Backlog Beatdown: Theming Hospitals with Theme Hospital

In 1998 I bought Theme Hospital and played it on my Dad’s laptop. Nearly 20 years later in 2018, I completed the game on my own laptop. And what a delight it was to play it again!

Vomit waves are always fun to deal with...

Theme Hospital has you managing a succession of different hospitals, researching cures, helping patients and run your hospital at a profit. It was an interesting age of video gaming; 3D graphics were becoming the standard for consoles and there were interesting franchises on PC as well. The game’s developer, Bullfrog, had done very well with Theme Park a few years before, and were pushing the envelope with what could be done with thematic management games. And then along comes this little gem of a game…

How it works is that each level has a certain criteria that must be attainted in order to progress to the next. You have to have your reputation above a certain level, have cured a number and percentage of patients, have made a designated amount of money and have your hospital above a certain value. Curing patients happen as a matter of course, and you plan your hospital carefully so that not too many of them die. The value of your hospital increases as you buy more buildings and build more rooms. Reputation is affected by a number of different factors; the better you perform, the higher your reputation will be. Acquiring money takes time, but once you reach a certain point in the level it will come rolling in. When you fulfil the criteria, you’ll be offered the next level on the next quarter of a year, but if you underperform, you’ll lose the game.

As for curing patients, this is where the design of the hospital comes in to play. They first have to visit the GP and potentially a number of diagnosis rooms before they can be cured. Once the diagnosis is established, they are then sent for treatment, if it is available. If not, you have the option to tell them to leave, or wait in the hospital for you to build a treatment room. However, you only have a limited amount of time to cure the patient before their illness kills them. The process is straightforward, but researching all the available diagnosis and cure equipment can take time. Also, in a busy hospital, they may have to wait a hopelessly long time in order to see the GP if you don’t keep on top of managing the queues. Not to mention the amount of walking between diagnosis and treatment rooms, and the occasional need to use the toilet!

Funnily enough it never occurred to me to
design my toilets like that...

Managing the staff of your hospital is crucial as well. Generally, the higher level of skill each staff member has, the quicker they will do their job, so you want this as high as possible. Certain doctors are needed for certain specialisations; for example only researchers can research, only psychiatrists can handle psychiatric cases and only surgeons can perform surgery. Doctors can be trained to improve their skills, and in later levels this is crucial to the efficient running of the hospital. Also they need to take a break every now and then.

The game starts out basically, and introduces mechanics and gimmicks as it progresses. This does a good job of teaching you what does what, but ultimately it is on you to come up with the best strategies for creating the most efficient hospital possible. The emergencies (cure a certain number of patients in a few minutes or they will die,) epidemics (cure everyone infected with a contagious disease within a few minutes without any of them going outside or face a fine and take a reputation hit) and earthquakes (maintain your machinery properly or they’ll blow up in the event of a quake) add random layers of challenge to the proceedings and make sure there’s always something to do after you’ve built all the rooms.

I really enjoyed playing through Theme Hospital again. It’s brilliant concept, and while the graphics are pretty basic, they’ve lost none of their charm. It’s great fun to play and beat, with the occasional wobble with execution and glitches. I’d highly recommend giving this one a go.

Last Week's Games: Atari Anthology, New Super Mario Bros U, Theme Hospital

I started this week by playing the Atari Anthology on the PlayStation 2. This is a compilation of 85 games that were a mixture of the Atari 2600 console and Arcade games, and with my borderline OCD method of decision-making, I tried some of them in alphabetical order. I had a go on a 2600 years ago which my friend Richard inherited off his Dad, and even with my age in single digits, I knew that games had come on a long way since then. Most people who collect and play these games now do so because they have some nostalgic investment in it; I don’t have this but it’s an interesting concept nevertheless. The games showcased by this compilation “Started a Revolution,” and from what I understand about the 2600, it needed this shortlist! Many of the games released for it weren’t very good, and contributed to the over-saturation of the market that cause it to crash in the 1980s. Video games were in their infancy at that point, and a lot of what makes them fun for me – an end goal, an engaging plot, a challenging process and a satisfying resolution – just wasn’t there.

I like how the art for the early video
 games looked significantly better than
 the actual game...

