From Idea to Proposal — First Stage Surgical Video Strategies —
I had a client a number of years ago relate to me her adventures in creating a total knee surgical video before she had met me. It was not her first video, but her third. For her, she said, the process was like running a triathlon over gravel without shoes, biking with a tricycle, and swimming through tar. Yet she understood the marketing value surgical video has for surgeons, so she persevered.
Her champion surgeon was exceptionally helpful and smoothed the way to the OR. That was no problem. Surgeons are mostly eager about video. But the videographer she hired, previously had shot only five surgical procedures of various kinds, none of which could be called major surgeries. He showed up with only a single camera on a tripod that merely elevated to five feet. It was a shorty. Even the surgeon’s shoulders got in the way, much less the head. The videographer did not use a dolly, which is a tripod spreader with wheels, so he could only park the camera in one position, then had to pick it all up and move it to the side when the surgeon needed to show the lateral aspect of the joint. On top of this, the OR lights were the only lighting used, so the result was that harsh, over-bloomed, over-exposed, washed out wound shot with dark, contrasted features like you see on so many YouTube surgery videos.
Because the videographer did not know the procedure and basically did not know what he was really looking at, he simply parked the camera and let it roll in a medium shot that showed no detail and very few close-ups. This is not uncommon for videographers that don’t know surgery, so they typically wait for the surgeon to direct them as to what to do. But this surgeon was appropriately dedicated to the principles of ‘patient first’ and could not tell what kind of shot the cameraman was getting anyway. And the surgeon pretty much said very little throughout the whole procedure. So the cameraman simply planted the camera and kept the focal length in medium out of fear that he would miss something.
As the case progressed, my future client said she could see the details of the procedure slipping away. Added to this, the surgeon wasn’t giving instructions on the instrumentation she had hoped for. She prompted the surgeon to talk during continuing stages, but she knew she was missing commentary from earlier.
At the end of the case, she had a sinking feeling that she had a lot of work cut out for her in order to make this thing work. She was well familiar with what needed to be done as she was a veteran with two previous procedures to her name. She had been through this before and at that time assumed it was the norm.
Within weeks, the videographer, who was also the editor, supplied her with window dubs—those VHS tapes with time code burned into the image of the tapes (Yes this is all the way back in those days). Since the videographer/editor had no familiarity with anatomy or the steps of the procedure, then the fastest route to editing was best in the hands of the product manager who knew the procedure.
She also knew that to engage the busy surgeon in such a footage search would take too long. What was hardest for her is that although she had previously made editing decision lists, she never felt like she developed that vision that could see the program as a whole. Video was like laying bricks one by one to her and she wanted that something extra, which comes with experienced editors.
For two months she pored over the window dubs to come up with an editing decision list. By day she tended her marketing responsibilities, by night she sat with her window dubs playing and pausing her tape deck, jotting down in and out points. She could count the opportunity costs piling up into a towering heap.
What she began to discover was that she had large swaths of footage missing audio commentary. And sometimes the associated commentary happened during a different time than the very thing the visuals were showing. This demanded some fancy notations about transposing audio over different video, and this was especially complicated when mallets were used or clicks could be heard. She knew she would have to return to get more voice-over from the surgeon in order to complete the program.
Months went by. A script had to be written. And follow-up voice-over was recorded before it could all be put together. The efforting she felt over the project was tremendous and she vowed to take a vacation once she finished that video.
Light At The End Of The Tunnel
So you get the idea. Remarkably it took her ten months to complete that project. And remember it was not her first. She was a veteran. Yet she was a determined and eager beaver, understanding the value of surgical video to her market—the surgeons that needed to learn how to use her instrumentation. Seeing is believing when it comes to a surgeon audience.
To her, surgical video was a necessity. Some of the difficulty was inherent to the technology of those times. She was reporting from those videotape days after all.
