My experiences with the game that far

145 hours of play down I think I can share some stuff I learned. Do not consider this a guide, somehow and still I have not tested all features of the game.
I might explain things by department. This is all sandbox-experience.

Emergency clinic
This is the most basic thing to start with. The doctors here need a good diagnosis skill if left alone, or they might do strange examinations that only cost time and discomfort but do not help to find out the symptoms. You will get standard diseases, that are not life-threatening. I have not seen a case, where a patient collapsed in the early stages of the game. The payment for the diseases is rather low. You cure common cold on the low end and contusions on the high end of payment. We are talking from sums ranging from 80$ to 400$ per treatment. At first glance it might seem better to send patients home with minimal effort done as you gain the same money but there is another mechanism that is not easy to understand. The happier the patients and your staff are, the better your prestige will be. Prestige will give a bonus to patients turning up each day and also for payment which can and will have an impact. Now how to make patients happy? Well, avoid the following things:

- long waiting times. If too many patients are waiting at your clinic, you might think of hiring more doctors. Keep in mind, that most patients will come during daytime and only few at night so it is not reasonable to staff your clinic doctor's room with a full night shift. Some things take long like laboratory examinations. Try to hospitalize first. Patients can flee your clinic unless they are in bed. Also, the General medicine skill and diagnosis skill of your doctors might have an indirect impact. High general medicine skill means - AFAIK - that the doc works faster. High diagnosis means, that the doc will pick the right procedures to reveal symptoms and have the final diagnosis quickly. You can also fine-tune this, by setting the level of security in the department to which extent the diagnosis is to be done. Low means, the docs will guess more but can lead to wrong results, which is bad. High can exclude this at cost of longer examination times as more are prescribed. Another overlooked impact have the treats of the doc. Docs might have perks, that will have them leave workplace often to fill needs. During that times the patients are waiting. I am talking gluttonous, fresh parent or fast metabolism here. Perks like diagnostic genius, spartan, gamer or other positive traits are welcome. Patients getting bored can be distracted by informative posters on the walls. They will stand up and take a glare, then sit again. If you have hospitalized persons waiting too long consider hiring more nurses and maybe set the role that one of them will always act as a porter. Give them Code Blue to be treated quicker (free Doctor's Mode DLC required)

- having to stand. This can happen, if you have spent too few dollars into a proper waiting room. The penalty is severe and seats are cheap. The right thing to do is to have enough seats where you expect patients to wait. Waiting rooms are not the only rooms, where patients will sit. Receptions, pharmacies and lounges fall into this category.

- dirty floors. Floors get dirty over time and annoy both patients and staff. Hire janitors to cope with that. Plan your cleaning closets not too minimalistic so you can have more than one for a big department. Depending on size of the department and people with the dirty feet perk running around you might need more than one.

- discomfort. Being in pain is no fun. So try to suppress as many symptoms as possible that cause discomfort and be sure you do not prescribe a procedure that is highly discomfortable without a reason. If you even shut down all pain the patient has by treating him fully, you get a big bonus instead (++ treated)

- boring and ugly rooms. Do not forget decoration. It can make a difference.

- bad personal. There is a treat to avoid at all costs for persons that interact with the patient and this treat is called unpleasant.

- unable to fulfill needs. Have toilets, water dispensers and vending machines ready. Otherwise the patient will leave your clinic healthy and angry.

- unable to dry or wash hands. Your toilets should have enough hand dryers and sinks. Patients will not wait, if one of those is occupied but leave the restroom and slap you with a penalty. Each sink will need one hand dryer. Less can lead to problems.

To make them happy have persons giving the 'nice staff' bonus, treat the symptoms, have short waits, nice and tidy rooms and be professional.

You can boost the income from your clinic by having a pharmacy (Hospital services paid DLC required). Every time a patient is sent home cured, he will visit the pharmacy to buy medicine. The boosts might range from 10$ up to over 200$. I have not seen or yet observed a special mechanism behind it, but I assume the more and special medicine a patient needs, the more expensive it will be. Pharmacies need a tech with the pharmacology specialization so this means they start at level 2. This is important for your payroll. I have yet to discover whether having a big biochemistry skill lets them work faster. Keep in mind: patients do not want to wait too long in the pharmacy. If you have a pharmacist that always runs away to the buffet or sofa you might consider having a second one or hire one with less unpleasant perks.

A reception will help to sort out patient cases and put them into a certain order. Occasionally, a patient might get relocated to the correct department or initial symptoms are revealed so you can manually triage yourself. A high receptionist skill seems to be important here. Build benches for waiting here as well to avoid the (-- could not sit) penalty.

