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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

Industrial Region

Level 7: Smogley - Case Study - From Failing 1 Star to Succesful 3 Star

OK, bear with me, this is going to be a very long case study, but it shows what happens when you're in the red, everything seems lost, and you don't want to restart the level. This is a "full recovery" hospital. This case study will detail my misadventures with Smogley. After seeing the devs play Melt Downs, I made a full speed ahead for it once it unlocked. And of course, understanding the game better now, I was up to the challenge of revisiting it. This was probably my worst-run 1-Star hospital at the outset. But slowly and surely, I turned it from a losing profit mess with poor employees and patients dying left and right to a prestigious, well-run 3-star facility. Follow along, and as always, see what you can learn from my mistakes!


OK, the goals seem easy enough, and I'm not that far into debt. As I always do to start when I have problems in my hospital, I always first zoom out to get a lay of all of the problems. Here's what I see so far:




  • GP Offices queues are all to at least 6
  • My diagnosis rooms in Plot 4 are all well past capacity.
  • I just bought a new building and I haven't moved anything into there.
  • My rooms aren't built together well, my toilet blocks are too small, the gift shop has a crowding problem
  • Money keeps going down

In situations like this, where money is the first and foremost issue, I always start there: pausing the game and taking out a loan. However, considering the month just turned over and I'm now down more than $100,000, I will wait for the money to come in. While doing so, I'll take a look at what I can do for free, and in this case, moving rooms between buildings sounds like a plan!

Notice that I have Plot 2 available to me already. It's empty space, and according to the 9 rules of layout, I should be building the diagnosis rooms closer to the GPs office. Considering I have a mixture of rooms in the building above, I rearrange them between Plot 2 and Plot 4. I'll move both of the X-Ray machines to Plot 2. This frees up some space in the middle plot. I also add in the general diagnosis room...



This also allows me to consolidate my treatment area towards the back of the hospital, which will improve patient flow.



I'm already feeling better about that layout, and see if I can now go to the other side of my hospital and do something similar. My westmost plot is really just a hodgepodge of rooms, and there's a lot I can see that I can do as well. What do you think?



I had prime patient real estate being used by the marketing office and research room. There's no point in me having it there now. So I move it to where my small treatment area is, and that opens up some new corridor space. Again, i also had an awkwardly placed gift shop, which I'll finagle with a bit.

In its place, I'll add an additional GP's Office to help with my queues there. I'll also fill in the extra space with a General Diagnosis room, because it's cheap and will help better spread my diagnostic room queues. It also helps me get closer to the 1:1 ratio for GP offices to diagnosis rooms. Is there anything else you think can be made more efficient?



Although it's true that I could also have moved the Head Office for my turtle patients with the other treatment areas, it's still being utilized right now so it can stay as is. However, there is one room which is much too big for my staff size the way it is, and that's the staff room. I will now cut it in half without sacrificing much, and utilize that empty space for something else.



Doing so nets me a generous 3x3 space - definitely enough to fit another GP's Office! I'll leave it empty for now, as I added a couple of offices already and that space could be better used with something else.



And look, my hospital is out of the red! Super! Now that I've built a couple more GP's Offices, let me examine the staff in them and see if I can improve anything without spending too much more money.



Wait...why is my consultant surgeon playing GP? She's got zero qualifications to be in there! No wonder I'm in the red, she needs to be in the operating theater cutting patients open! Hm, let me check my Job Assignment roster...I have a feeling this won't be very good.
(Note: This screen has been updated graphically since this was taken, but the screen is still the same otherwise).


Yep, as expected, there's too many hands in too many pots. It's time to file this madness down. I go through and assign doctors where they have appropriate talents. Sending my surgeon back to surgery gives us the chance to make some good money! Not to mention, it's one of the things I'll need to do to pass the level!