Yet although much of the workflow has changed and we are well past the birth of HDTV and non-linear workflows, when a marketer hires a video crew that does not have surgical or even medical expertise, there are certain obstacles, DIY tasks, and slow-downs that will be routinely encountered that you don’t otherwise have to worry about with surgical video expertise. Surgical video experts are rare indeed. How many fingers do you have? That may be the number of surgical video experts in this country, maybe the world. Sure you can find videographers that have shot at least ten surgeries. But that is not expertise. Expertise is when a videographer or editor sees the surgery and not just the image, someone who can mentally inhabit the intentions of the surgeon and is tenacious about getting the shot.
And many projects simply do not require the expertise in the first place. I was once asked to shoot an injection in Poland. Really? Any videographer can shoot an injection. There are many surgical procedures that can be shot well with your local video guy. But you need to determine if you can accomplish your goals with the local video guy. So what I want to show you here are several techniques that will help you through those obstacles you may encounter when you don’t hire surgical expertise or as well when you do hire expertise and want to know how to produce surgical video efficiently.
Making Surgical Video A Lot Easier
Creating a surgical video program may sound like a daunting, months-out-of-your-life activity, especially for the newbie. But the truth of the matter is that with the right planning and know-how, surgical video can actually be an easy and a very predictable process, executed with control in every corner of the workflow.
With proper preparation you can have a pain-free surgical video experience that meets your marketing needs and makes your champion surgeons look exceptional, even if you hire that local guy. But one very important caveat is that the less complicated the surgical procedure, the more you can get away with hiring the local guy. Yet there are still several conditions to this that I will go over in future articles.
So in this series of articles, I want to lay out the process of creating surgical video for the marketer of surgical devices and procedural technology in a step-by-step, stage-by-stage manner. This will hopefully not only get you out of the rut of throwing good money after bad, but also give you way more control, more predictability, decreased opportunity costs, and I cannot even begin to tell you how much time you can save by planning this process correctly.
So let’s get started!
Stage 1: From Idea To Proposal
So you want to make a surgical video?
You have met with your boss, concurred with your department that the product you need to market might be best served up to your surgeon customers through video. After all, surgeons learn through seeing, visualization (who has ever heard of a blind surgeon). Or maybe you have inroads with one of the world’s prominent surgeons and he wants to make a procedural video demonstrating either a new invention, a new product line, or new technique. You want his or her name, you want that exposure that radiates from the podium at meetings.
You have explored your market insights and prepared a brief outlining the project, the objective, audience, value proposition, the calls to action, your creative considerations, global considerations, and you may have even located a video that is similar to what you want to do. Now is the time to prepare to speak with a video producer.
There are certain questions you want to first answer.
The Big Six Questionnaire
Start with answering this questionnaire for yourself first. Run it by other members of your team before you send it to your video producer. Or at least have these answers when you first talk with a producer:
- What is the purpose and objective of this video?
- Who is the primary audience?
- What is the genre of this program? Live? Or capture then edit?
- What is the surgical procedure if it is a procedural program?
- How many running minutes do you envision for the program?
- By when do you need the program?
These are the most important first questions to ask yourself and convey to the producer. As well, here are a few more questions that will help:
- Are there any peculiarities to the production that you can think of?
- Do you need or want to incorporate animation?
- Who is the surgeon you have in mind? And which hospital/location might it get shot at?
- How do you intend to use the program? Are there multiple forms you want it edited in? Where do you want to show it?
Let’s go through some of these.
What Is The Purpose And Objective Of This Video?
At the center of the stage of the purpose of the video program is the value you want it to bring to your market, your audience. Value is the engine of purpose, and skillful aim provides the accuracy for hitting the center of your target. A good, simple but powerful purpose and objective statement will ground your efforts right out of the gate. Most marketers are very familiar with this part of the process.
Who Is The Primary Audience?
Defining your primary audience is key. This is simple enough with a surgeon audience but sometimes you want to hit another kind of audience at the same time. Be careful that your primary audience is attended to fully first. And don’t mix audiences unless they have the same motivations. Otherwise you risk losing your primary audience.