Once you have hospitalization unlocked, you can put patients into observation wards. This is very useful, as they do not care for waiting times anymore. Do it, if you expect a long number of examinations as your revealed symptoms do not point into a certain direction and you might take longer procedures like blood sampling. Everything related to the labs will take lots of time. The observation wards must have life monitors so they work essentially similar to an HDU. The doctors in the on call rooms will come and visit the patient and do the examinations there and your doctor's office stays free of long processes and can churn out more $$$. Hospitalized patients will leave the hospital at 8 a.m. as a rule of thumb if they are cured. This is the time you will get money for that. The observation ward can be used to park patients from overcrowded HDUs of other departments. Look out for patients already treated and with no surgeries scheduled. By transferring you can free up bed space. Drawback is, that you need a nurse to haul the patient around with a stretcher to the X-Ray rooms and other places. They will go to the loo themselves. Cozy wards may have things like a sofa and TV and their own toilet to quench the needs. It is advisable to look at hospitalized patients at night to see if examinations and more important, treatments are missing and schedule them manually. Mind that disturbing the patient at nighttime will give the '- rough night' penalty. ER wards can also have trauma centers. These act as delivery place for ambulances. They will mostly deliver someone in pain and dripping blood. Your docs must stabilize them and then send them to the correct facility to have them cured. What kind of patients you get and how many depends on the number of ambulances and opened special departments. A trauma center can also act as a wild card ward room as many more sophisticated treatments can be done here as well as alcohol therapy for methanol poisoning. Patients can also intubated here like in an ICU.

Opening a special department gives you more options and will split the number of patients you have a bit between departments. Each department covers certain diseases and will need some special equipment on top of that. But the payment is usually better. Hospitalization needs regular ward and HDUs as well as on call rooms and nurse's rooms. The number of regular wards versus HDUs will vary on the department as some diseases are more dangerous than others and patients more likely to collapse. Having a lounge will make patients happy as long as you also have a gift shop. You will get some extra money out of it even.

Orthopedy
This covers broken bones mostly. Payment is fair and risk is rather low. ER cases might come with complicated bone fractures accompanied by hypovolemic shocks or haemorrhaging wounds but most stuff is harmless. Many patients can be put into regular ward which sport simple beds without gadgets and bric-brac. They are cheap. However, if you have surgeries, you will need HDUs. Surgeries are most profitable but will have their patients come mostly from HDUs and place them there after surgery. To save space, you can send treated patients back to ER observation room. A stable money maker. Best buddies are X-Ray room and CT. Sometimes a MRI can be helpful to decide between two possible final diagnoses.

Inner medicine
This covers poisoning and infections mostly as well as some dangerous symptoms like pleural efflusions (water in the lung) that needs to be covered in the HDU or special procedured room unique to inner medicine. Unlike an operating room, only one doctor will work on a patient and not a full team of 5. Inner medicine can save money in terms of expensive special rooms and wages but beware that you will need more HDUs than in orthopedy and your patients are more likely to collapse so you might need a big ICU as well.
Positive factor: many treatments can be done in the ward and no operating room is needed. Expect transfusions here and oxygen therapies astreatment. Currently, there is a bug that prevents inner medicine to administer cold wraps (not possible currently)

Intensive Care Unit
A special department used to park critical patients. Best chances of survival there and many complicated treatments can be done here as IV processes. As the patient usually goes to another department to finish his treatment, this will most likely not generate money but is to be subsidized by other departments. Number of beds required depends on critical cases to be likely. Orthopedy might need only few for patients with bad blood losses and cardio will need them regularly. Keep in mind that this department should grow with the number of ambulances you have as they usually deliver patients with danerous symptoms and expect more than one to collapse. I have 9 of those beds and this is not enough to handle 6 ambulances. Without them, expect to have low prestige and a need for...

Pathology department
A unit that only wotks when someone dies. Cheap to upkeep as one doc and one nurse is enough. An autopsy generates money. After obduction, you will get some cash. I got 1300$ for it and it will reveal all yet hidden symptoms and tell you, which one of it killed the patient. Send the patient home for funeral. I observed, that in the cold room the body fridges are pure decoration. Patients are stored on the morgue tables, which is odd. Should be that one fridge could hold 3 corpses. The morgue tables need room around them to work.
IUf you have a bigger patient intake it will be normal that patients die despite your best efforts. Good anesthesists help only so much and having units like cardio medicine will lead to dead ones almost automatically.

I have yet to test out the missing 3 departments and I think I will take general surgery next.
Other things to know:
- always have a boss. Janitors need the manager in his office (paid hospital services DLC needed). This makes personal neutral, otherwise they get (- unattended) penalty or even a (+ good boss) bonus.
- use common rooms for your workforce to relax. Proper meals make them happy so do not forget the fridge or use the canteen.
- Study rooms will help your personal to get skill more quickly. It will not level them, but also might remove bad perks. Worked with gluttony and alcoholic until now. It is always a good idea to hire some spare personal and train it to have them available later or to remove bad traits.
- Labs can be staffed with more than one person. Per person you need a pc on a desk with a chair. I have 4 tech blood labs and they can cope with the workload quite well. I have one of them locked for the role hospitalized patients so he will leave the lab to collect samples in the wards. The others should concentrate on waiting room patients as they are not keen on waiting.

