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Wards, nurses and ancillaries

Theme Hospital's diagnosis and treatment was unrealistically quick. In real life, patients are sometimes tested and diagnosed over the course of months, not hours, visiting hospital on appointment when doctors and resources are available.

More seriously ill patients, esp. those awaiting or recovering from surgery, must stay there on wards, another aspect of medical life Theme Hospital barely featured and which plays a big role in planning hospital lay-out IRL. Doctors do diagnosis, but patient care--esp. on wards--is the responsibility of nursing staff. They are the ones administering treatments from the pharmacy, monitoring patients' vitals day-to-day, and taking samples for lab testing. It would be nice to see this reflected in Project Hospital.

Additionally, though nursing staff once changed patients' bedding, supplied bedpans and served food on wards, this is now mainly the responsibility of ancillaries. They're in Project Hospital already as cleaners--vital as much to stop spread of hospital infections (MRSA) as for mere tidiness--but hospital laundries and kitchens should also be part of basic design. If hunger and bladder bars already exist for patients waiting in corridors, why can't this mechanic be extended to those on wards too?

Incidental to this is hospital visitors and visiting hours to wards. Though these hours would bring increased revenue (and realism) to Project Hospital through cafeteria and gift shop sales, they would also interfere with diagnostic access to patients and bring litter, increased risks of infection, and the need for more restrooms, bins, and receptionists. The cafeteria could be supplied from the hospital kitchen too (BTW, not wanting to turn this into Sim-Cafeteria/Giftshop - 'rabbithole' space with price/service sliders might well be enough to do the trick.)

A last, unrelated thought: outside walk-in clinics, appointment / referral system makes most patient treatment predictable; players should know how many patients to expect, who will be treating them and what tests will be done on them at the start of every day (missed appointmnents excepted). Where numbers are *not* predictable and treatment is more urgent is in A&E (Accident & Emergency) and here additional factors in the number of patients arriving and their survivability are availability of ambulances and paramedics staffing them, their turnaround time, and effectiveness of A&E triage. It would be particularly exciting to model - and, given its unpredictability, to play.
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Plans for difficulty levels?

Out of interest what do you plan for differing levels of challenge in the game? I
was playing an unrelated game recently (Rimworld) and was thinking about what it is I love so much about that particular game. One of the real draws of it to me is the permadeath mode; this is a user setting where you cannot cheese the game mechanics by saving and reloading during the game (you can only save on exiting the game). In permadeath mode, if you mess up you live with the consequences and to me this makes for much more interesting and challenging game play. One of the problems I have with a lot of strategy games is how little strategy is actually required to get anywhere in the game. For most games you can just do the old quick save/reload switcheroo and for others you can continually make poor choices and still come out a winner! I’m hoping that Project Hospital is going to be challenging; I don’t mind if that challenge is behind different difficulty settings but I’m hoping there is a mode where if I’m a completely rubbish hospital manager, then the Hospital is actually rubbish!!

Another issue I have with a lot of management games and is this is tied in with difficulty is the speed at which you can expand at. There are a few games that get this right, but an awful lot that don’t. What I’m trying to get at here is that I hope that Project Hospital sets the pacing of the game as such that I’m not constantly in a position to expand, and when I am in a position to expand, I’m having to think carefully about which departments would best suit the hospitals needs rather than start with a GPs office, wait a few months and then build a giant district hospital. In the real world hospitals tend to expand at a snail’s pace; this is driven in part by the requirements of the patients but also by the excessive monetary requirements of building and staffing the various departments.

The TL:DR version of all of this is; Please give us some challenge, try not to make this Project draw a Hospital :)

Really looking forward to the game, keep up the good work!
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