Speaking of easy money, I have qualified Researchers on staff. Since I'm hurting for money, I'll have them focus on bringing in some extra money. Obviously this was going back after I had researched everything, but consider too that if you're hurting for money, it's not a bad idea to send your scientists off to do some research until things settle down.



Taking a more general look, I see that my changes have brought down the GP queues, given me a space to put a proper bathroom in my middle plot, and now my queues have reduced a little for my diagnosis areas, but they're still there. My cafe will also help address food and drink, and I'm comfortable doing it here because of its pretty central location. My psychiatrist is out of her office, so it might make sense to train another one.....hm....



So I check out what's available, and golly gee, I did it again - I forgot to train a large number of staff who are sitting around waiting for this. By the way, this also creates a small happiness decrease. Now granted, with money so low, affording higher level trainers isn't easy, but I need to make it a priority - my patients are dying. I'll prioritize GP doctors, diagnostic-skilled nurses, higher qualifications for surgery, and maintenance for my janitors - I know there's going to be a number of machines in this hospital when all is said and done. This is going to be on-going for several months. Right now I'd rather save the money instead of building multiple training rooms, so this will do.

And now while that's going on, there are other areas of the hospital I can improve. These GP offices, for example, are very long. I can foresee that if I shorten them, it will let me better center my reception desk which will help improve flow, so away I go!



While I'm still in the red, I'm generally making more at the end of the month, so I won't worry about it too much - my surgeon in training is backed up by another surgeon to keep the knives moving. I also re-size and re-center my reception area towards the center of Plot 1. Considering the two door entrance, this is a better choice with the future in mind - patients will be able to queue on both sides. I also check my radiators and move them around the area to make sure my hospital stays cozy.



Just a reminder that when you're up and able, keep the research train rolling. It's a great bargain!



Award season comes by as a reminder of what I can work on - lack of training the whole year had me give up rising star, lack of money had me working against beautifying it for Most Prestigious hospital, and lack of research earlier in the year cost me. That's basically a free $15,000 I gave up just for not being attentive! Yikes!



Things are already starting to look up! A recent VIP visit came up a smashing success. When things are going all wrong, remember you will have random events like this to save you. Money is still up and down with the month change, of course, but that's par the course.



But of course, I'm still having crowding issues across the hospital. My Fluid Analysis room could use a duplicate, and the operating theater, one of the most important pieces of this level's puzzle, is also too crowded. What can I do?



As in the past, polling your patients works. I'm looking at why here, so I click around. Why are patients low-health or dying? This one died because his health depleted - which experience tells me means under-qualified GPs can't identify their illnesses fast enough, or queues for diagnoses are backed up. Since the diagnosis bar isn't yet to 100%, I know the cause is either one of those and not with the treatment rooms. So I'll need to prioritize GP training and more diagnoses rooms. My patients aren't going to make it to the profitable Operating Theater if they're dead prior to arrival!



Another area I see issues is my ward. It's built weird, but works. But it also has an awkwardly placed bathroom above it. I'm still in the red too, you know? I might also want to try to build up the Ward Management skill as well - I know that better-trained nurses will mean less low-health in the ward. I will also want to expand it to get a better room score, but that's for later on. I just want to show that you have to do a lot of thinking across multiple plots to put the pieces of a failing hospital puzzle together. The Ward is an issue room too.



As my training goes on, I look for other areas I can improve. Near my surgery office, I had an awkwardly placed gift shop that could be moved, and instead, I'll make this small area a vending area. I know they're not perfect, but I feel they're a better use of a 2-tile-wide corridor than cramming a tiny bathroom or staff room there.



Having saved up quite a bit (vending machine purchases do add up!), I've now got enough to train a General Practitioner to the second qualification. This starts to make a difference, the second level will reduce the multiple trips some, and aiming for the third qualification is really all that's needed for just about all of the game. Plus, training just one Doctor allows them to train all the other Doctors, as opposed to paying out the wazoo for trainers each time.



