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by CityBuilderAK47

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FAQ/Strategy Guide by CityBuilderAK47

Version: 1.11 | Updated: 09/19/19

Table of Contents

  1. Intro
    1. Theme Hospital vs. Two Point Hospital
    2. Additional Resources
    3. Where Your Save Files Are Stored
    4. Updates / Additional Content
  2. Before You Build: What Makes An Effective Layout?
    1. 11 Tips for Hospital Success
    2. The Patient Process
    3. Patient Happiness
    4. The 9 General Rules of Hospital Layout
    5. Kudosh & Recommend Items
  3. Before You Build: Staffing
    1. Staff Happiness & Staff Threats
    2. Doctor Skills
    3. Nurse Skills
    4. Assistant Skills
    5. Janitor Skills
    6. Common Skills
    7. Staff Traits
    8. Staff Attire
  4. Countryside Region
    1. Level 1: Hogsport
    2. Level 2: Lower Bullocks
    3. Level 3: Flottering
  5. Cold Region
    1. Level 4: Mitton University
    2. Level 5: Tumble
    3. Level 6: Flemington
    4. Level 6: Flemington - Case Study - 2 Stars to 3 Stars
    5. Level 6: Flemington - 3-Star Winning Layout
  6. Industrial Region
    1. Level 7: Smogley
    2. Level 7: Smogley - Case Study - From Failing 1 Star to Succesful 3 Star
    3. Level 7: Smogley - 3 Star Winning Layout
    4. Level 8: Melt Downs
    5. Level 8: Melt Downs - 3-Star Winning Layout
    6. Level 9: Duckworth-Upon-Bilge
    7. Level 9: Duckworth-upon-Bilge - 3-Star Winning Layout
  7. Tropical Region
    1. Level 10: Sweaty Palms
    2. Level 10: Sweaty Palms - Case Study - A Failing Hospital (When to Give Up)
    3. Level 10: Sweaty Palms - 3-Star Winning Layout
    4. Level 11: Grockle Bay
    5. Level 11: Grockle Bay - 3-Star Winning Layout
    6. Level 12: Blighton
    7. Level 12: Blighton - 3-Star Winning Layout
  8. Urban Region
    1. Level 13: Rotting Hill
    2. Level 13: Rotting Hill - 3-Star Winning Layout
    3. Level 14: Pelican Wharf
    4. Level 14: Pelican Wharf - 3-Star Winning Layout
    5. Level 15: Croquembouche
    6. Level 15: Croquembouche - 3-Star Winning Layout
  9. Sandbox
  10. Interior Designer
  11. (Snowfall) Pointy Mountain Region
    1. (Snowfall) Level 16: Underlook Hotel
    2. (Snowfall) Level 17: Swelbard
    3. (Snowfall) Level 18: Roquefort Castle
    4. (Snowfall) Level 18: Roquefort Castle - 3-Star Layout
    5. (Snowfall) New Items
    6. (Snowfall) New Rooms
    7. (Snowfall) New Illnesses
    8. (Snowfall) Other New Things
  12. (Pebberley Island) Pebberley Island Region
    1. (Pebberley Island) Level 19: Pebberley Reef
    2. (Pebberley Island) Level 19: Pebberley Reef - 3-Star Winning Layout
    3. (Pebberley Island) Level 20: Overgrowth
    4. (Pebberley Island) Level 21: Topless Mountain
    5. (Pebberley Island) Level 21: Topless Mountain - Case Study - Working Successfully with Waves
    6. (Pebberley Island) New Items
    7. (Pebberley Island) New Rooms
    8. (Pebberley Island) New Illnesses
  13. (Close Encounters) Desert Region
    1. (Close Encounters) - Level 22: Goldpan
    2. (Close Encounters) - Level 23: Camouflage Falls
    3. (Close Encounters) - Level 23: Camouflage Falls - Anatomy of a 3-Star Wave-Smashing Hospital
    4. (Close Encounters) - Level 24: Chasm 24
    5. (Close Encounters) - New Items
    6. (Close Encounters) - New Rooms
    7. (Close Encounters) - New Illnesses
  14. (Superbug Initiative) - The Superbug Initiative
    1. (Superbug Initiative) - Research Projects
    2. (Superbug Initiative) - Project-Unlocked Items
  15. Building a Better Hospital
    1. GP Queues
    2. Hospital Level Snowballing
    3. Expansion Strategy
    4. Examples in Efficiency
    5. Room Prestige
    6. The Great Patient Purge
  16. Training
  17. Marketing
  18. Common 2-Star Challenges
    1. Money Troubles
  19. Common 3-Star Challenges
    1. You want HOW Much in Hospital Value?
    2. Attractiveness Rating
    3. Bump that Cure Rate Up!
    4. Staff Morale? Are You Kidding Me?
  20. Staff Challenges
  21. Illnesses
    1. List of Illnesses
    2. Chance of Cure
    3. Rogue Monobrows
  22. Epidemics
  23. Emergencies
  24. Disasters
  25. Rooms
  26. Item Listing
    1. Kudosh Item Listing
    2. (Special) Item Listing
    3. (Retro Items Pack) DLC Item Listing
  27. Research Projects
  28. VIP Visits
  29. End of Year Awards
  30. Steam Achievement Guide
  31. Two Point Humor
  32. Contact the Author
    1. Legal Bla Bla Bla

