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Several authors have examined the lean healthcare literature, but besides all efforts made, articles comparing conceptual and analytical studies were not found. Thus, a systematic review is conducted aiming to understand the state of the art of lean healthcare by investigating and comparing how conceptual and analytical articles address tools/methods, application fields, implementation barriers and facilitators and positive and negative impacts.

Articles in English about lean healthcare, published in journals in the last ten years (2009–2018) and indexed in Web of Science (WoS) or Scopus were examined and assessed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) protocol. A qualitative content analysis on the eligible articles was conducted, and results from the conceptual and analytical studies were compared.

There is a literature gap regarding tools/methods in both conceptual and analytical approaches once they prioritize for different items. Barriers, facilitators and negative impacts are perceived differently within both categories and might require more extensive analysis. The same items prevail in both conceptual and analytical categories when analyzing healthcare fields and positive impacts.

There is a lack of articles comparing conceptual and analytical studies concerning lean healthcare. So, this study's relevance is in identifying theoretical and applied research gaps to strengthen the lean healthcare state of the art and to integrate theoretical-applied knowledge. For healthcare professionals, it might provide an overview of the key factors that can promote lean implementation.

COVID-19 played a crucial role in the development and enlargement of learning via electronic media. Still, the recent fourth industrial revolution [Industry 4.0 (I4.0)] paved the road toward Education 4.0. In this regard, several research challenges arise, involving the preparation of gamification strategies in online learning environments. In this sense, this paper aims to investigate the relationship between technologies of I4.0 and gamification practices in online learning around the world. Specifically, to categorize the studies of the scientific literature in the area into knowledge domains and the mention of I4.0 technologies and to verify the relationship of these technologies with the different educational levels.

The preferred reporting items for systematic reviews and meta-analysis protocol was used as a research method with 130 papers included for full content analysis and obtained from the Web of Science.

The leading I4.0 technologies mentioned in the analyzed papers were simulation, Internet of Things and augmented/virtual reality, in this order. Although there are more mentioned technologies, the domain of knowledge to be applied and the educational level interfere in choosing these pillars. With this, the main findings of this relationship were exposed in a singular, modern, active, realist, technological framework to demonstrate how I4.0 relates to the practice of gamification in online educational environments.

To the best of the authors’ knowledge, this is the first study that brings together the relationship of gamification applied in e-learning with I4.0 technologies.

Lean healthcare (LHC) applies lean philosophy in the healthcare sector to promote a culture of continuous improvement through the elimination of non-value-added activities. Studies on the subject can be classified as conceptual (theoretical) or analytical (applied). Therefore, this research compares bibliometric indicators between conceptual and analytical articles on LHC.

For data collection, the PRISMA Protocol was employed, and 488 articles published from 2009 to 2021, indexed in the Scopus and WoS databases, were retrieved.

This study reveals how conceptual and analytical LHC studies are organized in terms of the most relevant journals, articles, institutions, countries, the total number of citations, collaboration networks (co-authorship, international collaboration network and institutional collaboration network) and main co-words.

Only four papers conducting bibliometric analysis on LHC studies were identified in the Scopus and Web of Science databases. In addition, none of these papers compared conceptual and analytical bibliometric indicators to reveal the evolution, organization and trends of each category. Therefore, this work is not only the first to make this comparison but also the first to analyze the collaboration between authors, institutions and countries in relation to studies on LHC. The analyses performed in this work allow one new possible understanding, by researchers and health professionals, of the literature behavior in this field of study.