As I'm getting more money, emergencies are coming in to help make it rain. Having a newly trained couple of Surgeons with the second qualification, I thought a surgery emergency would help. The fact that only 1 made it tells me I'm still having issues, and need to continue to prioritize surgery training and upgrades to win this level.



In cases like this, it's a good idea to see that my nurse who was also performing surgery (part of the equation) had absolutely no treatment skill. Nurses in the operating theater will only benefit from increased Treatment skill, as they don't have a Surgery capability.



So as money is down right now, I'll train who I can for free...and then I'll fix what I can. Seeing as how an influx or surgery patients is shooting my queue numbers way up, I need to build an additional surgery suite (or two). I know that the money risked will pay off because I'll see more patients before they die. I consider the other high queues and decide I need to move things around a bit. I have plenty of space in my plot below this one, so I'll move the Fluid Analysis room below, allowing me to build a second operating theater (which has a minimum size of 4x3, perfect for this area).






Now that I've got a second room to take some of those patients (thank you loans), I want to analyze the chance for a cure and see that even still, my patient only has a 69% (snicker) chance of being cured. The main reason for this is a very low staff skill - which is combined from the nurse and the surgeon. There is also a low room upgrade score, so I'll need to focus on room upgrades and staff training to bring this up. Wall monitors are an easy way to add a few points, but unlocking the Operating Monitors with Kudosh allows a +2% Treatment score per object. And Floppy Discs is a relatively "easy" surgery condition - the other illnesses area more challenging. Time to step it up! With the extra income I'm gaining from two operating theaters, continuous research, and the loan, I also have enough cash to build an additional training room. This will be important as my staff size is slowly growing to accommodate new GPs and more patients.



As you can see, my hospital is growing at the seams, but I still have a fair amount of patients with low health. I'll need to continue to expand GPs' Offices, work on the diagnosis qualifications for my diagnosis rooms to get more out of them, and possibly upgrade the machines - but considering my balance is still fluctuating between red and black every month, it'd be easier to train up with what I have first. So more diagnostic training for my doctors and nurses it is!



But surgery isn't the only thing! I see that my treatment skill is also improving the nurse's performance in the Colourizer, turning a hefty profit. Make sure you're giving attention to all your treatment rooms- they are the main source of income after all! Hopefully this group of emergency patients will help fill the coffers...



Notice that with a lot of failed cures and deaths, my reputation has gone way down. Fortunately, I have a little bit of money and some willing Marketing-trained Assistants to help me take care of that. They'll help bring in more patients to give the staff more experience. This is why you need them in each and every level! Marketing is not a frivolous expense!



Oh dear, I didn't quite make it. This tells me I need to stop and look at what may be going on. Let's take a look at my nurse's stats, because this is often a helpful clue.



In this case, this nurse has a diagnostic ability of 130% versus a treatment of 50% - this one needs to be somewhere else. I can also try upgrading the machine now that I have a chunk of change. This only makes the cures easier!



Award season rolls around and tells me I'm in the right direction - more research and training netted me a better award, and I still could be giving my staff more experience. Somehow patients still love the place despite my incessant killing of many of them. Those amenities like the Café sure do help!



As I am hiring more staff, I am careful to take a little more time to weed out candidates with multiple bad traits, and instead keep my eyes peeled for ones like this - already qualified for something I need with a GOOD trait on top of it! Be relentless and reject all candidates that are over-skilled or aren't worth your time. This is one of the things that starts making a difference in patient care. As you can see, I've been well on my way training and I finally feel like I'm making good progress on my goals. The level is finally heading in the right direction!



It's also a good idea to peer in on your already hired staff and see how they're doing. What are their current feelings? What are their needs? Why is my surgeon in a GP's office again? UGH! Although I try to stay on top of it, when you hire and train a lot of staff, it can be fairly easy to lose track of them. Another visit to my Job Assignment table is in order!



