While Lean methodologies have been widely adopted in large enterprises, their application in small and medium enterprises remains an area requiring further exploration. This study aims at a hybrid approach combining a systematic literature review based on the PEO framework and PRISMA methodology with comprehensive data analysis from 780 respondents to examine the direct relation between Lean and SMEs. Various statistical methods were used to identify different patterns and themes. The findings suggest that while resource constraints pose significant challenges for SMEs in adopting Lean, tailored approaches with a significant reliance on leadership commitment can considerably enhance operational efficiency, resilience, costs, and waste reduction. Insights from the analysis further revealed a preference for operational methods with limited adoption of complex and strategic methods of Lean across SMEs. The paper concludes with practical recommendations for SMEs and lays a foundation for future directions in terms of integration with ESG and sustainability.