Frame and fortune

In acclaimed film 'Court', cameraman Mrinal Desai's view adds a vital edge

The trick is to be close to the action but also far enough to be able to see it for what it is, says the cinematographer.

Chaitanya Tamhane’s highly praised Court, about the trial of a radical poet accused of abetting a suicide, derives some of its impact from Mrinal Desai’s camerawork. The 43 year-old Film and Television Institute of India graduate has shot several acclaimed independent documentaries, including Unlimited Girls, The House on Gulmohar Avenue, A Few Things I Know about Her, and The World Before Her. He hasn’t worked on many features, but that is bound to change after Court’s release on April 17.

Court’s visual palate includes faithfully realistic production design, lengthy shots and location shooting. Its most striking feature is a middle-row perspective from which director, cinematographer and viewer witness the trial and the people it impacts. By placing the camera at a half-way point that is neither too close nor too far away from the central action, Tamhane and Desai strike a careful balance between involvement and detachment. Desai explained his stylistic approach on Court and his previous projects in an interview.

"Chaitanya was clear that he wanted the camera to be a dispassionate observer that was not involved with the process and not expressionistic in any way. We would be watching as neutral observers, and this approach dictated all the choices in the positioning of the camera. Sometimes, if you go too close, it feels too close.

The decision-making process began at the script level. Line producer Kishor Sawant had started looking for locations, and the vetting happened over a long period of time. They had to fit in with the veracity in the script. It wasn’t about being ornate. There was no emphasis, no drama, and no making an obvious point of anything.

When you shoot a lot of documentaries, you quickly get used to the dynamics of a certain space. You are also looking a lot more closely. You look at what the architecture conveys, for instance, and so you can feel a location and see if it works for you or not.

The courtroom itself was an interesting thing. It was created from scratch. I realised how difficult it was to do that kind of work, to create a feeling of reality. One false note could spoil the whole thing. If the set design had not been done properly, it would have been difficult to create that look.

Chaitanya’s instinct for what is not right is very strong, which is important because not everything falls into place the way you want it to. He is comfortable coming from a position of, 'I don’t know,' but he is also very methodical and works in a painstaking way.

In documentary, on the other hand, you have to rely a great deal on instinct, so there was some push and pull between us. Sometimes he had to tell me to slow down. Because he is very clear in his thinking, it became easy to tune into that. It is what a cameraman does, after all – tune into the director."

Building a relationship with subjects
"The approach was different in The World Before Her. [Directed by Nisha Pahuja, to whom Desai is married, The World Before Her contrasts female Rashtriya Swayamsewak Sangh followers with Miss India contestants.] It was very traditional, observational, verite filmmaking, about being with the person and going with the flow. Most of the beauty pageant bits were shot by a Canadian cameraman."

"Different directors have different ways of doing things. Good directors have a strong and genuine relationship with their subjects. As they talk to them, things unfold. As a cinematographer, you are present and you let the director guide the flow of the subject. A cameraman is trying to tune into where the director wants. Everything has its own position and its own vibration, and you find the right thing that satisfies that. Your presence makes a difference, of course, so if you have a calm demeanour that is not threatening in any way, it helps. I am very quiet. Once in a while, I do pipe up and say my little piece if it supplements the situation.

Basically, your job as a cameraman is to capture the thing that the director has set up. The relationship between the director and subject has developed over time. The sound recordist and you are very late entrants.

In The World Before Her the shoot at the Durga Vahini training camp was sensitive. The camp organisers got cold feet after giving us permission and wanted to chuck us out. But then Nisha spoke to them at length. She has a very genuine relationship with the people at the Durga Vahini camp. She still speaks to them and is still in touch with them. There is empathy towards each other’s positions, and that probably comes out in the film.

The atmosphere there was hardly threatening, it was like a summer camp! It was a happy and friendly scene. The cause and effect that leads to a certain kind of political system… I didn’t see that there."

Intellect versus ideology
"When you choose a project, you look to work with a director and understand his or her formal arrangement. All directors want is purity, some kind of truth. You have to delete yourself from the picture. You become a tube, a pipeline between the director and the project."

"I feel that the best cameramen are those who don’t have an intellectual position on things. This can become a barrier, since you start filtering things in a very intellectual way and you miss the humanness of the person in that moment. Over time, I have been able to let go of my political predilections and I feel that my work has become purer.

I was all over the place for the first few years of shooting after I graduated from the FTII. Five people would tell me, wow this is so nice, and five others would say, this is shit! The first time I started feeling comfortable in my own skin was in 2008 or 2009.

Nobody has really asked me to shoot features – perhaps it has to do with the kind of films I have been working on. The people I work with are important. You need to gel with the director, get what is going on, and not have a kind of anti-reaction to something. If I feel that something is crass at some level and not right, I don’t take up a project. I would like to work on features, but it will happen when it does."

Mrinal Desai.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.