Tropical Region

Level 10: Sweaty Palms - Case Study - A Failing Hospital (When to Give Up)

In a bit of a departure from the peppy "Let's beat it!" style of most FAQs, I actually want to diverge a bit from the usual and show you a case study of a hospital that truly failed, to a point where it got to a pretty much financially unsustainable point, to where although a loan could in theory save it, the money just could not ever get back to the black. As such, consider that if a $250,000 loan can't help your hospital, and you're still in the red routinely, month after month, you're at a point where you need to stop and start over. There's a few lessons I learned from this valiant attempt worth sharing however:

  • The hospital failed due to bad design, or more accurately, not making a good jump from a 1-star to a 2-star hospital
  • Sometimes, purging a couple of members of staff is prudent. However, it turns out I was actually at a point where i fired necessary staff. This created a backlog of patients which then created a self-defeating cycle.

Let's take a look-see at what went wrong:



So far it doesn't look too bad. The hospital is a bit disorganized, but I'm doing a few things right and going into an expansion phase: training staff to make them more effective, not too many queues - I obviously still have a problem with cure rate, but that's to be expected into the first and second star. So what's wrong? Well, the hospital is outgrowing its one-star/one-building approach quickly and staff happiness is low.



This would be the view of the second plot before I started doing many changes. This is typical for a 1-star hospital, where a 2nd building may be needed to accommodate extra rooms. However, as you may well already see, I already have a mixture of diagnosis rooms, a GP's office, and treatment rooms. If you compare this with the first screenshot, you'll already see areas where I should have swapped rooms from the first building into the second building. There's no point in a "field" GP's Office this early in the game - I only have two buildings which are not terribly far from each other. It would be better to have moved the General Diagnosis and GP's Office here to the first building, and swapped out some of the administrative/treatment rooms here, keeping my patients closer to the main GPs' block for more effective diagnoses. Additionally, although my field office idea sort of works, it also pulls patients just checking in, already starting with a longer walk than necessary, had I just kept them all in one building near the reception.
(Lesson: Improperly organizing like rooms will lead to queues becoming blocked.)



The 2-star goal also has a simple 70% Thermal Comfort rating, which is dragged down with the addition of new buildings not being properly outfitted. The lack of Air Cons shows I was in too much of a rush to build, and didn't add extra amenities as well, which meant that patients are walking between buildings to meet needs. In the future, I will need to prioritize larger toilet blocks and more vending and entertainment. The Arcade Machine, for example, generates a steady profit of $10/use. Not bad and it pays for itself pretty quickly. Thermal Comfort is the easiest of all goals to meet - not meeting it usually means you haven't decked out a new building in your rush to build bigger and better plots.
(Lesson: Forgetting to add heating/air cons and amenities drags down a new building's ability to meet patient needs - you must build new rooms and amenities in equal parts.)