Due to the limitations of the hardware, and that the entire concept of video games was still in development, the better games concentrated on their playability. I had a lot of fun with 3-D Tic-Tac-Toe, a game played over a 4x4x4 cube. There is definite strategy involved, but if you mirror the computer’s moves, you’ll reach a draw. It took a while to beat but I managed it in the end.

Air and Sea Battle was reminiscent of early shooters, in which you play a gun turret shooting planes and helicopters out of the sky. Set up correctly, you have two minutes to score more points than the gun on the opposite side. As a single-player experience it’s over quite quickly; I’d imagine it would be better with two players, but most things are!

When I needed a few moments to wind down, I had a go with New Super Mario Bros U on the WiiU. I find that, with such wide gaps between playing this game, I forget about some of the newer techniques and power-ups and have to remember what they do before I can use them in any meaningful way. But it’s a nice fun game that I don’t have to think too hard about, which is exactly what I need at eleven o’clock at night!

Last Friday I beat Theme Hospital. I’ll put out a Backlog Beatdown review next Friday, but developing the points I made last week: The Epidemics and the Earthquakes are difficult to deal with, need to be included. In the later levels, there comes a point where everything needed to beat the level is basically done, and all you’re doing is waiting for the money to roll in so you can progress to the next one. The Epidemics, which gamble some money and reputation on being able to cure a certain number of patients in a certain time and none of them going outside, and Earthquakes, which damage your machines, appear at random and add some challenge to the game when everything is done. It’s a harsh way to extend the game, but they needed to exist.

Oh dear, that doesn't look too good...

Also the last level was deceptively simple to beat. I’d researched all the cures, built all the rooms and trained all my doctors to be as efficient as possible. While the criteria for beating the level is quite high, I was waiting for a curveball I didn’t think was going to come. It arrived right at the end: Most of the levels end on the next quarter of a year. With the last one, it only ends at the end of the year – and you have to maintain the standards until then. It took me longer than it should have to clear it, as just before the year ended, an earthquake that destroyed a few of my machines, a couple of doctors working on them – and my reputation. It took a long time to pull it back, but I did, and finished the game I originally bought in 1998!

Last Week's Games: Ninja Gaiden: Dragon Sword, Theme Hospital, 3D Pawn

Yeah, she's terrifying.

My new game for this week was Ninja Gaiden: Dragon Sword for the Nintendo DS. I wondered how many other franchises were brought to the system with a suffix that abbreviates to DS, as one of my other games is Resident Evil: Deadly Silence. Still, at least Dragon Sword makes sense in the context of Ninja Gaiden, as that is the weapon that the player character, Ryu Hayabusa, is using. It’s an odd game in many ways, not least because you hold the DS vertically and control the character almost entirely with the stylus. Hold the stylus down in a location, Hayabusa will go there. Tap a location or an enemy, and he will throw a shuriken. Swipe across an enemy, and he will slash them with his sword. There are a number of different combinations of swipes that will do different techniques that are more difficult to do but more powerful if you manage it. The only control mapped to any of the buttons is block; you can press any button for this. 

I played it for a while, and even though the combat can get repetitive, doing it with the stylus is enough of a novelty that it remains fun. The trickier move combos are satisfying to pull off; some semblance of physical effort is required so you feel like you’ve earned it when the move is executed. The boss battles are good as well: It’s not enough to mash the controls; you need to learn their attack patterns and wait for your opportunities. I’m enjoying the game so far and I’m looking forward to playing more of it!

Someone needs to buy more drinks machines...

I continued playing Theme Hospital after getting stuck on the tenth level. I had to re-start it; the vomit virus around the hospital was getting out of hand and the rapid succession of epidemics was haemorrhaging all my money. I beat the level by making sure I had enough Handymen (who keep the hospital clean and stop viruses from happening) to keep the area clean, and spamming GP’s offices and receptions around the hospital. These are the busiest areas because the patients visit the GP regularly, so I arranged it so that the patients were spread out and that there were no more than six people in a queue at any given time. That worked for the tenth level; I now find myself on the eleventh, where I tried to create an efficiently-running hospital in the same manner, only to spend a lot more money than I had and got fired due to an increasing amount of debt, as a rather on-the-nose metaphor for recent changes in UK health policy.

