Every health service I know is being trying to “improve access and flow” and reduces the queues (ramping!).

But there are queues everywhere:

• queues to get into ED - Ramping!
• queues to get out of ICU!
• queues to get a bed - Exit Block
• queues to get a scan - Diagnostic waitlists
• queues to get a clinic appointment - Wait Lists
• queues to get out (because community, aged care, NDIS, housing… pick your constraint) - Stranded!

But here’s the truth we don’t say out loud enough:

When demand consistently exceeds capacity, flow can’t be “fixed”. It has to be designed.

Because what we’re really managing isn’t movement. It’s scarcity.

And scarcity creates a predictable pattern:

• clinicians spend time negotiating
• leaders spend time escalating
• patients feel the system’s stress in delays, cancellations, and uncertainty
• teams create workarounds that keep things moving… until they don’t!

All in all, we all end up trying to fight it when we really need to redesign it!

The job we need to do in leadership is to make visible choices about where we place capacity, what we protect, and what we stop doing.

We can't all be all things to everyone, we need to be strategic about where the front door is.

A few reframes that feel more honest to me:

1) Queues aren’t a moral failing — they’re a signal. A queue tells you where demand meets a constraint. The work is to decide whether you:

• add capacity
• smooth demand
• change the rules of entry
• change the model of care
• or accept the trade-off and name it clearly

2) “More beds” is rarely the answer on its own. If the bottleneck is diagnostics, pharmacy, transport, medical decision-making, or community discharge pathways… more beds just moves the queue.

3) We’re not short of effort. We’re short of options. So flow leadership becomes: how do we create options?

That’s where “outside the box” lives:

• cohorting and alternative pathways (not everyone needs the same front door)
• virtual care / Hospitals in the Home that are resourced and governed
• short stay models that protect ED from becoming a holding bay
• discharge-to-assess / discharge-to-shared care partnerships
• standardising “minimum viable SAFE discharge” steps so we stop reinventing every day
• protected capacity for the work that prevents future demand (yes—prevention inside acute care)
• ​

And one more uncomfortable truth:

A system under constant demand pressure will default to the loudest queue. So unless leaders protect time and attention for redesign, the only strategy becomes firefighting.

If you’re living this right now, here’s the question I keep coming back to:

Where is the queue negatively impacting people the most, staff or consumers — and what’s one change that would create an option, not just push harder?

What queues are you challenges with in your everyday? I'd love to hear y=any innovative solutions you are trying.

And if this resonated with you, please feel free to share it with a colleague who may also benefit.

​ Jo Glover Leadership Coach & Operational Expert in Health Empowering Health Leaders to Believe, Lead & Achieve 📧 jo@jo-glover.com​ 🌐 jo-glover.com​ 🔗 LinkedIn​ Previous editions can be found here​

Prefer to listen instead of read?​ If you enjoy this newsletter, you might like my new podcast, The 10-Minute Coach. Each short episode expands on themes like this one and coaches you through one practical shift you can make in your leadership this week. Ideal for busy health and government leaders who are listening on the move. 👉 Listen on Spotify: Search - The 10-Minute Coach by Jo Glover.

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