As the level progresses, I expand outward to four plots, and as usual, there start to be too many patients due to a stellar reputation and an additional later-game-level challenge. From this picture, it seems clear that I need more GPs, and more GPs' Offices. It's also a little worrisome I'm almost $50,000 in debt, and it's still early into the month. At this point, the goal seems clear: I need more GPs' Offices because all I can see are 6's, and 7's, and even 9's for my queue numbers. What else can you see that could be made better? For starters, I have four buildings and I still have research, training, and staff rooms taking up space in a prime building. You might also see the impending earthquakes (very frequent in this level, some are of a major intensity) which would become a downfall later into the level because I just didn't keep enough fire extinguishers on hand.
(Lesson: Not anticipating accelerated growth of the hospital and not training GPs proactively will hurt you, as will not effectively organizing buildings)

Now let's take me to a little later into the level. By now I had taken out the lucrative $250,000 loan from Smell My Cash to help build more cure rooms, train more new GPs (including a marketing campaign, as I was routinely rolling high-salary or non-GP qualifications for my doctors), and trying to expand. You may see by now that I also forgot to build a good influx of diagnostic rooms to balance out the GPs offices, which is also a big part of why my patients are experiencing such GP queues, rather than necessarily a lack of staff (although that was true as well).

Because my patients were still stuck in the GP/diagnosis part of the patient process, they weren't making it effectively to cure rooms, which kept me in the red for most of the months. Because I wasn't addressing that, profitability never improved, so taking out the lucrative loan made my situation worse by adding an extra $8,000-$9,000 a month in interest, because my patients were not at all making it to the treatment rooms I had invested in. Even though I was getting plenty of messages about needing new treatment rooms, that wouldn't matter if only half of the patients were making it to treatment rooms. So in short, I got short-sighted and excited about the second half of the patient process, and did not address the first half.

(Lesson: Make sure you balance GP offices with new diganosis rooms at a near 1:1 ratio, rather than bee-lining to treatment rooms.)

When you're routinely in the red, as nice as the inflow of all the cash of a high-interest loan is to get a handsome quarter of a million dollars, that's an extra $8,000-$9,000 you'll be hemorrhaging every month. Instead, I should have been more patient with diagnosis rooms and GPs' Offices, waiting to build a positive cash flow and healthy profit month after month to then build new treatment rooms. If you really need to take out a loan, try to utilize the lower interest rates of Two Point Bank and Swindles Bank first, opting only for the $250,000 from Smell my Cash only for a giant capital works/building project when you're flush with money and a healthy hospital and healthy month-over-month profit



As you can see, a few months later, the long-term consequences of short-term thinking are starting to take effect. Many patients are stuck in the GP/diagnostic loop and not getting to their cure rooms in time, leading to many with low health and dying in the hospital. Even the advisor, Albert Crank, has something to say about it! My reputation is going down from all the death and fails and rage quits, and I'm still in the red near the end of the month. I'm slightly saved by research projects, but my researchers don't research fast enough to turn a quick monthly profit from their projects. Although I thought running a campaign to attract patients who have high-profit diseases, it's not doing me any favors that they can't get to the treatment rooms. As I realize I'm not turning a profit, my hospital value is going way down, and I realize that on top of my failing hospital, I have an additional $8,000+ loan obligation draining my money further every month. The hospital is quickly reaching a point from which it can't recover, barring a miracle.



My profitability doesn't get much better. I'm trying to train staff with higher qualifications to improve their effectiveness, but it's the end of the year and I'm still in the red. Now I have to start making tough decisions to cut costs, and again, I don't have the forward-thinking that I need. I fire critical diagnosis staff members who then exacerbate shortages in diagnosis rooms, going on the logic of "Well, they're looking for work, so I don't need them, right?". Wrong. Now I'm short a doctor that can effectively run the X-Ray room, and all of my patients suffer. I would have been better off selling off rooms that had low use, and replacing them with more diagnosis rooms instead. I could have also considered selling off the marketing office or research room for an influx of cash. I can always go back and build those with extra money later, as my patients should come first.

(Lesson: If you must reduce your spending, cut first from excess Assistants and Janitors, then moving on to selling off unnecessary or under-utilized rooms for quick influx of cash.)

Then, use the money strategically to address your hospital's shortcomings and improve the patient process. If it comes down to it, sell off a treatment room and reject those patients until you're back on stable ground. Try to avoid firing doctors and nurses with qualifications you need. However, if you have a staff member who isn't specialized to one qualification, with several random ones, and demanding a large salary, you may ultimately be better of firing them and training a new member in their place. You will of course, have to absorb that loss of a body in the months it takes to train the new member, as well as their trainer. You'll still need a few extra doctors and nurses on hand for when other doctors/nurses need breaks too!