A case in point is when you want to show circulating nurses using the details of a console while in the middle of showing a surgical procedural program that surgeons are already engaged with. This is mixing the audience when their interests are not the same. By showing the console operations in the middle of the surgery surgeons want to see, you will lose your primary audience. You need two videos for these two separate audiences. It may well entail shooting only one surgical procedure, but the end product must be appropriate if the audiences are not cohabiting the same values.
What Genre Is The Program? Live? Or Capture Then Edit?
Once you determine your audience, figure out what genre of program you think will best meet your marketing needs. Also, live video has a whole different set of requirements from shoot-and-edit video. Live events require a considerable amount of manpower and planning. This includes webcasting or satellite broadcasting.
Here is a list of program genres:
- Academic Surgical Procedural Programs
- Surgical Procedural Programs
- Product Promotional Programs
- Convention Floor Promotional Programs
- Live Surgery & Events, Streaming & Satellite Uplink
- Instructional & Assembly Programs
- Cadaveric Dissection Programs
- Surgeon Interview & Forum Discussion Programs
- Seminar & Workshop Capture
- Patient Education Programs
- 2D & 3D Animation
- Sales Force Motivational Programs
- National Sales Meeting Programs
- Employee Motivation and Instructional Programs
- Eye-Candy Product Promotional Set To Music
- Video News Releases, Documentary, & TV Commercials
I discuss a few other aspects for considering genre at: Plexus Genres
Finding The Right Video Producer
Surgical videographers are hard to come by. Many average videographers have shot some surgical procedure or another, but very few actually have the experience that is needed when you have to market a surgical device that has some detail involved with the use of that device.
One of the key points to consider as a marketer is that the quality of the video implies the quality of your product. Take the garage sale sign for example.
I have often used the idea of a garage sale sign compared to the clean-looking company logo. With the garage sale sign you know the quality you’re getting. Is this what you want to show your customer audience when you show them your product—a garage sale sign? Video quality works subliminally, like advertising. Home video and bad audio irritates the viewer, although they may never level with you about this. And surgery is not easy for most videographers to shoot.
Added to this, most surgeon audiences are focused on the procedure and don’t always consider video quality unless the surgery is obscured. A case in point was a surgeon who once hoisted an Achilles tendon repair shot with a GoPro up onto YouTube, and all you could see was a small splotch of red in the center of the screen. The GoPro was too distant from the wound, which is a problem with fixed wide-angle lenses. You couldn’t see any detail to speak of. The surgeon thought it was great, at first. He had that initial glee I have seen when a kid gets a new toy before the limitations are discovered. And he admitted later he was looking to improve the technology. But at first, in his mind, he was able to fill in the steps of the procedure over the compromised imagery. This is not uncommon and there is a whole psychology about this. The mind will fill in what’s missing. But do you want them to do this for your product? Or do you want to support a message that subliminally adds impact to the quality of your product?
So if the surgical procedure is complicated enough and you want to make it look good, hire experience and expertise. Ask to see examples of the surgical procedures they have shot before. Have they shot only a few procedures or many? Do they understand medical nomenclature? Do they have the right equipment for capturing the specific procedure you want to capture? Or do they say things like, “Wow, that is really interesting! What are they trying to do there?” That’s a dead giveaway you are not speaking to expertise. If they are talking about bringing a ladder into the OR so they can get up high with the shot, you’re talking to the wrong person. If they want to bring one of those monster jib arms into the OR that takes up half the room, again you are talking to the wrong person.
Simple procedures are typically easy enough to capture with average videographers. But once you enter the realm of deep wounds or complicated surgical procedures, you will kick yourself if you don’t go with expertise.
Assumptions vs. Communications
For either the newbie or veteran marketer to video production, assumptions are the prickly gnats of the initial relationship between marketer and producer. I cannot tell you how many times marketers come to me and miss communicating their full vision of a video program. This might partly be due to my expertise with surgical video and surgical device promotional programs. They typically trust me, and I am happy about that.
