The coroner asked the medical director to provide an explanation of the handover process between ambulance crew and hospital staff, in order to free up the ambulance to be deployed to another emergency.
Professor Makin said the hospitals and the ambulance service had a joint target time of 15 minutes when it comes to handing over a patient.
He said on March 20th last year, the health board only achieved this handover target time with 57% of its 197 admissions.
He said, however, that on that day, North Wales had done better than the average for Wales, which was 53%.
The all-Wales target is to achieve a 15 minute handover time with 95% of admissions.
Professor Makin said: "All too often in the health service we trot this thing out about lessons being learned. I want to see changes that significantly improve performance."
He said a number of measures were already in place to improve the health board's process of managing patients and minimising delays in admissions.
Coroner John Gittins told the medical director: "The reality is, the crux of how this problem arose was due to this triaging process, where a patient is cared for in an ambulance whilst waiting for admission... in this instance it's hugely important that improvements happen rapidly."
Betsi Cadwaladr University Health Board conducted a serious incident review following Fred Pring's death and found the hospitals had been under considerable strain that week.
The coroner asked: "Does it fundamentally come down to an issue of staffing and bed numbers?"
Professor Makin, medical director, said it "doesn't characterise it appropriately to say it was just about not enough beds being available."
He then provided the inquest with a snapshot of what the health board was dealing with that day. He said all three major hospitals in North Wales were reporting a problem with over-capacity and anticipating having more admissions than beds available.
"Twenty-two ambulances were waiting outside hospitals to transfer patients; there were major patients being held in minor [units]; there were long waits for medical beds," Professor Makin said.
He added it was important to say that the problem was a Wales-wide problem at the time - not just specific to North Wales.
The Fred Pring inquest has resumed, with evidence from Professor Matthew Makin - medical director of Betsi Cadwaladr University Health Board.
He said it was clear that there was "considerable stress" on the system within A&E last March, when Mr Pring needed an ambulance. There was an increased demand for in-patient beds, which was a fairly typical pattern for March and April.
"In the last 20 years, the populations of patients who attend A&E department has changed considerably," he said.
"Now they are very elderly and frail, and when they are admitted they are in for a longer stay.
"The question is, how do we keep up with that demand?"
A Welsh Ambulance Service manager has told an inquest she held an investigation after Fred Pring's death, which concluded that there were no ambulances available to go to his aid.
Jill Plemming said: "Between 0109 hours and 0142 hours there were no resources available to this patient. The reason for this was the significant delays in transferring patients both to Wrexham Maelor and Glan Clwyd hospitals."
She added the delays were further impacted by the urgent requirement to give crews 'non-disturbable' breaks after five hours of duty.
An accumulation of these breaks also had a knock-on effect on resources available at that time, Ms Plemming said.
The inquest has heard that one ambulance, which would have been allocated Fred Pring's emergency that night, was stuck at Wrexham Maelor Hospital waiting to transfer a patient for almost five hours - 287 minutes to be exact.
Coroner John Gittins told manager Ms Plemming that is "a very long time" to wait to transfer a patient.
She replied: "Yes, it is."
When he asked if there was a target patient transfer time, she told him it was 15 minutes.
Mr Gittins: "So, in a nutshell, six ambulances waiting to transfer patients at Wrexham Maelor, three ambulances waiting to transfer patients at Glan Clwyd. All experiencing delays significantly longer than the 15 minute target time?"
Ms Plemming: "Yes."
The Welsh Ambulance Service call centre manager has told the inquest that once an emergency call has been received and logged, an ambulance is allocated as soon as possible.
Coroner John Gittins asked Ms Plemming: "So for Mrs Pring's first call there was no ambulance available?"
Ms Plemming: "No there wasn't."
Mr Gittins: "Clearly the caller is not told that, are they, that an ambulance isn't available when they call?"
Ms Plemming: "No, they're not."
She described the night Fred Pring was taken ill as "exceptionally busy", with delays in North Wales' three A&E departments during the day having a knock-on effect on the ambulance service.
The manager of the Welsh Ambulance Service call centre on the night Joyce Pring rang four times for an ambulance is now giving evidence.
Jill Plemming said the delay in reaching Mrs Pring's husband would not have bumped the 74-year-old up the queue for response, despite the delay being a significant factor in his chance for survival.
Following Mr Pring's death, Jill Plemming conducted an investigation to see if the call handlers treated Mrs Pring correctly. She found there were minor errors, but overall each call complied with the Welsh Ambulance Service's protocols.
She told the inquest each call made by an individual like Mrs Pring is treated in isolation by a call handler.
Coroner John Gittins asked her: "So how can the call handlers assess a deteriorating condition?"
Ms Plemming: "They can't. Each call is being treated in isolation because they can't be influenced by previous calls."
She said each call handler was required to go through the same script, which was why Mrs Pring had to answer the same questions four times during her four calls.
She tells the inquest there is a target response time of eight minutes for an emergency like Mr Pring's condition, which was classified a 'code red 2' emergency for his wife's first three calls.
When Mrs Pring called to say her husband had died, it was elevated to a 'code red 1' emergency, which has the same target response time of eight minutes.
Yesterday Mrs Pring told the court she believed the final call handler showed "a total lack of compassion" when she rang to report her husband had died.
Ms Plemming said today that the call handler was found to have "a professional tone and showed compassion for the caller's feelings."
The second day of Fred Pring's inquest at Ruthin has started with evidence heard from a forensic pathologist.
Mr Pring died at his home in Mynydd Isa, Flintshire, in March last year, after waiting for an ambulance.
Dr Brian Rogers undertook an autopsy following Mr Pring's death. He concludes the former gardener experienced significant congestive heart failure and the chest pains he complained about whilst waiting for an ambulance would have been similar to angina.
Dr Rogers added that Mr Pring was clearly a very ill man.
Asked whether or not Mr Pring would had survived if the ambulance had got there sooner, he replied: "I find it impossible to say, though I think it's unlikely."
The inquest into the death of 74-year-old Fred Pring, who died after waiting 50 minutes for an ambulance, has been adjourned until tomorrow.
A cardiologist has told the inquest into Fred Pring's death that if an ambulance had attended quicker, "more likely than not he would have survived".
Dr Raj Thaman said he would expect an ambulance to get to a patient within six minutes of an emergency call and this would have been enough time to save his life, "in all probability".
Coroner John Gittins asked him: "If an ambulance had responded after the first call, within the expected time frame, then it's more than likely that a patient like Mr Pring would have survived?"
"Yes," replied Dr Thaman. "The faster the response, the greater the chance of survival."
Dr Thaman said that, in his opinion, the ambulance service had a 10-minute opportunity to save Mr Pring.
He added that Mr Pring's condition appeared to deteriorate very quickly and by the time his wife made the second phone call for an ambulance it was probably already too late to save him.