Journal of health organization and management · 2026
Combining Industry 4.0 technologies and lean tools for the sustainability of healthcare organizations: a Triple Bottom Line analysis.
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Reis Luciana Paula, Fernandes June Marques, Dos Santos Luis Henrique Rodrigues
Аннотация
PURPOSE: This study aims to evaluate how the combined use of Industry 4.0 technologies with lean healthcare tools can improve healthcare organizations' sustainability. Sustainability will be assessed from the Triple Bottom Line (TBL), which includes three perspectives: economic, social and environmental.
DESIGN/METHODOLOGY/APPROACH: A systematic literature review (RSL) was performed and, after identifying 987 studies and applying the selection criteria, 43 articles published between 2011 and 2022 were analyzed, exploring the combination of I4.0 technologies with lean tools.
FINDINGS: The most prominent combination identified in the literature was the use of simulation technologies integrated with the value stream mapping (VSM) tool, a core element of the lean methodology. This pairing was primarily applied to enhance the service level indicator. The findings suggest that such combinations are particularly effective in improving efficiency, resilience and internal processes in healthcare organizations. These insights are especially relevant for the development and adaptation of I4.0 technologies to the healthcare context, offering strategic value during periods of instability and uncertainty, such as those experienced during the COVID-19 pandemic.
RESEARCH LIMITATIONS/IMPLICATIONS: The study presents several correlations worked by the articles, however, when there are two different combinations of technologies and tools for a single TBL indicator, it is not possible to measure the strength of these relationships and, therefore, to infer which one contributes most to performance improvement. This represents the main limitation of the study. Furthermore, a limitation of the study is the exclusion of 13 articles due to the unavailability of full-text access, even through the Portal CAPES (a Brazilian platform with more than 455 research bases).
PRACTICAL IMPLICATIONS: The results of this research can guide hospital managers in identifying combinations of I4.0 technologies and lean tools with the greatest potential to contribute to improving business sustainability, as measured by the TBL. Thus, through this combined use of technologies and tools, health organizations are expected to achieve better performance, offering high quality services to society.
SOCIAL IMPLICATIONS: The TBL encourages companies and organizations to take responsibility not only for financial profit but also for the social and environmental impact of their activities. This aspect promotes equity, diversity, employee safety, and engagement with the local community and other stakeholders. It is necessary to highlight that the combination of I4.0 technologies with lean tools and the TBL has the ability to mitigate process waste in the healthcare sector.
ORIGINALITY/VALUE: A similar study was found in the manufacturing area and another in the healthcare area focused on evaluating only the simulation technology. Thus, the originality of the research focuses on evaluating the contribution of the combined use of I4.0 technologies (in addition to simulation) with lean tools for business sustainability, measured through TBL, specifically in the health context.
DESIGN/METHODOLOGY/APPROACH: A systematic literature review (RSL) was performed and, after identifying 987 studies and applying the selection criteria, 43 articles published between 2011 and 2022 were analyzed, exploring the combination of I4.0 technologies with lean tools.
FINDINGS: The most prominent combination identified in the literature was the use of simulation technologies integrated with the value stream mapping (VSM) tool, a core element of the lean methodology. This pairing was primarily applied to enhance the service level indicator. The findings suggest that such combinations are particularly effective in improving efficiency, resilience and internal processes in healthcare organizations. These insights are especially relevant for the development and adaptation of I4.0 technologies to the healthcare context, offering strategic value during periods of instability and uncertainty, such as those experienced during the COVID-19 pandemic.
RESEARCH LIMITATIONS/IMPLICATIONS: The study presents several correlations worked by the articles, however, when there are two different combinations of technologies and tools for a single TBL indicator, it is not possible to measure the strength of these relationships and, therefore, to infer which one contributes most to performance improvement. This represents the main limitation of the study. Furthermore, a limitation of the study is the exclusion of 13 articles due to the unavailability of full-text access, even through the Portal CAPES (a Brazilian platform with more than 455 research bases).
PRACTICAL IMPLICATIONS: The results of this research can guide hospital managers in identifying combinations of I4.0 technologies and lean tools with the greatest potential to contribute to improving business sustainability, as measured by the TBL. Thus, through this combined use of technologies and tools, health organizations are expected to achieve better performance, offering high quality services to society.
SOCIAL IMPLICATIONS: The TBL encourages companies and organizations to take responsibility not only for financial profit but also for the social and environmental impact of their activities. This aspect promotes equity, diversity, employee safety, and engagement with the local community and other stakeholders. It is necessary to highlight that the combination of I4.0 technologies with lean tools and the TBL has the ability to mitigate process waste in the healthcare sector.
ORIGINALITY/VALUE: A similar study was found in the manufacturing area and another in the healthcare area focused on evaluating only the simulation technology. Thus, the originality of the research focuses on evaluating the contribution of the combined use of I4.0 technologies (in addition to simulation) with lean tools for business sustainability, measured through TBL, specifically in the health context.