Nursing Capability in Lean-Oriented Hospital Improvement: Narrative Review

Background/Objectives: Nurses’ capacity to enact Lean-oriented hospital improvement is often conflated with organizational support. This review examines capability, context, implementation, sustainment, and outcomes. Methods: Targeted, non-exhaustive searches in PubMed and Scopus, supplemented by Google Scholar and citation chaining, were updated on 30 July 2026. Sixty empirical reports published during 2007–2026 were synthesized using interpretive comparison and claim-level appraisal, without quantitative pooling. Results: Three psychometric reports concerned two nursing-specific Lean instruments; no identified instrument directly validated the specific capability construct proposed here. We interpret practical knowledge and judgement, collective problem-solving, learning, professional agency, and enacted leadership as candidate manifestations requiring validation. Operational process changes were reported, but causal attribution was weak. Evidence for reallocated bedside time, net economic value, workforce or patient benefit, environmental benefit, and long-term sustainment was limited or inconsistent. Conclusions: The framework is a provisional interpretive map. Future evaluations should measure capability, context, implementation, sustainment, benefits, and harms separately.