This study describes the practical aspects of designing, developing, and implementing a video methodology to observe patient care. The investigators outline their approach in capturing 270 operating room cases with lessons learned and suggestions for others interested in applying a similar approach for research and quality improvement activities. Discussion includes important technical considerations, processes for handling the captured video, and appropriate sensitivity and compliance with issues of human subject consent, provider privacy and confidentiality, and related medicolegal concerns. This video technique may provide a necessary mechanism to study the complex interplay of systems, individuals, and human factors, which represent a critical aspect of addressing patient safety improvements.