A few weekends ago we needed to access out of hours NHS GP services. NHS direct organised an appointment promptly and we arrived on time. A GP also arrived to start her shift and we were her first appointment. Everything seemed to be going well. Then there was a delay then a wait. Huddled discussions could be seen taking place between GP and other staff. Thirty minutes later we get to see the GP. The problem was she had been on holiday and had not logged on for a couple of weeks. Because she had not logged on for a period of time her access had been removed from system. As we had now missed our alloted slot other patients were arriving and a queue had begun.

There are a number of things we can learn from this story. First is that delays and waiting times often build up from very small causes that have nothing to do with resources or other often cited causes! In this case an IT security policy. Queuing theory teaches us that when systems are loaded to high levels, small disruptions can cause significant delays (this is the same reason motorways grind to a halt even when there is no obvious cause of a delay).

The second piece of learning concerns what happened next. Did the issue that caused the delay get raised at the end of the shift? Was the problem logged? Did anyone think to problem solve and did senior managers know why a delay had occurred? As I was not around later I can only speculate as to the answers here but the impression I got was that this was written off as just one more annoyance in the system.

Delays and waiting times in a service situation are analogous to stock or inventory in a manufacturing business. In a service you can’t build up stock so queues replace stock.

Stock is not good for business and one of the secrets of Apple’s success is that Tim Cook has reduced inventories in Apple to an unprecedented 5 days! It is probably no coincidence that with his background as a COO he has such a ruthless focus on the supply chain.

The supply chain is the leaders responsibility!

Notified of difficulties with one Chinese supplier, Cook said: “Someone should be in China driving this.” Half an hour later, he glanced at an operations executive and said quietly: “Why are you still here?” The executive left the meeting, drove to the airport and hopped on a plane to China.

So I have two questions for leaders in the public sector. First of all do we have such a ruthless focus on our supply chains or do we delegate this responsibility? Secondly are we confident that we have rigorous systems in place so that at the end of any shift problem that have occurred are logged and fixed?

It is the attention to operational detail that is needed alongside a culture of continuous improvement if we are to improve customer service, improve productivity and reduce queues and delays.