The ISO 45001: A systematic review of global adoption trends, outcomes, and barriers (2018–2023)

This systematic review examines global trends, outcomes, and barriers in the adoption of ISO 45001 from 2018 to 2023, focusing on its impact on occupational health and safety (OHS) management systems. Following PRISMA guidelines, the review analyzed 92 empirical studies sourced from PubMed, Scopus, and Web of Science. Thematic and narrative synthesis methods were employed to evaluate adoption patterns, implementation outcomes, and challenges across sectors, regions, and organization sizes. Key findings include a 32% average reduction in workplace injuries within two years of ISO 45001 certification, significantly outperforming OHSAS 18001 (14–20%). Adoption was concentrated in high-risk sectors (e.g., manufacturing, construction) and larger firms, while SMEs faced disproportionate costs (3× higher per employee) and delays. Barriers included regulatory misalignment (e.g., Brazil’s NR-12 laws increasing costs by 58%), technical capacity gaps in developing economies, and cultural resistance to worker participation. Successful strategies included phased implementation, regulatory harmonization (e.g., EU’s 35–45% cost reduction), and AI-driven tools (e.g., 35–45% assessment cost savings). Policymakers should prioritize SME subsidies (e.g., Malaysia’s 50% program accelerated certification by 68%) and regulatory harmonization. Organizations are advised to integrate ISO 45001 with existing systems and leverage technology. ISO 45001 demonstrates strong potential for improving OHS outcomes, but equitable adoption requires targeted support for SMEs and developing economies. Future research should explore longitudinal impacts and AI applications.