But if you are working with any producer, you best go a little overboard on communicating your vision. If you’re hiring the local videographer, then you have to state your camera capture and angle needs clearly. This may seem daunting, but making a rough plan will help. Not all videographers have access to the kind of gear that is best used in surgery. So it is good to establish shots and camera angles early.
I could say more here, but the next two articles in this series will show you specific situations at the pre-production planning and production stages where this principle can help tremendously.
Details About The Surgical Procedure
As a producer of surgical video programs, I always want to know the details of a proposed surgical procedure. When you’re interviewing producers, it helps to tell the producer the details of the procedure in order to evaluate the camera needs. Not all procedures are alike in this regard. And as well, often the same procedure in the hands of another surgeon can demand a completely different approach. Planning is everything at this stage. Someone in the mix, besides the surgeon, has to have a surgical mind that they can apply to how best to get the shots. If you’re working with the local video guy, then that person is likely you.
Once I was asked to shoot an endoscopic thyroidectomy, which seemed pretty odd to me at the time, because in my imagination I could not conceive how a virtual space would be developed in the neck through portals. It seemed like that would be a hairy dissection indeed. The product manager could tell me no more about the technique and the surgeon was out of the country until the day of the shoot. Great. She called it an “endoscopic” procedure. I thought I had better set up the overhead camera just in case. Sure enough, the case was an open thyroidectomy with the use of an endoscope, not through portals, but through the open wound so as to see the microscopic detail of the tissues. The scope was simply in lieu of pulling in a microscope. Yet well over half of the procedure was conducted without the scope.
Who Authors The Program?
You have a choice. In the academic surgical procedural program you want to make it look like the surgeon authored the program. With this style you want to keep the company voice to a minimum or with only a company logo at the head-slate and company website at the tail-slate titles. As well, if you wanted to submit this program to an academic video library, all that is needed is a change to the logo and titles. You can quickly make it look like an academic or a company program.
Surgeon audiences tend to respond more positively when the company voice is kept to a minimum or they can’t see it or hear it at all. They perk up when the program seems authored by a champion surgeon. Surgeons get suspicious when there is too much company voice.
Typically if you shoot for the academic program first, you widen your possibilities considerably. You still have the option to add some things to the program to make it look more like it was authored by the company. You can add titles, a pro-voice, or do the program in a reportage style. But once there are company instructions in a surgical procedural program, it is not so easy to get it to qualify for an academic submission.
This is why I always advocate to start from the academic foundation first, then create your two or three variations. Often an academic program will satisfy your company voice needs.
Producers, Surgical Videographers, & Editors
So you love the producer you are working with and he is under a three-year contract with your company but he doesn’t have surgical expertise. Then collaborate with your producer on hiring a surgical videographer from outside his standard set of people. I personally happily do these kinds of shoots quite often.
As well, I have often been handed footage to edit that I didn’t shoot. It is important that you think about the editing process this early, at the idea stage of production.
Which brings me to one very important point—always ask your producer up front about how they handle post-production workflow. Unless you want to sit for hours watching an editor cut and drag footage on a timeline, it is best to get an idea of how the editing process will be handled so that it takes most of the work out of your hands. Remember my client who spent two months looking at window dubs and ten months to finish the whole program. These days with the marvelous world of technology, the editing process can be simplified and efficient. But once again, surgical expertise needs to be part of the workflow. Knowing what stage of the editing operation your expertise may be needed will smooth out the whole process.
I still hear horror stories about editors who do not know what they are looking at in a surgical procedure, getting utterly lost, and taking a program through cut after cut after cut, revision after revision, while also needing to call every ten minutes to ask about some anatomic feature or instrument name. It’s a tall order to ask just any editor to know anatomy and cut surgery, but if you can prepare by making sure your producer has a handle on the post-production process, it will make everything glide.
There is a lot to mention about editing, and this we will visit in the post-production part of this series of articles.
