Lean Adoption in Healthcare: Between Promise and Practice

Background: Lean Management (LM) is recognized for its significant potential to improve efficiency and quality in healthcare. However, despite its promise, widespread and sustainable adoption across healthcare organizations remains paradoxically limited, with many initiatives failing to move beyond localized, short-term successes. This study examines the systemic barriers that hinder the long-term integration of LM in healthcare settings, to understand why a gap persists between its theoretical potential and practical reality. Methods: A systematic literature review was conducted following the PRISMA 2020 guidelines. A search of Scopus, Emerald Insight, PubMed/MEDLINE databases and Google Scholar was performed to identify peer-reviewed articles published in English between 2015 and 2025. The review focused on studies addressing the adoption, implementation, or sustainability of LM in healthcare. Data on measurement frameworks, influencing factors, and reported barriers were extracted and synthesized to develop an explanatory model. Results: The synthesis of the ten included studies yields three thematic clusters, each documented in the reviewed evidence and, in this analysis, connected as mutually reinforcing loops: (1) the Measurement–Accountability Gap, (2) the Tools–Philosophy Disconnect, and (3) the Complexity–Resistance Cycle. The proposed connections among these clusters are elaborated in the Discussion. Conclusions: The principal contribution is the synthesis of these previously reported barriers into an integrated conceptual model in which they are connected as mutually reinforcing mechanisms rather than treated as independent factors, offering healthcare leaders a structured perspective for interpreting the pattern of limited sustained adoption.