Linking Lean Hospitals and Management Control Systems:A Systematic Literature Review on Efficiency, DigitalTransformation and Sustainability
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https://doi.org/10.14419/gjjzx893
Received date: December 18, 2025
Accepted date: January 22, 2026
Published date: January 31, 2026
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Lean Hospital; Management Control Systems; Systematic Literature Review; Efficiency; Digitalization; Sustainability -
Abstract
Lean hospital practices have gained increasing attention as healthcare systems face pressure to enhance efficiency, patient safety, and financial sustainability under bundled payment schemes such as iDRG/JKN. While lean management reduces waste and improves service delivery, its effectiveness depends on robust Management Control Systems (MCS) to ensure alignment with organizational goals. This study systematically reviews the literature to examine the intersection of lean hospitals and MCS. Using the Scopus database, 114 peer-reviewed articles published between 2008 and 2025 were selected. Bibliometric and content analyses were conducted, supported by VOSviewer and R Studio, to identify research trends, thematic clusters, and knowledge gaps. The findings reveal four dominant clusters: (1) process-oriented lean practices, (2) organizational efficiency and performance, (3) integration with Industry 4.0 and sustainability, and (4) quality improvement and benchmarking. The results indicate a clear shift from operational process improvement toward broader strategic agendas involving digital transformation and sustainability. This review highlights research gaps in integrating lean hospitals with strategic MCS tools (e.g., balanced scorecard, activity-based management), the adoption of digital technologies (IoT, AI, digital twins), and sustainability-driven frameworks (green lean). The study contributes by framing lean hospitals not merely as operational toolkits, but as strategic frameworks for smart and sustainable healthcare transformation, offering new insights for both scholars and practitioners.
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References
- Abdallah, A. B., Basheer, S. N., & Alkhaldi, R. Z. (2025). Unraveling the interplay between lean healthcare and patient satisfaction: the mediating roles of quality performance and process innovation. TQM Journal. https://doi.org/10.1108/TQM-07-2024-0258.
- Abu, F., Gholami, H., Mat Saman, M. Z., Zakuan, N., & Streimikiene, D. (2019). The implementation of lean manufacturing in the furniture indus-try: A review and analysis of the motives, barriers, challenges, and the applications. Journal of Cleaner Production, 234, 660–680. https://doi.org/10.1016/j.jclepro.2019.06.279.
- Aissaoui, N. O., Ben Mbarek, H., Layeb, S. B., & B. Hadj-Alouane, A. (2024). A BPMN-VSM based process analysis to improve the efficiency of multidisciplinary outpatient clinics. Production Planning and Control, 35(5), 461–491. https://doi.org/10.1080/09537287.2022.2098199.
- Almagtome, A., & Shaker, A. S. (2019). Impact of Lean Accounting Information on the Financial performance of the Healthcare Institutions: A Case Study. Journal of Engineering and Applied Sciences, 14(2). https://doi.org/10.36478/jeasci.2019.589.599.
- Anggadwita, G., & Indarti, N. (2023). Women entrepreneurship in the internationalization of SMEs: a bibliometric analysis for future research di-rections. European Business Review, 35(5), 763–796. https://doi.org/10.1108/EBR-01-2023-0006.
- Baas, J., Schotten, M., Plume, A., Côté, G., & Karimi, R. (2020). Scopus as a curated, high-quality bibliometric data source for academic research in quantitative science studies. Quantitative Science Studies, 1(1), 377–386. https://doi.org/10.1162/qss_a_00019.
- Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa.
- Costa, L. B. M., & Godinho Filho, M. (2016). Lean healthcare: review, classification and analysis of literature. Production Planning and Control, 27(10), 823–836. https://doi.org/10.1080/09537287.2016.1143131.
- da Silva, P. F., Saurin, T. A., & Marodin, G. A. (2025). Resilience and risk: adding complexity-informed variables to patient-centered internal lean logistics in hospitals. Production Planning and Control. https://doi.org/10.1080/09537287.2025.2458590.
- Deepu, T. S., & Ravi, V. (2020). An integrated ANP–QFD approach for prioritization of customer and design requirements for digitalization in an electronic supply chain. Benchmarking, 28(4), 1213–1246. https://doi.org/10.1108/BIJ-06-2020-0298.
- Farris, J. A., Van Aken, E. M., Doolen, T. L., & Worley, J. (2009). Critical success factors for human resource outcomes in Kaizen events: An em-pirical study. International Journal of Production Economics, 117(1), 42–65. https://doi.org/10.1016/j.ijpe.2008.08.051.
