.org/10.1590/0103-6513.20200033

Guz, A. N. & Rushchitsky, J. J. (2009). Scopus: a system for the evaluation of scientific journals. International Applied Mechanics, 45(4), 351-62. https://doi.org/10.1007/s10778-009-0189-4

Kim, C. S., Spahlinger, D. A., Kin, J. M., & Billi, J. E. (2006). Lean health care: what can hospitals learn from a world‐class automaker? Journal of Hospital Medicine, 1(3), 191-99. https://doi.org/10.1002/jhm.68

Lisowska, A., Kleszczynski, J., Wilczek, A., Wolf, G., & Holecki, T. (2024). Improving workflow at the emergency department: simple lessons from the lean management concepts. European Journal of Translational and Clinical Medicine, 7(2), 50-8. https://doi.org/10.31373/ejtcm/197441

Marsilio, M., Pisarra, M., Rubio, K., & Shortell, S. (2022). Lean adoption, implementation, and outcomes in public hospitals: benchmarking the US and Italy health systems. Bmc Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-07473-w

Murphy, C., Mullen, E., Hogan, K., O’Toole, R., & Teeling, S. P. (2019). Streamlining an existing hip fracture patient pathway in an acute tertiary adult Irish hospital to improve patient experience and outcomes. International Journal for Quality in Health Care, 31(1), 45-51. https://doi.org/10.1093/intqhc/mzz093

Narayanamurthy, G., Gurumurthy, A., & Tortorella, G. L. (2024). Qualitative leanness assessment of hospital using benchmarking: a case study. Production Planning & Control. https://doi.org/10.1080/09537287.2024.2437040

Organização Nacional de Acreditação. (2020). Manual brasileiro de acreditação. São Paulo: ONA

O’Mahony, L., McCarthy, K., O’Donoghue, J., Teeling, S. P., Ward, M., & McNamara, M. (2021). Using lean six sigma to redesign the supply chain to the operating room department of a private hospital to reduce associated costs and release nursing time to care. International Journal of Environmental Research and Public Health, 18(21). https://doi.org/10.3390/ijerph182111011

Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., & Thor, J. (2010). Lean thinking in healthcare: a realist review of the literature. BMJ Quality & Safety, 19(5), 376-382. https://doi.org/10.1136/qshc.2009.037986

Morales-Contreras, M. F., Chana-Valero, P., Suárez-Barraza, M. F., Saldaña Díaz, A., & García García, E. (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

Raveglia, F., Orlandi, R., Rimessi, A., Minervini, F., Cioffi, U., De Simone, M., Guttadauro, A., & Scarci, M. (2021). Standardization of procedures to contain cost and reduce variability of care after the pandemic. Frontiers in surgery, 8. https://doi.org/10.3389/fsurg.2021.695341

Rosa, A., Trunfio, T. A., Marolla, G., Costantino, A., Nardella, D., & McDermott, O. (2023). Lean Six Sigma to reduce the acute myocardial infarction mortality rate: A single center study. TQM Journal, 35(9), 25-41. https://doi.org/10.1108/TQM-03-2022-0082

Sales, M., Castro, R. de, Aguilar, A. O. de E., & Ibanez, V. M. (2023). Lean healthcare: improving surgical process indicators through prioritization projects. Journal of Industrial Engineering and Management, JIEM, 16(1), 102-14. https://doi.org/10.3926/jiem.4628

Sallam, M. (2024). Enhancing hospital pharmacy operations through lean and six sigma strategies: a systematic review. Cureus Journal of Medical Science, 16(3). https://doi.org/10.7759/cureus.57176

Sethi, R. K., Drolet, C. E., Pumpian, R. P., Shen, J., Hanson, K., Guerra, S., & Louie, P. K. (2022). Combining time-driven activity-based costing and lean methodology: an initial study of single-level lumbar fusion surgery to assess value-based healthcare in patients undergoing spine surgery. Journal of Neurosurgery-Spine, 37(5), 639-45. https://doi.org/10.3171/2022.4.SPINE211516

Souza, D. L., Korzenowski, A. L., Alvarado, M. M., Sperafico, J. H., Friedl Ackermann, A. E., Mareth, T., & Scavarda, A. J. (2021). A systematic review on lean applications’ in emergency departments. Healthcare, 9(6). https://doi.org/10.3390/healthcare9060763

Tsai, H.-W., Huang, S.-W., Hung, Y.-L., Hsu, Y.-S., & Huang, C.-C. (2021). Use of the smart lean method to conduct high-quality integrated perioperative management prior to hospitalization. International Journal of Environmental Research and Public Health, 18(24). https://doi.org/10.3390/ijerph182413391

Zdeba-Mozola, A., Rybarczyk-Szwajkowska, A., Czapla, T., Marczak, M., & Kozlowski, R. (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). https://doi.org/10.3390/ijerph19020800

Cover Image
A blue calculator and a stethoscope rest on medical documents and spreadsheets spread across a desk. The image combines healthcare and financial management elements, illustrating the connection between hospital care, cost control, and operational efficiency in healthcare institutions.
Downloads
Published
2026-06-30
Issue
Vol. 12 No. 5 (2026): Special Issue VII Symposium on Production Engineering (SIENPRO)
Section
Innovation, Sustainability, and Entrepreneurship: Paths to Transforming Production Engineering
License

Copyright (c) 2026 Ribeiro, T. L. M., Melo, I. C., & Tinoco, C. M. M.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

All works published in the Brazilian Journal of Production Engineering (BJPE) are licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). This means that: Anyone can copy, distribute, display, adapt, remix, and even commercially use the content published in the journal; Provided that due credit is given to the authors and to BJPE as the original source; No additional permission is required for reuse, as long as the license terms are respected. This policy complies with the principles of open access, promoting the broad dissemination of scientific knowledge. 🔗 Click here to access the full license

How to Cite

Ribeiro, T. L. M., Melo, I. C., & Tinoco, C. M. M. (2026). Lean Healthcare for financial management in accredited hospitals: a bibliometric study of scientific production. Brazilian Journal of Production Engineering, 12(5), 119-128. https://doi.org/10.47456/bjpe.v12i5.53090