Objective To analyze the current application status of lean healthcare management in hospital pharmacy services domestically and internationally, and provide evidence support for optimizing pharmacy service practices. Methods The literature on the application of lean healthcare management to pharmacy services in domestic and foreign hospitals published in China National Knowledge Infrastructure, Wanfang, PubMed, SinoMed from January 1, 2006 to June 30, 2025 was systematically searched. The characteristics, application scenarios, lean tools, and implementation effects included in the literature were analyzed. Results Finally, 22 articles were included, including 7 English articles and 15 Chinese articles. The publication time of literature in domestic and foreign research showed different trends. Foreign research showed a sustained and stable number of publications, while domestic research showed an overall trend of being flat in the early stage and active in recent times. The application of lean healthcare in pharmacy services mainly involved optimizing outpatient pharmacy service processes (8 articles), managing inpatient pharmacy operations (9 articles), specialized management of ward pharmacies (2 articles), and management of intravenous medication dispensing centers (2 articles). The included literature usually used multidimensional indicators to evaluate the improvement effectiveness of lean healthcare management. In China, it focused highly on patient waiting time for medication retrieval (7 articles) and patient/medical staff satisfaction (6 articles), while in foreign countries, it mainly involved drug dispensing/turnover time. The application of drug dispensing/turnover time was relatively balanced in domestic and foreign literature (5 domestic articles and 3 foreign articles). The included literature covered 11 lean tools, with the most frequently used tools being value stream mapping. More than half of the studies used a combination of multiple tools to improve the model, with foreign applications highly concentrated on value stream maps (6 articles), and domestic tool choices being more diverse. Conclusions There are differences in the development stages and evaluation focuses of lean healthcare management research related to pharmacy services in domestic and foreign hospitals, as well as the application models of lean tools.