- Fauzi, M. A., Muhamad Tamyez, P. F., & Kumar, S. (2025). Social Entrepreneurship and Social Innovation in ASEAN: Past, Present, and Future Trends. In Journal of Social Entrepreneurship (Vol. 16, Issue 1, pp. 146–168). Routledge. https://doi.org/10.1080/19420676.2022.2143870.
- Fontoura, L., Nascimento, D. L. de M., Neto, J. V., Garcia-Buendia, N., Garza-Reyes, J. A., Lima, G. B. A., Tortorella, G. L., Caiado, R. G. G., & Meiriño, M. J. (2023). Real-time energy flow mapping: A VSM-based proposal for energy efficiency. Journal of Cleaner Production, 419. https://doi.org/10.1016/j.jclepro.2023.137871.
- Gündüz, M. (2015). Value Stream Performance Measurement in Lean Manufacturing Business. International Business and Management, 10(3), 40. https://doi.org/10.3968/7128
- Harsono, A. (2015). Analisis Implementasi Sistem Informasi Manajemen Rumah Sakit Umum Daerah (SIM-RSUD). EKSPLORA INFORMATIKA, 5.
- Ivcovici, A., Bamber, G., Bartram, T., Stanton, P., Borg, J., & Pariona-Cabrera, P. (2025). The regulation and reconciliation of hybrid professional-managerial identities in a public hospital: the case of Lean management. Journal of Health Organization and Management, 39(9), 284–304. https://doi.org/10.1108/JHOM-02-2024-0058.
- Jadhav, J. S., & Deshmukh, J. (2022). A review study of the blockchain-based healthcare supply chain. Social Sciences and Humanities Open, 6(1). https://doi.org/10.1016/j.ssaho.2022.100328.
- Janka, M. (2021). Enabling formal MCS design and use: A meta-synthesis of qualitative research. Journal of Accounting & Organizational Change, 17(2), 133-163. https://doi.org/10.1108/JAOC-01-2019-0002.
- Jiao, H., Wei, J., & Cui, Y. (2010). An empirical study on paths to develop dynamic capabilities: From the perspectives of entrepreneurial orienta-tion and organizational learning. Frontiers of Business Research in China, 4(1), 47–72. https://doi.org/10.1007/s11782-010-0003-5.
- Leite, H., & Quadros, F. C. (2025). Lean applications across the healthcare ecosystem: Value creation, destruction and a research agenda. Opera-tions Management Research, 18(1), 24–47. https://doi.org/10.1007/s12063-024-00523-y.
- Mokogwu, C., Ozoemenam Achumie, G., Adeleke, A. G., Okeke, I. C., & Ewim, P.-M. (2024). A Conceptual Model for Enhancing Operational Efficiency in Technology Startups: Integrating Strategy and Innovation. In International Journal of Engineering Research And Development (Vol. 20, Issue 11). www.ijerd.com.
- Narayanamurthy, G., Gurumurthy, A., & Tortorella, G. L. (2024). Qualitative leanness assessment of hospital using benchmarking: a case study. Production Planning and Control. https://doi.org/10.1080/09537287.2024.2437040.
- Nguyen, A., Lamouri, S., Pellerin, R., Tamayo, S., & Lekens, B. (2022). Data analytics in pharmaceutical supply chains: state of the art, opportuni-ties, and challenges. International Journal of Production Research, 60(22), 6888–6907. https://doi.org/10.1080/00207543.2021.1950937.
- Núñez-Merino, M., Maqueira-Marín, J. M., Moyano-Fuentes, J., & Castaño-Moraga, C. A. (2025). Product development process for a new healthcare service in the Industry 4.0 context: an action research approach. Production Planning and Control, 36(2), 177–196. https://doi.org/10.1080/09537287.2024.2349224.
- Pakdil, F., & Leonard, K. M. (2014). Criteria for a lean organisation: Development of a lean assessment tool. International Journal of Production Research, 52(15), 4587–4607. https://doi.org/10.1080/00207543.2013.879614.
- Paul, J. (2024). Strategies for Effective Crisis Management in Healthcare Systems: Patient Safety and Lessons Learned. Medical Research Archives, 12(7). https://doi.org/10.18103/mra.v12i7.5424
- Podsakoff, P. M., Mackenzie, S. B., Bachrach, D. G., & Podsakoff, N. P. (2005). The influence of management journals in the 1980s and 1990s. Strategic Management Journal, 26(5), 473–488. https://doi.org/10.1002/smj.454.
- Pribadi, M. R. (2015). PENERAPAN TATA KELOLA TEKNOLOGI INFORMASI DENGAN MENGGUNAKAN COBIT FRAMEWORK 4.1 (STUDI KASUS PADA RSUD BARI PALEMBANG). EKSPLORA INFORMATIKA, 4(2). https://www.researchgate.net/publication/350672075.
