How do you deal with a genius surgeon who refuses to wash their hands after using the toilet? In Two Point Hospital's simulation, answering this question might be more trying than you'd think.
While Two Point Hospital is essentially a spiritual successor to the classic Theme Hospital from ex-Lionhead and Bullfrog staff who helped to create several classic simulation strategy games including the original Theme Hospital and The Movies, it's far more than a high-resolution retread.
The extra horsepower of modern machines is being used to create a more detailed and in-depth simulation, though one that also tries to maintain the unique tone and style that made Theme Hospital - for my money - one of the best strategy simulation games ever.
Thus we return to the example from the opening of this article, offered to me by Two Point Studios designer Ben Huskins when we chat about the game EGX Rezzed 2018.
It's not just about 'here's some hospitals dotted around', it's about this world that they exist in that has lots more going on in it."
"Imagine you've got an unhygienic doctor, for example... He goes to the toilet, doesn't wash his hands," Huskins explains. "Then he goes straight into surgery. That's going to have knock-on effects."
The answer seems obvious, of course: kick him to the curb. It might not be that simple, however. That Doctor might be potentially dangerous, but that's only potential risk - what if he's really good at surgery? You need those dirty hands.
Anybody familiar with Theme Hospital will know that your employees are the lifeblood of your hospital and livelihood. In Two Point Hospital the same is true, though instead of tracking a few basic stats like diligence, intelligence, qualifications, and pay, players will now have to worry about staff well-being in more detail. They'll need to eat, use the toilet and rest, and they'll come packing unique traits. That might be something helpful, or something mildly annoying like being a litterer. Worse, they could be unhygienic even when they know they're going into surgery. It's another level of simulation.
"There's definitely quite a lot that's tracked on each person," Huskins says. "Patients have various different needs and moods, plus their health and happiness... if they get really unhappy, they're just going to storm out and go to another hospital."
Patients will even react to each other. That means they'll talk, but patients will also see and smell the person vomiting in the hallway bin. There's much more to consider.
"There's more going on there, but there's also more going on in terms of character traits and that sort of thing," Huskins explains. "So one guy might learn faster than other people, so he's really good for the training, but another guy is a litterer and is just constantly dropping litter - which is super annoying as it means you'll need more janitors. There's also temporary modifiers on characters, so if you stick down a coffee machine somebody can get a caffeine buzz from that coffee machine and they'll be zipping about for a bit afterwards - and things like that can have a knock-on effect on the rest of the simulation.
"Some of these effects are more subtle than others, obviously, but we're hoping that when you look at it across the board you'll get these interesting decisions. If you cram a hospital full of coffee machines, that's going to run very differently to one filled with water fountains."
The core Theme Hospital ideology of a fun, slapstick tone and a more direct, contained simulation is present in Two Point Hospital, but hearing the developers talk about makes clear that it's a more in-depth, even-handed experience in general. It won't be as ludicrously difficult later on, but nor will it be as limited in design.
In Theme Hospital, for instance, there was one type of plant that had one effect and had to be maintained by janitors in one way - one of only three jobs for janitors alongside fixing equipment and picking up litter. In Two Point Hospital, players will be able to unlock and have the choice between different types of plants with different benefits - more basic ones won't impress patients and improve your hospital's atmosphere as much, but will require less attention. Janitors also have a lot more to worry about, like unblocking toilets and restocking vending machines.
One major area in which the game differentiates itself from its spiritual predecessor is in its progression, too. While that game was a linear series of levels, Two Point Hospital aims to be more open-ended in its structure, and in doing so allows players to choose precisely how much of a challenge they want to tackle in any given hospital.
"It's not just about 'here's some hospitals dotted around', it's about this world that they exist in that has lots more going on in it," Huskins explains. That world is 'Two Point County', a larger map that'll eventually be filled with medical facilities managed by the player.
