Thoughts: Two Point Hospital

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I’ve always regarded Theme Hospital as the odd one out when it comes to Bullfrog’s strategy games. Theme Park made all the sense in the world, even when I was 11 years old, but I just didn’t understand the concept behind Theme Hospital. Even now I think running a for-profit hospital was a really weird theme for a British developer to build a game around; unfortunately the severe cuts the NHS has suffered over the last decade has given private healthcare the opportunity to become more deeply entrenched in the UK’s healthcare system1, but back in the 90s it was still a deeply alien concept to the British psyche and I often wonder how exactly Bullfrog ended up deciding to make it. Odd choice or no, though, Theme Hospital remains one of Bullfrog’s most fondly-remembered titles (for those who actually played it, at least), and so it’s no surprise that it’s the latest one to receive a modern attempt at a do-over in the form of Two Point Hospital.

What is a little surprising is how literal that do-over is. I suspect Two Point Hospital is called Two Point Hospital because it is a pretty much a direct point-for-point remake of Theme Hospital, right down to the radiators. At first I was a little taken aback at how little the developers (they’re called Two Point Studios, and they have ex-Bullfrog devs at the company — this is a little less impressive-sounding when you consider that just about every British game developer has ex-Bullfrog devs at the company) have done to take the mechanics forward — I’ve only spent a few belated hours with the GOG version of Theme Hospital, but even I can see that it and Two Point are pretty much identical — but after a brief mental review of the previous attempts to update Bullfrog classics I decided that perhaps they were on to something. Satellite Reign did good work but ultimately came unstuck because it messed with Syndicate’s winning formula. War For The Overworld did good work but ultimately came unstuck because it messed with Dungeon Keeper’s winning formula. Perhaps it is about time somebody just tried to remake one of these games without messing with the formula, and we can see just how well it stacks up when transported into the glorious future world2 of 2018.

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Two Point Hospital sets you up as the head of the Two Point Foundation in, uh, Two Point County (they really hammer that name home), which serves as your Dungeon Keeper-esque overworld. Your foundation is put in charge of a series of hospitals and it’s your job to make sure that the hospitals turn a profit. Note that it is not particularly your job to cure people, or to stop people from dying, as patients will often pay up for even a lethal course of treatment as long as the price isn’t too high and you’ve kept them relatively happy as they shuffle off this mortal coil. The only way to lose a level of Two Point Hospital is to stay in the red for a full year — however, as you’re paid for diagnosing and treating people and unsuccessful treatments will lower your reputation as (presumably) you receive bad reviews on Yelp, which in turn will lower the number of people coming to your hospital, it is generally in your best interests to make sure at least some of the treatments work so that the patients — and the money — keep flowing in. Staying solvent is only part of the game, however, as each level has its own set of tiered objectives, each of which awards one of three stars. Only the first star is required to progress to the next level, and this will have a basic set of objectives attached which revolve around the level’s gimmick — usually by treating a certain number of patients afflicted with the level’s themed disease, which in turn requires researching and building special treatment rooms. Cure rate is not a factor for achieving this first star; the second and third stars often require you to have cure rates of 70% and 90% respectively and are intended to provide additional hours of fun for people who like optimising their hospital layouts, but tackling those challenges is entirely optional.

To describe the inner workings of one of Two Point’s hospitals it’s probably best to consider the route a typical patient will take through its gauntlet of diagnosis and treatment rooms. All patients go to Reception first, which is staffed by an Assistant. From Reception they’ll always be directed to a GP’s Office for their initial diagnosis from a Doctor. This diagnosis comes with a percentage value attached; if your Doctor has high Diagnosis or GP skill and the disease is relatively minor, the patient will immediately receive a 100% diagnosis and be routed straight to a treatment room to attempt a cure. If the diagnosis is less than 100%, then they’ll be sent for further tests in a selection of diagnosis rooms — General Diagnosis, Fluid Analysis, X-Ray Scanning etc., all of which are staffed by Nurses — each of which adds to their diagnosis level, but which also adds to patient congestion as they’ll need to visit the GP’s Office again after each diagnosis room so that they can be sent for further treatment. Once they’re fully diagnosed they’ll be sent to a treatment room, which can be anything from a general purpose Pharmacy serving a single patient at a time to a Fracture Ward with multiple beds. The chance of their treatment actually resulting in a cure is dependent on the quality of the treatment equipment and the Treatment skill of the staff member applying it. Each diagnosis step yields around $500 from the patient, but treating them will pay out anywhere from $6,000 to $15,000 (assuming you haven’t cranked up the prices) so it’s in your best interests to get as many patients into your treatment rooms as possible.