Incidentally, that Epidemics mechanic is a pain in the bum. The idea is that some of your patients have an illness that is contagious and could spread. When you get the memo, you have two options: Either declare the epidemic, take a fine and a reputation hit, or try to cover it up by curing all the relevant patients in a given amount of time. There is a cash bonus if you manage this, but if you fail, your hospital is either fined or all your current patients are evacuated. The trouble is your time is instantly over if any of the patients go outside – even if it’s to access the other buildings in the hospital. I’ll have to plan it so that the patients can get through the entire diagnostic process and be cured before they have the opportunity to go outside – this will take some doing!

An impressive concept, if nothing else.

Finally, Kirsty and I had a go at 3D Pawn, the game with the name that sounds ever-so-slightly suspect when you say it out loud. It’s a magnetic cube with a 3x3 grid on each side, with nine pawns of a light and dark colour on opposite sides. The pawns move like pawns in chess, except you can move sideways. The object of the game is to get one pawn onto your opponent’s side of the cube without being immediately captured. Not an in-depth experience, but a nice ‘travel’ game to be played in bed or in the back of a car. Which also sounds suspect when combined with 3D pawn…

Last Week's Games: Fantasy Zone, Alien Syndrome, Altered Beast, Theme Hospital

Yeah, I didn't get to this level.

Needing to fill an hour on Monday Night, I had a go at some of the Arcade games on the Sega Megadrive Ultimate Collection. My new game for the week was Fantasy Zone, a very colourful shoot-em-up. You play as a small flying ship that looks like it was made from Duplo bricks, and fly around the screen shooting at other creatures invading the land (I couldn’t tell you what any of them are right now!) There are eight larger targets in the level, which take some heavy shooting before they are destroyed. After that, there’s a boss battle, in which the game becomes a Bullet Hell as you try to attack the boss’s weak point while desperately looking for a gap in the projectiles flying at you. I got to the boss on the second level and was defeated, after that my concentration failed and I couldn’t reach that point in the game again, so I moved on. I do want to come back to it though; it was a lot of fun!

I also played Alien Syndrome, which I really enjoyed. I was expecting another side-scrolling beat-em-up when I first saw the game, as you unlock it by getting to a certain point on Alien Storm. But it’s actually a top-down shooter, in which you fight your way through constantly-spawning aliens to rescue your comrades, and once you’ve rescued 10, you go into an arena for a ferociously hard boss battle. It’s a good game, and one I look forward to coming back to in the future!

One game I will be glad not to have to play again is Altered Beast. I played the arcade version of this on the same disc. I didn’t really enjoy it that much but I managed to beat it eventually; you can see it covered in my Backlog Beatdown review. I also persevered with Killer7 for a while; I’m not sure whether I’m “enjoying” it in the usual sense, but I’m finding it intriguing enough to keep going for now at least.

I'll show you the games once
I've played them, alright?

I ordered a copy of Atari Anthology for the PS2, having been persuaded by one of the Metal Jesus videos, and before playing I had a look at the manual to it. With compilation discs, I usually mark the individual games off as complete once I’ve beaten them. One of the problems I was going to have with the Atari games is that most of them aren’t supposed to be “beaten” in any meaningful way. They’re arcade games; you play them until you die and aim for the high score. I wondered how many of the games I’d be interested in playing, because I like to see them through to the end. But Atari fixed this by putting unlockable items in the game; different game modes and interviews etc. Hot Seat mode looks intriguing! So once I’ve unlocked everything, I’ll mark off the whole disc as complete. Otherwise I’ve just taken on 85 games that can’t really be beaten!

Brilliant game, still playing it 20 years later.

Finally, I played Theme Hospital. I downloaded this from GOG a year ago; I have a copy of it on CD-ROM, but the chances I’ll ever get that to work on a modern laptop were slim, so I downloaded a digital version that runs off DosBox. And for a while, I enjoyed it hugely, building the hospitals, researching the cures, trying to let as few people die as possible. It took me right back to when I used to play it in the late 90s! I got to roughly the 8^th or 9^th level (I can’t remember which, it was a while ago!) and played quite a long way in to it before the game crashed and, since Autosave wasn’t a thing back then, and I hadn’t saved the game for a while, I lost a couple of hours of play. I know these things happen, but it’s a dangerous game to play with someone who was already looking forward to the end of the game by then. So I left it for a year, came back to it this week, and played two hours of the level I was stuck on before exactly the same thing happened. Well, darn.