- Raval, S. J., Kant, R., & Shankar, R. (2020). Analyzing the Lean Six Sigma enabled organizational performance to enhance operational efficiency. Benchmarking, 27(8), 2401–2434. https://doi.org/10.1108/BIJ-05-2019-0221.
- Rinawiyanti, E. D., Huang, X., & As-Saber, S. (2021). Adopting management control systems through CSR strategic integration and investigating its impact on company performance: evidence from Indonesia. Corporate Governance: The international journal of business in society, 21(3), 463-478. https://doi.org/10.1108/CG-04-2020-0150.
- Samanta, A. K., Varaprasad, G., Gurumurthy, A., & Antony, J. (2024). Implementing Lean Six Sigma in a multispecialty hospital through a change management approach. TQM Journal, 36(8), 2281–2296. https://doi.org/10.1108/TQM-02-2023-0043.
- Sedaghat, A., & Hopkins, C. (2020). Chronic rhinosinusitis disease control as a metric for guiding treatment. In Rhinology (Vol. 58, Issue 3, p. 193). International Rhinologic Society.
- Singh, P. (2019). Lean in healthcare organization: an opportunity for environmental sustainability. Benchmarking, 26(1), 205–220. https://doi.org/10.1108/BIJ-04-2018-0104.
- Sitalaksmi, S., Indarti, N., Anggadwita, G., & Sambudi, A. D. (2024). Knowledge leakage and collaborative innovation: a systematic literature re-view. Knowledge Management Research and Practice. https://doi.org/10.1080/14778238.2024.2431111.
- Skalli, D., Cherrafi, A., Charkaoui, A., Chiarini, A., Shokri, A., Antony, J., Garza-Reyes, J. A., & Foster, M. (2025). Integrating Lean Six Sigma and Industry 4.0: developing a design science research-based LSS4.0 framework for operational excellence. Production Planning and Control, 36(8), 1060–1086. https://doi.org/10.1080/09537287.2024.2341698.
- Srijithesh, P. R., Gijo, E. V., Raja, P., Bhat, S., Mythirayee, S., Taallapalli, A. V. R., Kulkarni, G. B., Siani, J., & Aravinda, H. R. (2025). Leverag-ing Lean Six Sigma principles in an Indian tertiary care hospital: a case study. International Journal of Quality and Reliability Management, 42(2), 600–630. https://doi.org/10.1108/IJQRM-01-2024-0025.
- Sunder, V. M., Ganesh, L. S., & Marathe, R. R. (2023). A Dynamic Capabilities View of Lean in a Service Context. IEEE Transactions on Engi-neering Management, 70(11), 3887–3901. https://doi.org/10.1109/TEM.2021.3089850.
- Tortorella, G. L., Fogliatto, F. S., Mac Cawley Vergara, A., Vassolo, R., & Sawhney, R. (2020). Healthcare 4.0: trends, challenges and research di-rections. Production Planning and Control, 31(15), 1245–1260. https://doi.org/10.1080/09537287.2019.1702226.
- van Kleeff, R., & van Harten, J. (2025). Leaning on leadership? Understanding how a lean implementation impacts hospital workers’ performance. Production Planning and Control, 36(11), 1558–1575. https://doi.org/10.1080/09537287.2024.2386432.
- Wang, C. N., Vo, T. T. B. C., Hsu, H. P., Chung, Y. C., Nguyen, N. T., & Nhieu, N. L. (2024). Improving processing efficiency through workflow process reengineering, simulation and value stream mapping: a case study of business process reengineering. Business Process Management Journal, 30(7), 2482–2515. https://doi.org/10.1108/BPMJ-11-2023-0869.
- Yamamoto, K., Milstead, M., & LIoyd, R. (2019). A review of the development of lean manufacturing and related lean practices: The case of Toyota production system and managerial thinking. International Management Review, 15. https://www.researchgate.net/publication/340449306.
- Yun, G., & An, J. (2025). Revealing the intellectual foundations of healthcare supply chain risk: a bibliometric mapping and research agenda. Benchmarking. https://doi.org/10.1108/BIJ-10-2023-0703.
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How to Cite
Ambarriani, A. S., & Pradana, B. G. V. (2026). Linking Lean Hospitals and Management Control Systems:A Systematic Literature Review on Efficiency, DigitalTransformation and Sustainability. International Journal of Accounting and Economics Studies, 13(1), 577-586. https://doi.org/10.14419/gjjzx893