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Now, if your patients were happy to spend all the time in the world waiting for a cure there wouldn’t be much of a game to Two Point Hospital, but while they do have a lot of patience3  – Two Point Hospital works on an extremely odd timescale where patients are willing to spend weeks sitting on a bench in a lobby awaiting treatment — it’s far from infinite. Patients have needs that must be satisfied during their stay such as food, entertainment, somewhere to empty their bladder etc., and if you don’t provide some way for them to service each of these needs they’ll get angry and storm out after a mere 150 days; when it can easily take 30 days for them to just walk to reception and get assigned to a GP queue this can be extremely bad news. By strategically scattering items such as snack machines, arcade cabinets and toilets around the hospital you can stave their ragequit off by an additional 120 days or more, but if your hospital layout is poorly optimised and your staff diagnosis and treatment skills are wretched and they spend months bouncing from diagnosis room to diagnosis room with no cure in sight, then they will, eventually, get pissed off and leave. Not only does this tank your reputation slightly (which drives other patients away from your hospital), but it also means that they’ve taken up valuable time in your hospital machinery without you receiving the big payoff of the final cure. If this happens too often you eventually run out of money and lose the level.

So what Two Point Hospital is all about, at the end of the day, is throughput. You need to put together a hospital that’ll diagnose patients in the shortest amount of time possible, send them for highly lucrative cures, and then get them out of the hospital so that somebody else can take their place in the queue. Building a high throughput hospital is equal parts room placement, staff selection, and patient management. You want to limit the amount of time patients spend trudging around your hospital, so you put all of your diagnosis rooms (where they spend 80% of their stay) close together in one building so that they can get from one to another quickly. The cure rooms can safely go into another building and can be quite spread out, because patients only ever visit them once. Staff selection isn’t such a great concern during the first few levels and any Doctor will just about do for staffing a GP’s Office, but soon enough you’re going to want your GPs to have specialist GP training to maximise their diagnosis power, and you’re going to want your Doctors staffing the cure rooms to have high Treatment skill — there’s a ton of skills you can teach your staff via the Training Room to maximise their effectiveness in certain rooms, as long as you’re willing to put up with having them go out of rotation for a fairly lengthy period of time while they receive the training, and later levels aren’t really doable without long-term incubation of these specialist staff so that when patient numbers ramp up you can get them diagnosed and cured as soon as possible.

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Finally there’s patient management, which is a little more hands-off. Ideally this is simply about making sure they’re comfortable by ensuring their needs are satisfied – making sure that wherever they are there’s some source of food and drink available nearby, for example. Unfortunately the patient management where we encounter the first of my considerable list of issues with Two Point Hospital, because their AI is utterly atrocious. They will attempt to satisfy their needs at the expense of every other concern, no matter how far they have to go to do so — so if they get hungry and the nearest vending machine is two buildings away, they’ll still walk all the way over there to buy something, and then all the way back to where they started. They won’t lose their place in the queue for whatever room they have an appointment in, so if they get to the head of the queue and they’re on the other side of the hospital, everyone else that’s in the queue behind them will have to wait until they’ve walked back to that room and used it before they can get a look in.

Given what I just said about Two Point Hospital being a game about managing for efficiencies in patient throughput, losing so much time to this is absolute poison to a hospital. You can ameliorate it somewhat by making sure that there are vending machines and arcade cabinets and toilets in every single building so that they don’t have to walk so far, but even then the simple fact that they’re down the corridor queuing for a Caramac instead of sitting on the bench you’ve helpfully put down just outside the GP’s office means some amount of lost time. And god help you if you build a Cafe, as the patient AI prioritises this above all other food and drink sources and will result in them ignoring the snack machines to make a pilgrimage all the way across your hospital to get a tray of crappy hospital food. What bugs me about this is there doesn’t seem to be any actual intelligence built into this AI — the patients don’t deprioritise their needs based on how far away things are or how soon their appointment is, so they’ll just walk away from your GP’s Office the moment their Food need drops below a certain threshold even if their number is about to be called. It means, paradoxically, that the best way to build a truly efficient hospital is to not bother putting any of these need-satisfying facilities down in the first place (except toilets, because your staff need those too). If there’s nothing in the hospital to distract them then they’ll stay in place right outside the room they’re queuing for — at least, right up until they hit that 150-day limit for storming out, but the efficiency savings you make by ensuring they’re routed straight to where they need to go and then stay there is often greater than the wait time you gain by catering to their whims.