Details About Titles & Animations
Again, let the producer know your vision. You may want something with lots of titles that describes steps of the procedure. Any details you can give the producer about the style of the program you envision will help. You may want animated titles but forget to mention this to your producer.
If you don’t have a vision, then discuss this with your producer. Sensitivity to how the surgery is captured is one aspect you want to see in a producer. As well, a vision as to how it will be edited is another important aspect to the fulfillment of your marketing efforts.
A Word About Video Minutes
A surgical procedure budget has to be estimated by the kind of procedure and the video needs of that specific procedural program. It’s not simply a matter of just shooting and editing surgery.
There was a standard in the video industry, for decades actually, that production budgets were estimated by how many final minutes an edited program took. The standard was $1,000.00 per video minute (with variations of course). However this does not work so well in the world of surgical video. But too often when a producer does not really know how to budget for a production like surgical production, they will use this standard. This is something to be aware of if you have the need to create a longer program. If you see the budget matching the minutes, you may want to question that. Again this is not always the case. Some procedures will match the final edited minute number.
And this is another reason to disclose your vision with your producer so they can better adjust for exactly what you need. I personally have never used this $1K per final minute standard. I go by the surgical procedure, knowing what it will take to shoot and edit the details of the procedure.
Live Video—A Whole Other Ball Game
Live surgical video is a whole other ball game and rather than go into detail here, I will write something separately about this topic. Here we will focus on the non-live, non-broadcast surgical video capture and edit.
Seeking The Proposal
Once you have mapped the vision of the surgical procedure you want to shoot, the next step is to disclose the details of your vision to your producer and request a proposal.
A good proposal will contain several elements. Of course the purpose and objective of the video will be stated, the primary audience, and a brief statement about the video format that will be used with a modicum of technical characteristics.
You might ask the producer for details about which cameras and what kind of jib arms they intend to use to get specific shots. If they say they will use Go-Pros, head-cams, DSL cameras, then they don’t know how to shoot surgery. I’ll explain this in another article. But evaluating how the producer thinks about surgery and the program needs, and how to get the right shots, will establish a sound video production foundation before it is too late and you find yourself in surgery with a videographer with the wrong gear for that particular kind of procedure.
And of course the budget is presented in a proposal in a manner that makes sense. Typically the video production day can be drawn out from the editing needs. Other budget considerations are travel, room and board expenses and equipment shipping expenses. And for surgery don’t forget hospital compliance expenses, immunizations and registering with hospital compliance sites. Some producers take care of distribution of the final edited product as well, but these days, it seems to be uncommon that DVDs are being duplicated en masse. You want to review your final edited product needs.
And finally, a good proposal will define the stages of a production and call for any extra items, such as a pro-voice or animation needs. Although a producer may or may not do animation, they may be able to help. Some producers actually specialize in animation. Those are the people to go to (for animation).
Once you are handed a proposal, it is time to evaluate if this producer is right for your project. Many producers do remarkable work but have no surgical expertise. Some have shot many surgical procedures but may not actually have reached a level of expertise. Consider the expertise level you need. Sometimes smaller surgical procedures, superficial procedures such as skin peels, some catheter procedures, injections, or mole removals can be shot without expertise. You will have to determine if that producer is the right fit for your needs.
Videographers and producers are a positive lot, and there is something about filmmakers that they think they can do anything. It comes with the territory. Yet sometimes this positivity needs grounding in sound planning. And the way to ascertain if you have a good producer for surgery is to determine how well they plan to get the right shots.
I hope these beginning guidelines help. In the next installment to this series on producing surgical video, Part 2, we will look at the preparation stage for finding the surgeon, the hospital, and arranging the surgical shoot date before entering the production stage. At this pre-production stage, scripting may be involved for some programs, as well as gathering a small army of people together. Which means for surgery, it can sometimes feel like herding cats, trying to get every member of the team lined up, unless a certain set of criteria is used. There is probably no other stage of producing surgical video that is as fraught with surprises and uncertainties than this stage.