PurposeThis study intends to reveal the existing research stream and predict future research avenues for lean healthcare (LH). This paper analyzes the progress of LH research and identifies key trends, research gaps and future directions. By mapping the knowledge structure, the study offers insights into the effects of LH on healthcare efficiency, patient care and organizational performance.Design/methodology/approachThe review used the bibliometric approach, involving 319 journal articles retrieved from the Web of Science database. Two science mapping approaches (i.e. bibliographic coupling and co-word analysis) were performed to investigate the current knowledge structure and future research direction in LH.FindingsThe current research trend in LH focuses on developing frameworks and strategic implementation by considering critical determinants and decision-making strategies. In the future, the research on LH will emphasize the holistic frameworks and efficient strategies for healthcare excellence, along with strategies to overcome barriers to its implementation.Research limitations/implicationsThis study will benefit researchers and practitioners by advancing their understanding and applying LH principles.Originality/valueThis study provides valuable practical implications for healthcare managers to navigate the complexities of lean implementation, optimize processes and drive sustainable improvements in the healthcare context.