So building hospitals with absolutely no patient amenities besides benches, toilets and radiators is one step along the road through Two Point Hospital. The second is that realisation that being able to instantly diagnose patients to 100% during their initial appointment in the GP’s Office is stupidly powerful, since then you cut out the entire rest of the diagnosis chain and go straight to a cure. But how do you manage this? Sure, a skilled GP can manage 100% on the low-tier Pharmacy-cured illnesses, but even they, paradoxically, with have difficulty instantly diagnosing what exactly is wrong with a guy whose head has been replaced by a light bulb. Sooner or later a patient is going to walk in with an illness whose diagnosis threshold is higher than your GP’s skill level, and you’re going to need to build those additional diagnosis rooms. That is, unless you build your GP Offices like this:

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Contrary to appearances I haven’t just stuck a giant server farm in this GP Office (although you can build those in your Research Labs). The rows and rows of grey blocks are Medicine Cabinets, a room decoration for the GP Office that multiplies the diagnosis power of the Doctor staffing that office by 1%. Obviously that’s not a huge gain, which is why you build your GP offices large enough stack 150 or even 200 Medicine Cabinets in the same room. This triples the diagnosis skill of any Doctor staffing that room, and there’s an additional bonus for having the room at max level prestige — you’re supposed to do this by putting medical-looking items such as skeletons and anatomy models in there to make a nice-looking doctor’s office, but since the Medicine Cabinets also boost prestige having a hundred of them in there inevitably ensures you hit the prestige cap very very quickly regardless. You will still need a Doctor with moderately high Diagnosis skill to act as a base for that multiplier (a +200% bonus on a skill of 0 is still 0, after all), and this setup is not necessarily the best solution in the late game when the influx of patients exceeds the maximum possible capacity of the two or three of these mega-offices you’ve set up (each office’s throughput is still limited by the time taken for patients to knock on the door, sit down, be instantly diagnosed with what ails them, get up, and leave); however, by the time that becomes a problem it means you’ve got so much money coming in that a) you can easily afford to buy additional buildings to put some regular GP Offices and diagnosis rooms in and b) you’ve effectively won the level anyway.

I would not have hit upon the super-GP strategy if it wasn’t for my hospitals running into the same problems over and over again: huge queues outside my GP Offices. Because patients go to a GP Office when they come into the hospital, and again after every visit to a diagnosis room, your GP Office capacity becomes a critical bottleneck. The obvious solution is to build additional GP Offices, but this comes with additional staff costs and also doesn’t scale; adding an additional GP Office when you only have two is a 50% increase in capacity, but when you have ten GP Offices struggling to cope with the sheer torrent of patients being spewed through the front door of your hospital then adding another one really doesn’t make all that much difference — and anyway, no matter how many GP Offices you add you’re doing nothing to solve the problem that if a full diagnosis requires that a patient visit a GP plus three diagnosis rooms then that’s seven room visits in total, and the patient will have to queue for each one. The only plausible way to bring order to this chaos is to take those diagnosis rooms out of the process, and the most effective way to do that is through hundreds of Medicine Cabinets.

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This turns Two Point Hospital from something that seemed initially quite promising — when you play it straight, there’s something very zen-like about the process of plonking down rooms and watching people bounce around your hospital like marbles in Ker-Plunk — to a ridiculously game-y nightmare. I don’t particularly enjoy individually placing a hundred and fifty room decoration objects just to build a single GP’s Office, but it felt like doing otherwise would be shooting myself in the foot — especially because there’s no way of making multiple saves of a given hospital, and if things spiral out of control all you can do is restart the entire thing from scratch losing multiple hours of play in the process. The other rooms didn’t escape this scourge either; they’re all given bonuses by being boosted to maximum prestige, which is achieved by jamming as many Gold Star Certificates on the walls as possible (as these have the highest prestige return for the space they take up). Meanwhile there are many hospital decorations — and entire rooms — that feel like traps because as soon as you place them the patients will go bananas and start sprinting away from your treatment pipeline to try and discover the fabled Coca-Cola machine. It turns out that the best way to build a hospital in Two Point Hospital is to build something that looks nothing like a hospital at all, which I feel is something of a fundamental failing for a game with the word “hospital” in the title.

