Independent operations & automation consulting for healthcare organizations
Everyone bought the AI first. Nobody fixed the clinic around it.
TOSC is the independent operations partner for medium-to-large clinical practices, allied health groups, and PCNs. We make the work visible, then efficient, then automated — and only then put AI on top of a process that already works.
Independent · Senior-led, end to end · Fees tied to milestones and measured results · Built in British Columbia
The case for action
of physician capacity Canadian healthcare organizations lose to administration every year — 9.1 hours per physician, per week.
CMA–CFIB joint report, 2026
of those hours are unnecessary — work that could be eliminated, delegated, or automated at the organizational level.
CMA–CFIB joint report, 2026
of capacity per clinician, per year — multiplied across every clinician your organization runs.
CMA–CFIB joint report, 2026
The technology to recover that capacity already exists — there is an app for almost everything. What organizations lack is the operating model, governance, and adoption discipline that make any of it hold. That is consulting work, and it is the only kind we do.
How we sequence the work
See it. Fix it. Automate it. Then AI it.
Most organizations bought the AI first. That is why it did not help. Each rung only holds because the one below it is solid — and most engagements start further down the ladder than the client expected.
Visible
The handful of numbers nobody currently has — how long a referral sits, what share of calls go unanswered, how many recalls fall through, how much of what you already pay for is switched on.
Efficient
Redesign or delete steps. Turn on the capability you already own and pay for. Write down the rules that currently live in one person's head.
Automate
Automate only the steps that survived rung 2 — in the tools you already have, not a new platform to buy and maintain.
AI
Apply AI where the underlying process is sound, and measure whether it actually paid. This is the rung everyone starts at. It is the rung that works last.
Happening right now
The scribe made the doctor’s evening better. Did it make the clinic better?
Canada Health Infoway’s AI Scribe Program enrolled more than 12,000 primary care clinicians and gave each a fully funded twelve-month licence. Registration is closed, and those licences expire twelve months from each clinician’s own start date — on staggered dates right across the year.
So someone now has to justify an invoice. A scribe fixes one clinician’s charting. It does nothing for the front desk, the phone, the referral queue, the recalls, or the panel — and most clinics have no numbers to make the call with. Getting those numbers is rung 1, and it takes days, not months.
Every altitude of the problem.
Operational failure looks different at each level of a health organization. We have worked at all four — which is the point.
What breaks here
Every site runs differently. Managers firefight, standardization dies in meetings, and the group carries duplicated effort it can no longer see. Growth multiplied the operations before anyone designed them.
What we do about it
One operating model, designed with the sites rather than imposed on them — then installed, measured, and transferred to your managers.
What we do.
Two practices. Workflow fixes and automation are deliverables inside them — never the offer.
What we don’t do: billing and fee-code optimization, EMR replacement, software sales, staffing placement, or anything inside the patient record.
The Operating Review.
One method at every altitude. Four phases, and you keep a named artifact from each — whether or not you ever engage us again.
Diagnose
Where the organization loses time, capacity, and money — quantified against your own numbers, from the floor to the leadership table.
You keep: the Leak Ledger
Design
The moves worth making, with cost and return attached — including “do nothing” and “buy the app” where that is the honest answer.
You keep: the Decision Memo
Deliver
The operating model, workflows, and automation — built with your teams, installed alongside your systems, measured as it lands.
You keep: the Install & Measure plan
Transfer
The capability stays when we leave: owners named, playbooks written, managers trained. The opposite of a dependency.
You keep: the Playbook
An operator, not a vendor.
Big firms bring juniors and alliance targets. Vendors bring a box. Coaches bring worksheets. We bring the thing none of them can: health-authority AI governance experience and floor-level delivery in the same seat, with no product to sell and fees tied to milestones and measured results.
Independent
No software to sell and no vendor commissions. The only agenda is the organization's result.
We deliver, not just advise
Most advisors stop at the deck. We build the operating model and the automation it calls for, then transfer it.
Run by an operator
Years inside BC healthcare operations and informatics — from primary care networks to regional health programs.
Led a health authority’s delivery within Canada’s first multi-vendor, multi-site evaluation of ambient AI scribes in a public health system.
Career background
Deloitte · IQVIA · Gates Foundation · The Global Fund
Led by Himanshu Khetarpal.
Clinician turned operator: global consulting with Deloitte and IQVIA, a $1.5B health-system transformation, and an ambient-AI deployment run inside a BC health authority. The person who scopes your engagement is the person accountable for it, end to end.
Meet HimanshuFrom the notes.
All essaysStart with a working session.
Thirty minutes with your leadership question on the table. You leave with an honest read on the moves worth making — including when the answer is an app, not us.
Engagements carry milestone-gated fees and measured results — in writing.