# Lean Management Framework in Healthcare: Insights and Achievements on Hazardous Medical Waste
## 5 Discussions  
HMW includes materials that pose substantial risks to health and the environment.  
Medical waste management typically involves a standardized sequence of steps: segregation at the point of generation, collection and interim storage, transportation, appropriate treatment, and final disposal [84].  
Each stage requires strict adherence to protocols and regulatory compliance to ensure the minimization of health and environmental risks. Common challenges across these stages include inadequate training of personnel, insufficient infrastructure, lack of real-time monitoring, improper segregation of hazardous and non-hazardous waste, and weak enforcement of regulations.  
Recommendations widely emphasized in the literature include the need for the following:  
* Strengthening segregation practices using color-coded systems [5];
* Capacity-building and ongoing training for healthcare staff [73];
* Investing in decentralized and modular treatment technologies [19; 27];
* Enhancing digital traceability and compliance monitoring tools (e.g., IoT, blockchain) [22; 38; 80];
* Establishing robust policy frameworks and funding mechanisms to ensure long-term sustainability [21].  
The COVID-19 pandemic has significantly increased the volume of hazardous waste, particularly from single-use personal protective equipment (PPE), which poses long-term environmental risks due to the release of microplastics and microfibers into ecosystems [85]. Addressing this emergent waste stream requires integrated strategies that combine material innovation (e.g., biodegradable PPE) with efficient segregation and disposal systems.  
This general framework underscores the need to integrate both foundational practices and advanced innovations, ensuring that basic waste-handling protocols are not overlooked in the pursuit of high-tech solutions.  
This study reveals the multi-dimensional nature of medical waste research, reflecting a convergence of technological, environmental, and operational themes. Through integrative bibliometric and thematic analysis, we mapped the conceptual structure and emerging trends of the field, highlighting the increasing alignment with sustainability goals and process optimization logics.  
The results show that research on medical waste has gradually evolved beyond its traditional biomedical and regulatory focus. New directions emphasize technological innovation (e.g., pyrolysis, gasification, plasma treatment), environmental performance (carbon footprint, emissions, circular economy), and systems-level efficiency, which is particularly evident in terms like optimization, value, and process. These trends suggest a shift toward frameworks that mirror principles of lean management, such as waste minimization, workflow improvement, and value creation.  
Consistent with the recent literature on sustainable operations, our analysis identifies four dominant thematic clusters--technical systems, behavioral change, environmental metrics, and computational modeling--each contributing to a broader understanding of how medical waste can be managed more efficiently and ethically. The overlay and density visualizations further reinforce this conceptual layering, revealing that recent publications increasingly focus on data-driven methods, life cycle-based assessments, and integrated decision-making tools.  
At a global scale, the co-authorship network analysis indicates that medical waste is a topic of shared international concern, with major contributions from China, India, and the USA, but also growing visibility of emerging economies. This highlights the need for knowledge-sharing platforms and international collaborations, particularly to support low-resource settings.