If you can look past these frankly baffling shortcomings, there’s quite a lot to recommend Two Point Hospital. It’s got a decent sense of humour that’s fully befitting something with Bullfrog DNA — the disease names are all bad puns that’ll make you groan, but these are secretly the best kind of pun — and if you dig into the rather obtuse UI there’s a pleasing array of levers to pull and knobs to tweak to get your hospital running just the way you want it. I needed all of them when I almost inadvertently destroyed one of mine through an over-successful marketing campaign; the level objective was to cure a certain number of patients in Surgery, so I thought I’d help it along a bit by running a marketing campaign for Surgery-related diseases. This led to my hospital being swamped by hundreds and hundreds of patients — more than even my uber-GPs could handle, and far more than my miniscule Surgery capacity. I had to take out every single loan available, crash-build some more Surgeries, very quickly train more Doctors up in the Surgery skill to staff them, designate the Surgeries as high priority rooms so that they were always staffed at the expense of other rooms that didn’t have dozens of patients clamouring to use them, lower prices on the Surgery treatment because my pipeline was so fucked up at this point that patients were spending far too long in the hospital and their Happiness was dropping so low that they were refusing to pay the standard rate — and this was tanking my income because almost every single patient in the hospital was now there for Surgery treatment — and finally, as a last desperate fix to try and buy some breathing room, I resorted to immediately sending home all the patients who looked like their Happiness was going to hit breaking point before they reached Surgery, as this meant they weren’t taking up capacity in my treatment pipeline only to storm out without paying once they got close to the end.

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Trying to manage that kind of self-inflicted catastrophe is when Two Point Hospital is at its best; it’s at times like that that its considerable strengths shine through despite the various screwed-up design decisions. The patient AI and room decoration system are failings, yes, and serious ones at that, but they are not fatal. What eventually ended up doing for Two Point Hospital — at least as far as I was concerned — was something far more mundane: starting each hospital anew and having to go through the same twenty minutes of setup to get it on its feet just so that I could get to the interesting part of the game quickly became fatiguing. Building a GP Office, a Staff Room, a set of Toilets, a Reception desk, a Pharmacy, hiring two Doctors, two Nurses, an Assistant, a Janitor, having to put down radiators everywhere (who thought it was a good idea to bring back the radiators?)… even if you’re not min-maxing with Medicine Cabinets this gets really boring really fast because the opening steps to a level never change4. Perhaps this is the surest sign that Two Point Hospital is indeed a worthy successor to the Bullfrog management titles as it’s a problem I also had with Theme Park and Dungeon Keeper twenty years ago; it’s certainly succeeded in reproducing a lot of the charm and whimsy found in your typical Bullfrog game, and for once this feels unforced and somewhat natural instead of a set of fanboys flogging the joke to death. Unfortunately it also comes with the pathfinding, AI and structural baggage of a game from 1997, and this was enough to ensure my visit to Two Point Hospital came to a premature end.

  1. A few months back I suffered a bad knee injury while running. A visit to my GP presented me with a rather stark choice: wait 12 weeks to see an NHS physiotherapist, or go private and start treatment that week. I was fortunate enough to be able to afford to go private so I coughed up the money and have no complaints about the treatment I received, but there wouldn’t have been a need to do that ten or fifteen years ago.
  2. I’m only using this term because referring to it by the more accurate phrase “terrifying hellscape” would just get everyone down.
  3. For once I’m actually trying to avoid the pun here.
  4. Except in Duckworth-upon-Bilge, but it comes after ennui has already set in.
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One thought on “Thoughts: Two Point Hospital

  1. I had assumed the name was intended to suggest Theme Hospital 2.0.

    This is on my list, and your review doesn’t phase me because I’m generally not one to try to game a system if it warps the experience I want to have. I’m torn between picking up this or Megaquarium, which seems a bit more subdued but also more in line with my own personal interests.

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