The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine. This is, in part, due to clinicians being faced with considerable ethical, legal and data protection challenges which are the primary barriers for services who pursue video recording of patient care. Existing accounts of video use rarely acknowledge the organisational and cultural dimensions that are key to the success of establishing a video system. Here, we address these issues and, using Kotter’s 8-step process for leading change, provide a ‘How to’ guide to navigate the challenges required to implement a continuous video-audit system based on our experience of video recording in our emergency department resuscitation rooms. Using Kotter’s structure emphasises the fact that the most significant hurdles in installing continuous video audit in a busy clinical area involve change management rather than equipment. By focussing on issues such as staff acceptability, departmental culture and organisational readiness, we aim to provide a roadmap that can be pragmatically adapted by all clinical environments, locally and internationally, that seek to utilise video recording as an approach to improving clinical care.