How To Make It Harder

One of the problems with Theme Hospital is it only had a few ways to make things harder. I think these were:

  1. Staff shortages (or shortages in particular skills)
  2. Vomit outbreaks
  3. Earthquakes (and machines exploding)
  4. Epidemics
  5. Emergences (which can be rejected anyway)

I think 1 and 2 work quite well, although they were made such an awful problem in the original game because you just don’t have enough control over staff. With staff zoning (Rollercoaster Tycoon style) you’ll be able to a great deal more control over things. Still, they should still pose a problem.

Earthquakes were overused I think. Epidemics were really stupid I thought and I didn’t like how they worked at all. This will need to be looked at. Also, there should be epidemics in the surrounding area as what happens in real life.

Emergences are good but not really so much an obstacle as an opportunity. We really want to add ‘Accident and Emergency’ into OpenTH although we’re not entirely sure how we should do it yet.

I think it’d be good to have a couple more ways, and also to refine those we have. Some I were thinking of are media interaction. Perhaps some guests will end up being ‘undercover journalists’ and will condemn your hospital if they have any reason to. Furthermore, if you send a dying person home or whatever then perhaps you will get bad media reports from this. However, if you say excuse a very poor uninsured person from paying, you will get favourable stories. This would be sort of a merge between newspapers in OpenTTD and media interaction in Championship Manager. Personally I think it’d add a lot to the game, although it won’t be there in the first release for sure. If you can’t cure one of the more basic diseases in a high level (e.g. Bloaty Head) then you’d expect the media to complain.

I also want levels to be more interesting. If you’ve ever played Rollercoaster Tycoon you’ll know you start with three scenarios and completing any of the unlocked ones unlocks a further one. This is great because it means you don’t have to play boring levels. Their scenarios are always very varied, whilst in Theme Hospital all but one of the levels were pretty much the same except for the size of the buildings. Some level ideas we have are:

  • Hospital in very limited space
  • ‘Posh’ Hospital with massive budget
  • NHS hospital
  • Fix a failing hospital (i.e. already half built)
  • Hospital with very limited staff
  • Hospital with poorly trained staff
  • Getting waiting lists down
  • Stopping an epidemic in a particular area

More ideas would be good.

I also think you should be able to target your hospital more to a particular audience. The poor, the rich, or the middle ground. Obviously the rich would want short queues, nice surroundings and the best treatment, but would pay high costs for that. Hospitals for the poor would not need to be anything other than affordable. This would mean there is a little bit of business decisions in the game, which I think would be good. The demographics of the surrounding area could be taking into account when deciding. Perhaps this could mean reputation needs to be changed to reputation in a particular demographic. All this is not for the first release though and so we can think it out properly.

Any other ideas would be appreciated though, as would comments on these areas.

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14 Comments on “How To Make It Harder”

  1. Joey Says:

    Like the ideas of different maps, although I do miss buildings with more then 1 floor. This is probably a pain in the ass to code, but still, how many hospitals you know only have one floor?

    Best would probably to write up a v1 where “Theme Hospital” and “OpenTH” are pretty much the same. From there on you can expend the features and possibilities!

    Two of my favorite “old” games are “Theme Hospital” and “Rollercoaster Tycoon”. If Theme Hospital had copied some of the Rollercoaster features like zoneable staffing it would have been close to perfect.

    Keep it going! 🙂

  2. Alex Says:

    Thanks for the blog thing, I like it. Your ideas are great too.

    You wrote about demographics of the surrounding area. One thing I always wanted to see in TH is excactly the surrounding area. You can only see a highway, but no buildings. What about a city with several free space shared all over the town, as in Hotel Gigant 2. This would make the game even harder, because people need to travel from one area to the next for diagnosis and treatment – resulting in less time and the need for well-thought-out sectioning. In a later stage emergencys could be “seen” in the city view, like car crashes, vulcanos or amoks.
    Another thing I am thinking of is a candidature of the rivaling hospitals in the area. This might be for additional funds, chief hospital chef, special technologies, skills and personal or even for more patients and reputation in town.

