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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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Hi, some good points there :) Tweaking difficulty settings will be one of the last tasks we'll need to address, but let me mention a couple of systems that are designed to bring some challenge to the game:

Insurance companies, especially in sandbox mode, are the main mechanic to unlock departments or equipment, so it won't be just a matter of accumulating a pile of cash to be able to progress, but instead you'll need to meet different criteria like overall reputation or solving a certain number of difficult cases.

And then there are events, which act as small standalone challenges that you can activate (like an epidemic or a big traffic accident).
Sounds good, I was worried that the pacing of the game would be all over the shop as so many get this wrong! Having a number of different criteria to unlock the various departments is a good way to do it, makes sure that you're always actively working towards improving the hospital you have before you can expand!

I'm liking the sound of the events! Imagine major events in a hard mode without the ability to save/reload or even pause? I'd love that :D