The above picture shows a consequence of these decisions - you'll see although I technically started the month in profit, my hospital is showing several signs of failure: not enough doctors for treatment rooms with patients in queues that are slowly dying, as evidenced by the ghosts and ectoplasms they leave behind. I've got Air Cons that are broken bringing down my Thermal Comfort level. I'm getting lava into the hospital, which requires either extinguishers or time to go away naturally. If I can't get back into the black, I can't buy an extinguisher, which means my machines could potentially explode with more earthquakes on the way. Another issue, because my rooms are still disorganized, is I've got treatment rooms in two separate plots. This means that my already limited staff have to walk back and forth between multiple buildings to reach patients who are already in low-health status. The writing is on the wall now: I'm deep in debt, understaffed, and the hospital is breaking down. My hopes are fading that I can turn this hospital around. Even though I'm technically in profit, the underlying hospital issues are like a metastatic cancer, spreading and affecting the whole hospital.

(Lesson: Janitors and amenities matter just as much as the heavy hitter treatment rooms, and without an ability to confine staff to one room or area, they logically are trying to go where they are needed. If I kept the treatment rooms in one or two buildings totally separate, they'd be fine.)



A few months later, I'm still turning a profit and my Hospital value is starting to recover. Maybe there is hope, right? Queues are down, reputation is up, and if only I could just get a few more janitors in, right?I haven't addresses the lack of diagnostic rooms by over-relying on psychiatry. I then try to scrounge up a profit to delete the Marketing office and replace it with a Fluid Analysis room. But then that room begins to have a massive queue, as it's one of the few new avenues available. This then of course, overloads that room, and as I am consistently in debt, my hope is fading. Continual earthquakes continue to rattle my hospital and send my Janitors scrambling to fix everything. This then of course, takes them away from machine maintenance...I'm sure you can see where this is going. I've also got staff with low happiness and patients that are rage quitting. Perhaps I didn't take amenities and Room Prestige seriously enough.
(Lesson: You will hit a roadblock every single time if you don't correlate GPs offices with Diagnosis rooms, and your staff and patients will lose out on happiness when your staff have bad traits and rooms aren't all to at least a Level 3 Prestige.)



I'm able to redirect treatment doctors to the treatment rooms, which helps improve my profit. Maybe my hospital is finally on the up! But again, I forgot amenities in this area, so now my janitors are tied up cleaning Vomit and Wee, where a bathroom and trash cans could have helped.



I occasionally get a boost from research to help send me back into the black, and by this time, after several years, my loan is close to maturing, so now I'm not down an extra $8,000 every month. I try desperately to make improvements with more extinguishers, small bathrooms, and giving out raises and promotions to staff I had to keep holding off. I even was able to scrounge together a new DNA Lab with a doctor with matching qualifications. I'm hopeful, as I know this room brings in money. But again, I find it's too little, too late, as a massive queue forms for this diagnosis and treatment room combined.
(Lesson: Relying on research alone is not a viable strategy - in this case, I may have been better off doing several smaller projects that were completed faster to build up money. I also have to factor in my researchers get tired and need breaks too! Because I also didn't address the diagnosis rooms earlier, I now face an impossibly large queue for too few rooms and now patients are getting stuck in the patient process and dying).



Even with the loan having matured, my hospital wasn't laid out well enough to wither ups and downs in patient numbers and delays in treatment. One staff member going on break has a domino impact on losing tens of thousands of dollars. Then this screen shows up.Now I know I'm circling the drain. My Hospital Value has shot down, and I'm truly on the brink of disaster, it's only going to take a few more bad months or another disaster to destroy a room.My hope is with all the extra fire extinguishers in the hallways, I can stave off a room exploding. My hospital is firmly in debt, every month it's getting closer to $-300,000 and bankruptcy.



And then finally, as if on cue, the fire breaks out that can't be fixed. My Colourizer explodes, my Healixer explodes in my DNA Room, and my X-Ray room on the other side of the hospital is about to explode, thanks to a massive earthquake. As my money climbs closer and closer to $-300,000 each month, and without any recourse to build anything to replace them, the hospital is now moving off of life support and on its very last, failing leg, I either "get fired" with bankruptcy, or throw in the towel. My goose is cooked.



Trying to claim an ounce of dignity, I give up on my terms, and resign to starting all over again. It was either I did it, or it was coming for me. There was absolutely no recovering from financial disaster. Sigh.