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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

(Pebberley Island) Pebberley Island Region

(Pebberley Island) Level 21: Topless Mountain - Case Study - Working Successfully with Waves

I have now attempted the level four times, and won on the fifth. I finally hit upon a good layout that averaged $500,000 at the end of every wave past Wave 20, and once I got the strategy down, while I may have lost profit, I didn't even need to take out a loan even once (up until the mid-30 waves). I was able to generate enough of a month-to-month profit to support building projects along the way too.

The biggest issue you'll run into is that you have to change the usual strategy a fair bit from how you run a normal hospital in a few concrete ways. You need to run your hospital as cheaply, but as effectively, as possible. In addition, the strain of all patients coming in at once also means everyone's health is draining every minute they're not in a treatment room.

1) Hospital layout and then an appropriate number of GP's Offices balanced with Diagnosis rooms should be your #1 and #2 priority

Consider that the cure ratio to reach a three-star hospital never passes 70%. So what this means is it's important to pass most patients through cure rooms, not all of them. As such, you can go down a little on your staffing expectations and upgrade requirements at first. In a normal hospital, you'd get those really good first. However, it still comes back to the same issue that shows up in all other hospitals: if the patient rage quits or never makes it to the treatment room, that counts against you, and in this level, you're dealing with both money being short and patients not coming in constantly. So what I've found different is that you may not want to beeline straight for upgrading all equipment. Instead, make those initial investments towards increasing GP's office/diagnosis room balance and a more robust layout. Your hospital will constantly be evolving, so you'll need to factor in things like leaving a buffer of space around Reception desks, leaving plenty of 2-tile wide corridors, and trying to keep patients from walking too far.

As you progress too, you'll notice that you may have more patients in low health - supplementing the hospital with a few more GP's offices will usually help fix this problem. You can also place the Laxative Vending machines if you don't mind the extra mileage your toilets and janitors are going to get (thanks to user Arnizipal for the tip).

2) Oh my god, the janitors and extinguishers.

For one of my attempts, I had a smooth running hospital going great in the mid-20s range, but still with some financial issues (up during the good parts,but in debt during the slow parts of the wave). I ran into the misfortune of being maxed out in loans and unable to purchase a single fire extinguisher, just after a solar storm depleted my hospital's supply. As the Janitors could only think "Fire! Fire! I can't put it out!", they stopped doing hospital maintenance. This then caused a chain reaction of causing more machines to explode, because they weren't being serviced. This had the secondary effect of stopping them also from cleaning up any litter, so the hospital became rancid in short order, and of course, those good environment buffs disappeared, which then naturally lead to staff and patients getting fed up. A disaster in its fullest. In subsequent attempts, I went a little paranoid and make sure to place 3-4 extinguishers in a room with a machine, and any time a solar event would occur, I would pause the game and quickly stock up each building's corridors with 8-12 extinguishers. This was with good reason: the solar storms get REALLY bad towards the end of the level - easily inflicting 10-15 flare spots in your hospital. Your janitors will ransack extinguishers from anywhere in the hospital, including any extras you placed in your rooms. After I did this, fires were never an uncontrollable problem again, although with a large hospital processing upwards of 100+ patients all at once, they are bound to happen.

So for goodness sake, make sure that you keep a large number of extinguishers in the corridors, and that you take the time to replenish them after every solar storm. I found that having a highly-trained team of janitors in Maintenance, not even a dozen, were able to carry me through the hospital very well.

3) Consider cross-training staff
In just about all other hospital levels, it makes sense to specialize your staff in only one area. However, you're going to have staff who are often sitting on their butts until it's their "turn" with the wave. It may be helpful to have nurses who have both a little diagnosis and a little treatment power together. Likewise with doctors. And when your initial rush is over, send your assistants to go staff kiosks to make some extra money and help relieve boredom. Those extra $60-$100 treats add up, and otherwise, they're just sitting at the desk, not doing anything or making any money.

4) Consider using the "train-em-up-and-let-em-go" approach (for doctors and nurses).

This is by far one of the best things I did that kept me with a nice and steady profit, precisely because it's salary bloat that will kill you financially in the later waves. As much as you want doctors to max their scores to guarantee superb treatment, the reality is that it isn't sustainable for keeping a constant wad of cash. When you play the odds, right around the III-level qualification is the sweet spot for hitting cures enough to be above 70% and still giving you money.

4) However, less is more with janitors and assistants.

The reverse is true for these staff. You'll want fewer, but more powerful Assistants and Janitors. You also wont want to give 'em the axe so quickly. The amount of patients a fully-trained Assistant can process with the Customer Service V qualification is mind-boggling. How quickly a well-trained janitor can run about your hospital and do maintenance on all the equipment when properly trained is also staggering. They will cover more ground with more experience and do things faster than their equivalents of 2-3 low-level janitors. And again, prioritize and economize: you only need one janitor for upgrades/Mechanics in this hospital. Train the rest in maintenance, have some ghost capture trained, and they'll come in handy.

