This study presents a literature review of 107 papers on lean healthcare to evaluate its evolution by updating previous literature reviews and to propose a classification and analysis of the papers reviewed. The literature classification was performed based on six parameters: research method, country, healthcare area, implementation, lean tools and methods and results. From the analysis performed, this paper presents a quantitative analysis of the state of the art concerning lean healthcare and indicates current research trends, based on the stage of evolution of the area, that may guide further studies on the subject. An example is lean healthcare expansion to other countries, such as Brazil and the Netherlands. Another aspect is the application of lean healthcare in hospital as a whole, not limited to a specific setting. Finally, a few studies detail the lean implementation process and use infrequently applied tools, present the barriers and main critical factors found in the lean implementation.