    I appreciate your great work,


    • openth Says:

      We’d need a lot of new graphics for that so if it happens it’d be far in the future, but the idea is noted.

      “Another thing I am thinking of is a candidature of the rivaling hospitals in the area. This might be for additional funds, chief hospital chef, special technologies, skills and personal or even for more patients and reputation in town” … Not sure I understood that?

  3. vommie Says:


    that all sounds excellent.

    I have to say one of the most annoying things in Theme Hospital relating to difficulty were salary increases. After playing some time and setting up a big staff there were requests to increase the salary every few seconds. I think it would be better to bring up a system that handles this. F.e.: If you have a nice hospital, good ratings, good temperature, a big and varied staff rooms etc, the staff should stay happy with their salery. Or setting up a new skill like as “Obstreperousness” (this word is from, i hope this really exists :D), so as higher this skill is the higher the frequency this staff member will ask for a higher salery, or “Loyality” with the opposite effect.

    The second annoying things for me were earth quakes. they were just too often. This wouldn’t be such a big a disturbing factor when destroyed rooms could get rehabilitated (as someone suggested in the forum). Or when earth quakes doesn’t appear in every szenario.

    The staff zoning is a cool thing, of course. I also think epidemics are really stupid, they always were very easy to handle because of to soft consequences if you dindn’t. I think if this feature stays it also should get more weight, f.e. with stuff like a quarantine room (and negative publicity if you didn’t have one and being constrained to close the WHOLE hospital for a couple of days). Or, another idea, also staff can get infected and will call in sick for some days, what could end up in big trouble.

    I like the part with the idea for a media interaction. Besides the directly effect on the rating of your hospital there could be some others. like acceptance of the publicity if you want to buy new land for your hospital. so the green around the hospital could act as a public park, which isn’t easy to buy without losing rating except media supports your plan.

    I also like the scenario-concept of RCT. But i don’t make thoughts about scenarios quite yet because it depends of what features finally will really get in openTH.

    I don’t know what i should think about the class system – how could it be realized? With progressing time you always receive the best machines and rooms, and you’ll earn enough money to design the hospital as good as it can be. if you would stay a “low-cost”-hospital, how could you bring in some changes (new rooms and such) without getting high-cost? so i can’t really imagine how to create a poor-only-hospital. but, what also could be nice, is to bring in people without health insurance. if you medicate them, you’ll lose (a lot of) money, but you’ll gain some rating or you have a low chance one of the homeless get rich some month later and spend some money and such (= random events?). but for balance there could only be the chance to get a epidemic.

    That’s my ideas yet 🙂

    • openth Says:

      Loyalty is a good idea, yes. We’ll probably have that as we are adding new attributes to doctors.

      Quarantine room ideas are noted, I think it is the best idea at the moment. When we come round to adding them we’ll have to have a proper debate about it.

      Class system: We’ll have to see if it can be realised. Perhaps not or perhaps so.

  4. pinchies Says:

    I am loving this new project and really looking forward to any release of any kind.
    My only comment is that the ideas are sounding great, but I liked the levels increasing in difficulty along with the size (and more complex shapes too…) of the hospital.

  5. Noah Says:

    WOOT! A BLOG! THis is exactly what i needed to keep my faith in this project…cant wait for any kind of release to sink my teeth into!

  6. Silva Says:

    Reducing earthquakes and epidemics? Bless you, too often I’ve quit and restarted a saved game because of those.

    About the handling of emergencies, I was wondering about having an actual A&E. A large, open, ward-like room that has to be placed next to the road (automatically creating the doors and the space for ambulances and helicopters) with it’s own reception desk (triage), with beds and some basic diagnostic equipment, the staff being two nurses for each doctor, plus a doctor working in triage. Add an “Emergency” specialization for both, which will affect the speed the patient is stabilized and referred for the second round of diagnostics and possible cure, as well as reducing the stress and fatigue of the staff working there. Obviously, the only patients arriving there are already on their way to meeting the skeleton fella, but for the sake of realism, there should be a few fake patients – make up some light, non-fatal (but that damage the reputation if uncured) illnesses that need to be cured by a quick visit to the shrink or the pharmacy.