Another visit to my Chromatherapy room shows me that I now have a better trained staff with an upgraded piece of equipment - my cure chance for this patient is at 93% - I like those odds. Of course, 99% would be even better, but this tells me I'm going in the right direction. This is why it's so important to properly assign staff where their strengths are!



As always, it's a good idea to do an overhead view and see if you're missing anything - I see doctors are needed in multiple rooms (perhaps a sign to hire more). I also still have cold areas (time to revisit those radiator overlays!). But in general, I don't have as many low-health patients, especially not in diagnosis areas - this tells me that the combination of multiple training rooms and machine upgrades is working. Notice I'm still in debt, but for the most part, still coming out ahead at the end of the month. Keep those researchers researching that extra money!



Another area I'm starting to see queues for is my Psychiatry room. It's probably time to build another one. Getting a little more confident in my staff's abilities, I've also set up marketing for diseases like Grey Anatomy as well as surgery patients to bring in some steady money. As always, it's a balancing act - my current psychiatrist could probably use some more training...do you get the idea yet? I could also add in Treatment and Diagnostic bookcases into the Psychiatry Office to help out just a smidge.



Yes! Finally! The tide is turning on my emergencies! I cured more than half, which is "good enough". I can now use this money towards all that training I need to do. As my cash is getting more flush, I'm starting to feel a bit more confident about building more rooms as well. This is also a sign my hospital layout is working well. If I want to get really good at emergencies, I obviously need to build multiple of the same rooms with trained staff and upgraded machines, ya know?



Now that money is pretty stable, I feel more confident in venturing out to train staff in other qualifications. My theory is always that it's better to train one employee first,make sure there's others to cover them, and slowly train everyone up. You may find that in certain circumstances it's easier to use the Guest Trainer. But a high-ranked Diagnostics II doctor or nurse will do you pretty well.



Another glance at a new Chromatherapy patient shows I'm now locked and loaded and ready for 'em all with a 99% Chance of Cure! Awesome! It's practically guaranteed money now so long as my hospital stays efficient.



I see there are still patients whose health is depleting to low health status, so I need to stay vigilant. Perhaps in this case I need to upgrade my diagnosis machines. Since this is happening in the diagnosis area, it's either my local GPs are getting to things quickly enough, or the diagnoses aren't good enough. Food for thought.



Another area I can improve overall patient experience is by improving the amenities. I have a strong preference for the Luxury Snack and Luxury Drinks machines, and add arcade machines where I can, as they do turn a tidy little profit.



...And yet somehow, I still end up with the occasional GP trying to play turtle extractor, who ends up killing people. Make sure to stay on top of your staff's roles!



It's also important that as you're figuring out the whole picture, you monitor how different feelings will affect your staff members' performance. Know that the surgery room is especially prone to hygiene issues, so don't be afraid to manually send staff on breaks if their performance starts slipping.



X-Rays continue to be a popular diagnosis, so I'll need to find another spot for one. But you can see that my diagnoses are becoming more effective and the money is staying up. We're almost to the second star now!



Considering the uptick in surgery patients, more Operating Theaters are in order...it all goes back to the simple idea: build what's in demand!



And before you know it...the star will be yours!

So that's just a step-by-step of what worked for me. From the second to third star was basically the same thing, just adding more rooms, training staff to higher qualifications.



The only further tip I have is that in Smogley, the helipad is adjacent to Plot 5, so it made sense to expand the building there, add a couple more Operating Theaters. Also, as time went on, I went ahead and re-did and expanded each operating theater to a bigger space, adding in additional Surgery monitors and Wall monitors for extra treatment points.I also added in more training rooms, and well, just fought slow and steady to the goal! I also expanded the Fracture Ward to add a few beds.





But in general, the over-arching lesson from this level is that money will be tight often, but so long as you build what's being asked for, train your staff properly, and aren't afraid to take out a loan if needed, you'll be able to overcome any obstacle!