5) Research and Marketing really don't help

I know. I know. I spend so much of this FAQ talking about how these are two game-winning rooms. This is true...in almost all other hospitals. Having those rooms run profitably. however, assumes a constant stream of income. While it is true that researchers can earn you money with research projects, they are not profitable with the wave format. For one, researchers are actually the most expensive of all doctors in the game. Second of all, in order to train them up, it requires a whole lot of time. And third of all, they kind of get bricked at any time they aren't actively researching if money dips below 0 (which it will at times, it's nature of the waves), and they're still costing you money. So in the name of efficiency...not in this level! Marketing, similarly, just isn't necessary by the nature of the beast.

Anatomy of a Profitable Wave-Smashing Hospital (What Did and Didn't Work)

Now in this section, we're going to take a glance at a few mistakes and a few "I did this right" from various attempts at this level.

Let's start from the actual winner and work our way backwards. Here's what worked for me on the eve of clearing Wave 30. So as you can see, it is possible to clear this level with a large amount of money in the bank.


OK, so from the beginning, let's look at how you might start the layout:

Seems pretty respectable right? There isn't too much wrong right now. But again, in hindsight, i can already see a few errors. For one, the research room will have been my downfall in multiple iterations of this level. Second of all, while the initial layout works for right now, I can easily see that my lines are going to start forming and bumping against that bathroom there. Also, I need more environment decor in my corridors - it makes a difference on how much crap my doctors will tolerate. And another small thing, but adds up - I went a little too crazy with the bamboo benches that cost 3x what a normal bench costs! It adds up quickly. Remember, in this level, we need to be both cheap and efficient. So now let's move on to examine how I fixed this in my initial build of the winning level, just below.



Some slight modifications as you can see. Taking out the research office allowed me to fit an extra diagnosis room to help facilitate patient flow. I also made the ward a little bit bigger, decorated with Ice Sculptures (which are practically Air Cons without maintenance). And while it seems like a small thing to do, you'd really want to do that in this level. Our hospital's janitors will be under nonstop barrage from all kinds of natural disasters on top of the pressure of a large number of people moving through it at all times. Anything we can do to free up the janitors is worth investing in. I shortened the toilets block to fit two lines of incoming patients at the Reception. This works a little more smoothly.



So now let's look at what an expanded clinic might look like as you build out. We definitely want to keep the base idea of keeping diagnosis and GP's Offices together, and moving the "admin" buildings furthest afield, with treatment areas concentrated near each other two in a separate area. Also, you'll notice as we look at more layouts that I routinely move the staff room(s) around the campus. As each building fills out, we want to make sure staff have fairly good access to any of the rooms in the nearby buildings too, so for this level especially, I'll always try to keep them near plot entrances for a quick exit. Considering that many staff will end up in staff rooms when waves start, staff room placements plays more of a role in your hospital this go round than in most other levels. Let's compare the above (a failed hospital) with the winner below and talk about the differences.



Now granted, the bottom picture (winner) is a little further along at Wave 11, vs. the top being Wave 6. But I want to point out how vital early game building and layout is! Also notice the staggering difference in money! In the bottom picture, I didn't upgrade any machines yet,and opted to first focus on building an efficient layout to process patients - being more conservative with my money, preferring to build a spacious layout over staff training and room upgrades. I still have a generous 60% Cure rate to work with - so I just have to get it a little over "half right" - and at this point in the game, that's all I need.

You'll also notice that the Ward is significantly bigger in the bottom one - the Ward is a vital early-game room as it serves both treatment and diagnosis functions. In addition, it doesn't need to be improved very much with upgrades, and your nurses with the Ward Management skill will build fairly quickly with the patient waves. So, don't skimp on your ward in favor of other diagnosis rooms! Also, you'll notice the GP's offices are a little spread out - this is intentional, as you'll have to efficiently move large numbers of patients with the additional time constraint that every single patient starts basically at the exact same time. It made sense, I found, rather than to cluster all GPs' Offices in one building or area, but to mix groups of 2 or 3 GPs' Offices with a diagnosis room to minimize walking between diagnosis rooms and GPs' Offices. I'm going to call this idea a "mini-clinic" for future reference, but it worked well for the constraints.

I also make sure to keep moving my training offices further away. I opted to minimize room size, and believe me, I kept playing around with treatment rooms and their layout to fit as many as possible into one big treatment building. Again, the staff room is still near the first building's door for quick entry to the treatment building. Another thing you may notice is that I expanded the Reception desk to have some buffer space on three sides - this reception area will serve me a little while longer until I have a third building. But you need to plan the buffer zone, because each time the wave hits, that queue only gets longer!



So let's take another look at what happens when you start building a little too quickly. This above screenshot is from another case of a failed hospital layout. As you'll notice, I'm already fairly deep into debt thanks to some bad design decisions, promoting staff a little too quickly, and trying to upgrade and expand too fast. Can you see what's not working above?