    About the staff, may I suggest the return of strikes from Theme Park? If global conditions are poor instead of asking individually for a raise, if half plus one of the staff is stressed out due to the same issue (knowing why someone is bothered would be welcome – poor working/relaxation conditions, low wages or high working hours), every worker, except those required to fill the “minimum services” (the newest contracted, of course) demanded by the current number of facilities, strikes and pickets the main door of the hospital, limiting hospital capacity and damaging public image until negotiations with the union take place and demands are met (for facility issues – coldness or bad staff rooms – there should be a time limit for meeting the demands before a harsher strike with higher demands happens).

    The “Class” thing should be purely level specific. For instance, in some levels, the player is capped with low charges for diagnostic or treatment while depending on grants to purchase a room (given according to the efficiency of the hospital) plus a monthly fixed grant to complement the daily income in order to pay wages and purchase basic stuff (juice machines, benches, plants and so on) to high-end clinics where money is no issue, but patients must be treated within a time limit before harming the reputation – which must obviously be kept sky-high. Or a more complex idea, adding different manufacturers for each equipment – cheaper brands require more maintenance and might fail (killing the patients) while better equipment is sturdier and more accurate. If you’re feeling adventurous with this idea, mix them. Cheap equipment that is sturdy but might pull that slack tongue a bit too much, or expensive equipment that works flawlessly and that even a receptionist could operate, but almost require their own handyman.

    One last thing for now, and a bit off-topic – a illness designer. Nothing too fancy, just naming it, describing the condition and treatment, and defining the “internals” (level of diagnostics required, treatment room, cost and perhaps graphic changes/packages).

    Sorry for the long comment, but I’ve been thinking about these since 1998 :p

  7. openth Says:

    Hey Silva, thanks for the comments.

    I like your emergencies idea. I’ll keep this in mind for when we discuses it more in the future.

    Strikes are possible. In any case, both staff and patients will tell you what they are thinking Rollercoaster Tycoon style, I hope. I’ll expand on this in a latter blog item when it is anywhere near going into effect (at the moment they don’t have a great deal to think about).

    Yes I like the machine class thing, I think we can do that.

    Illnesses can be written in XML, but I’m sure we can make an editor for it (in Construct or something). It is all totally external so this thing can be changed as you like.

  8. Tobols Says:

    I know this blog entry is quite out-dated, but I figured here would be appropriate to leave this anyway. I love all these old games, and i recently played a bit of the classic Constructor. One of the horrors in Constructor are the council missions: the pesky council asks you to get rid of a certain tenant, destroy a specific house or just build a specified type of houses in a certain area. If you fail you’re beeing punished in different ways, maybe even loosing the game but succeed and you get rewarded.
    Possibly this could be transfered into the hospital world as well. The board could set the player up for missions that had to be completed within a given amount of time.
    Have a certain percentage of your hospital covered with rooms.
    Reach a financial level.
    Hire or train an amount of specialists.
    Cure a number of patients, etc.

    In it’s current form, Theme hospital is a bit limited in terms of variation, but at least it’s an idea that might give some inspiration.

    Exploring ways to increase real competition between hospitals could also prove intresting. Having an AI actually building a competing hospital would be wonderful. Then you could sabotage his machines, steal his doctors, or perhaps hinder his patients in some manner. Obviously this would be far down the road though.

    • OpenTH Says:

      Don’t worry, I still get email alerts! Yes I like this idea.

      Any chance you could post either in this thread:

      Or start a new thread in ‘suggestion’s and see how many of these conditions you can think of.

      Do you think these conditions should be part of the level (like in Rollercoaster Tycoon when you have to do certain things, which vary, to win the level) or should the board just bring them up nearly randomly?

    • OpenTH Says:

      “Exploring ways to increase real competition between hospitals could also prove intresting. Having an AI actually building a competing hospital would be wonderful. Then you could sabotage his machines, steal his doctors, or perhaps hinder his patients in some manner. Obviously this would be far down the road though”

      Yes this is especially useful for multiplayer.

      Also why not be able to buy out other hospitals 😉

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