Abstract
<jats:p>Studies systematically examining the diffusion of lean management in healthcare remain scarce. This study addresses this gap through a multi-layered framework. The 1,000 most-cited English-language articles published between 2002 and 2024 constitute the research corpus. A four-stage analytical framework was employed, comprising bibliometric mapping, network analysis, topic modeling, and heterogeneity analysis. The literature exhibited rapid, multi-phase growth, peaking in 2020-2021 with an annual growth rate exceeding 25%. Citation distribution was highly asymmetric (Gini = 0.640), with the top 6.2% of publications accounting for approximately 45% of total citations. Topic modeling (k = 7) identified Implementation & Sustainability (36.0%) as the dominant theme, reflecting a post-2015 paradigm shift from tool-level application toward organizational transformation. Network analysis revealed four geographically distinct clusters; however, weak inter-cluster ties indicated a structurally fragmented collaboration landscape (density = 0.0446). Heterogeneity analysis demonstrated that the evidence base is predominantly observational (randomized controlled trials = 1.7%), knowledge production is concentrated in Anglo-American institutions, and mental health and long-term care settings remain critically under-represented (1.7% and 1.9%, respectively). This study offers actionable insights for researchers in identifying priority gaps, for policymakers in strengthening evidence-based decision-making, and for practitioners in bridging the research-to-practice divide.</jats:p>