"There's these characters that show up around the county and all these different places to go," Huskins says. "You start to get a feel for the different areas - the city up there, the mountain with the snow all around it and everything over there... and it just gives you so much more context to what you're doing in the game. Everything has got a bit more meaning to it because you're not just building something on a blank canvas, you're building something into this existing world."
All of this is about leaning into one of the greatest strengths of Two Point's inspiration, a world full of character, from the design of the staff and patients right through to brilliantly unique slapstick illnesses like 'Premature Mummification' and an 8-bit illness which sees patients morphed into a retro visual style.
"We didn't want to go down the route of having real illnesses and stuff like that - it's just not fun to do. We basically came up with illnesses that made us laugh," Lead Animator Chris Knott chuckles.
"For example, for the mummy one, Mark, head of art, just started making a mummy. We were like 'ok, cool!' I started doing some animation for him... so it walks like a mummy... smashes through doors like a mummy... but then stops and has a sandwich - and then carries on like a mummy! We want it to be clear it's a person who thinks they're a mummy. So we do that, and then it's like... how can we cure them? What can we do that's a bit weird that we can cure them with?
We didn't want to go down the route of having real illnesses and stuff like that - it's just not fun to do. We basically came up with illnesses that made us laugh."
"For the mummies, we came up with a huge sarcophagus that they get into that then lowers them down and all the bandages are ripped down out of their mouth. Then it comes back up and out they come, perfectly cured, and they're off out on their way."
The team are aware of the sort of mash-up of the macabre and the fun Theme Hospital took on with its mingling of slapstick humour and the grim reaper roaming the halls of the hospital waiting his next victim, and they seem keen to repeat that here. Some videos of the game have already teased that sometimes the dead might even stick around in the hospital in a spectral form, haunting your living patients.
"I think it's just making the illnesses kind of fun and recognizable so that as you're playing you can instantly recognize which is which very quickly," Knott continues. "That was a trait from the original. But also, we want it to be so that you look forward to certain illnesses coming in... we want players to be fond of certain illnesses and their treatment process. I think that's an important step in getting you invested in the characters and getting you to care about the characters, because ultimately that's the goal - to keep everyone alive and happy. Both staff and patients - you want everybody to be happy, so if you don't care about them that's a bad thing."
Players will start out in one hospital, aiming to get it up to a one-star rating out of three. Once they've done that, however, the world will open up some, with choices offered about which hospital you might want to tackle next.
"By proving yourself as a competent hospital administrator you get the chance to set hospitals up in other parts of the county. You're not leaving behind what you've built up, though - everything gets saved, everything persists, so really you're building up this hospital empire," says Huskins.
"There's obviously an order to which you can open up some of the different areas, but you can jump around between some of the different hospitals and carry across some of your progress - research and things like that. We're kind of trying to look at it as the big picture - it's not just about each isolated hospital but it's about your whole organization and this foundation we're building up, which we think is pretty cool."
Each hospital is unique in terms of layout, the challenges you'll face and the objectives for earning stars towards your completion, so each should offer a very specific challenge, and when combined with your ability to hop back and forth between different sites this will give players quite a bit of freedom.
"Each hospital has quite different goals, so we're kind of trying to make sure that we're getting you to use different gameplay systems in each area," Huskins continues. "Part of that comes down to which illnesses show up, as you're not going to see every illness in the first hospital."
"Some of those are linked to regions, some of those are linked to other things... but then there are other factors, like the Teaching Hospital. All of the goals there are based around training up your staff and trying to get your team of doctors, nurses, janitors and so on as good as you can possibly get them. But then there's another hospital where that might be nearly completely irrelevant to goals - it might be about research, or getting the best machinery through upgrades, or even... reducing the amount of ghosts?"
That last bit is said with a bit of a wink - but don't be surprised if you end up having to equip your Janitors with a sort of knock-off Proton Pack to deal with certain problems. That's the exact sort of madness Two Point Hospital thrives on. It certainly seems as though the legacy of Theme Hospital is in safe hands with this spiritual successor.