Human Digital Twins for Smart and Sustainable Hospital Operations: Trends Analysis and a Value-Sensitive Framework

Human Digital Twins (HDTs) extend traditional Digital Twin (DT) concepts by modeling both humans and hospital processes to support smarter and more human-centered healthcare. By integrating Industry 4.0 (I4.0) technologies with the human-centric principles of Industry 5.0 (I5.0), HDTs offer new opportunities to improve hospital operations. This study presents a PRISMA-based systematic literature review to examine the role of HDTs in hospital operations. A total of 329 papers were identified through the initial search, and after the screening process, 22 studies were included for in-depth analysis. The review combines bibliometric analysis to examine publication trends, leading authors, contributing countries, and keyword co-occurrence with a content analysis to identify the main research themes. Three major themes emerged: (1) HDT architectures and data integration, (2) human-centric and governance aspects, including explainable artificial intelligence and privacy, and (3) operational and clinical outcomes, including patient flow, resource utilization, and staff support. Based on these findings, the study proposes a four-layer HDT framework for practical implementation in hospital operations. Although the reviewed studies indicate that HDTs have considerable potential to improve operational efficiency and strengthen human involvement, most existing research remains conceptual or simulation-based. Future research should therefore prioritize real-world implementation and validation while incorporating ethical, explainable, and sustainable design principles.