  • Rooms are a little too haphazard - I've got random treatment rooms in my building on the left (which should be just GPs' Offices and diagnosis rooms) - it's shaped weird too. The giant research room is just eating up space that could be used by treatment rooms. And although I've got that mini-clinic idea down, in reality, I probably should have redone the leftmost building.
  • Having two check-in desks this early kind of gave the hospital a dual identity it wasn't ready for. I would have been better off keeping one bigger check-in to send patients on rather than two, and I could have very easily re-used that space to fit something else. Again, efficiency is what will make you win this level! You may benefit from a second Reception area in the late 20s/early 30s though, but again, all in its time.
  • While I do have the X-Ray in this hospital layout, in my other winning layout, I decided against using them and the M.E.G.A. Scans - nurses in the basic diagnosis rooms could work a little faster and achieve basically the same result with a couple of qualifications. Again, it's a case of a cheaper nurse vs. a more expensive doctor with the radiation and extra skills. And those small decisions add up.
  • There's really no need for the fourth building on the right just yet. In this level, buildings go for a minimum of $40,000. That's a lot of money when you're dealing with patient waves. Make sure you have utilized all space you have in your current buildings. Can you shrink some rooms? Can you move rooms between buildings? I should have held off on buying the land for my right-most building and instead reworked the design a little better, especially since I'm in the red.

Now to my credit, I actually did continue building from that previous picture and made it pretty far. Each of these new plots cost a good wave's worth of patient money! Although you can see my money is up, I also am in a bit of a weird place with this choice. My initial thinking was that building an extra surgery suite with the cash surplus would work well. Except in reality, it's very far from the rest of the hospital. And typically, by its nature, most surgery patients will be low health already. Most patients would rather take their chances in the main treatment building I already built up rather than send them to certain death walking all the way across the hospital to this second isolated area. Although I've tried to position another staff room nearby, the main part of the hospital is really elsewhere. I probably could have gotten by with just one surgery suite, to be honest and saved a good $100,000 right now. Again, efficiency and cheapness are key to this level. It may not be "perfect", but if it works and keeps the money coming, then roll with it!

Also, in the top right building, I have a M.E.G.A. Scan in the middle of a largely treatment area which is only going to make my patients walk more, especially if they need to go back to a GP's Office! So again, it bears repeating - even with awkward level design, keep like rooms together!

But you see, in order to finance those buildings above, I had to take out a bunch of loans. I was paying it off with the help of my researchers, but when you're in debt, they're no help and they still have to be paid like everyone else. They are actually the most expensive doctors in the game. And of course, with the waves and greater cost of the loans, it was an increasingly larger debt. I could only sit there and watch my hospital implode on itself when a solar storm set the hospital on fire, with no extinguishers around leaving mayhem in its wake. And it's also what you don't see in this is all the money that went into staff and raises too. In the next iteration, I would be much less giving and more quick to fire staff once they reached the consultant level. And of course, don't forget to prioritize hiring a good group of janitors and keep this hospital SUPER-well stocked with fire extinguishers.



Let's skip ahead to a layout that almost won, but still had some problems. As I get better with the concepts, some right ideas start clicking: I need more Psychiatry rooms, and wards need to be big (remember, they are also diagnosis rooms!). Buildings are relatively well-organized by function, and a big central Reception area to process patients. These are all parts of a winning hospital. Notice how much more well organized the main treatment building is, and then notice how this go-round, I made the building on the right a little more oriented towards handling the larger groups of people, and removed the queuing area in the left building. More GPs' Offices do become necessary in the later waves so I'll use that space indeed! One of the reasons that my GP offices are so well built-up is that I kept having queues.

Now the thing about queues in this particular level is they aren't as indicative of a "large" problem as they are in a normal level - it's normal for them to bloat a little bit, but go down once patient volume stabilizes and patients who got there first, to then move to treatment areas. If that's the case, it has more to do with the influx of so many patients rather than a deficiency on your part. So if I had been a little more patient, I probably would have seen them go down a bit and maybe built things a little differently.



...which, when you look at at more of the hospital, this starts to become an apparent error - there's simply not enough diagnosis rooms to go around, meaning that a lot of patients are getting stuck at diagnosis and not making it to treatment. By using the "mini-clinic" approach in the future, I can cut down on people who have to move across the hospital too much. For example, if I had replaced one or two of the consecutive GP's Offices with a diagnosis room, I probably could have served more people. In addition, staff wages are high, so I became ruthless in future iterations. What's that, you want to become a Consultant? Goodbye!



Now, here's the one that won. Notice how while I still have several GPs' Offices, they're not lined up in a hall, but rather split up with more diagnosis rooms between them (the "mini-clinic" approach). A patient is never more than a few doors down from a diagnosis room, and by using multiple kinds of diagnosis rooms in each building, I cut out the need for patients having to make many trips across the hospital to go to the one building where the room they want is. Also, by using less types of rooms, I make one less decision for the AI - it did a fine job of picking between Cardiology, Psychology, Ward, General Diagnosis, Fluid Analysis, and DNA Lab. And on that note, DNA Labs are just as important to success in this level: they bring in money, serve a dual diagnosis/treatment function, and can find anything the X-Ray or M.E.G.A. Scan would. I was actually able to do fine with just two DNA Labs in this level, actually.

I hope this food for thought helps you plan a little better. Good luck!