I might share more, if I find out something of interest or you ask here. Maybe I have found out something that might answer your questions.

i agree on placing the most seasoned doctors in the offices. The locations that are the most diagnostically-intensive really need these folks rather than interns. Since they (devs) have decided to end the ability to assign interns to depts/floors/wards I have effectively ended hiring any of them (certainly not sending them to my offices ) I let my residents progress through the floors then to either ICU or trauma (my elite depts) and then to medical offices. Then a select few of these become dept chiefs. I would say this too: keep your rad and lab offices close to your ER doctor offices, and have the area well saturated with common rooms, bathrooms and places to get a drink/food.

I partially agree on placing veteran doctors in the offices. I also like them in the trauma center as stabilizing a patient as quick as possible and diagnosing him with the least usage of rooms is crucial. Interns do not cost big money and this is crucial for ER rooms as payment is bad. And it is the room with the observed highest learning curve. Interns raise through the ranks quickly. Another thing is payment of staff. Hiring a specialist is expensive as they want around 500-600$ per day while an intern is about 150$ per day. Now the thing: an intern that was raised to specialist in your hospital is cheaper in the long run as on each level they do not ask much money. When they get specialist, they cost me about 400$ apiece. If they have the 'loyal' perk, they even are cheaper. You could also hire them as spare and train them to fill out places open later. The earlier you hire someone with loyal perk, the greater the benefit. This requires a little planning but the chief doctor of my inner medicine was hand-picked (good intern by insurance event and had good boss and loyal already) and trained by me and got his inner medicine specs high rather quick.
Training a staff member costs 800$ per run and raises a skill by 7-8%. The doc is unavailable during training, but will interrupt it to fulfill needs. If you have a really needy guy, the learning curve will be flatter as he spends more time in relaxing and eating, but as told above, some bad traits can be removed by training.

P.S.: 'Depressions' and 'unpleasant' are another negative traits that can be removed in a study room

Nice tips, perhaps you could throw them in a guide on Steam?
A lot of people would find this helpful

When ready, then maybe. I would like more life here in the forum. Steam discussion boards are a mess.

DocDesastro wrote:I partially agree on placing veteran doctors in the offices. I also like them in the trauma center as stabilizing a patient as quick as possible and diagnosing him with the least usage of rooms is crucial. Interns do not cost big money and this is crucial for ER rooms as payment is bad. And it is the room with the observed highest learning curve. Interns raise through the ranks quickly. Another thing is payment of staff. Hiring a specialist is expensive as they want around 500-600$ per day while an intern is about 150$ per day. Now the thing: an intern that was raised to specialist in your hospital is cheaper in the long run as on each level they do not ask much money. When they get specialist, they cost me about 400$ apiece. If they have the 'loyal' perk, they even are cheaper. You could also hire them as spare and train them to fill out places open later. The earlier you hire someone with loyal perk, the greater the benefit. This requires a little planning but the chief doctor of my inner medicine was hand-picked (good intern by insurance event and had good boss and loyal already) and trained by me and got his inner medicine specs high rather quick.
Training a staff member costs 800$ per run and raises a skill by 7-8%. The doc is unavailable during training, but will interrupt it to fulfill needs. If you have a really needy guy, the learning curve will be flatter as he spends more time in relaxing and eating, but as told above, some bad traits can be removed by training.

P.S.: 'Depressions' and 'unpleasant' are another negative traits that can be removed in a study room

within reason I don't pay all that much attention to salary, in fact, since the game is producing more opportunities for revenue than expenditures (especially with the new DLC) I upped the factors for salary by say 10-13% per level in my hospital just to keep things challenging and the revenue margins a bit tighter.

Here for another experience:

First: the balance of the hospital is fickle. If you open up another department this will lead to patients distributed almost evenly amongst them so in case of wards be prepared to build lots of them. I had the experience that a hospital that is very profitable with inner medicine and orthopedy will meet a real financial challenge when opening up a 3rd spec as general surgery. In that case you might have too much personal in your other stations and built not enough beds yet to cope with a flood of difficult patients as general surgery attracts mostly cases with damage to inner organs that need emergency surgery.
Same with clinics. If you played long with a big ER, then you could see patients wandering to other departments and your ER doctors without work so you might put them into TC instead.

I blame the patients per insurance and the 3 insurance limit. We should get rid of it in favor of unlocking further insurances up to 6. I do not think we need them at once, but changing insurance gives you a hit to handle and expanding hurts you as well, as you now have more docs but no new patients or even less. The ambulances are your long-term rainmakers as they deliver cases with high price-tags on them. In sandbox-mode we use the 'soft cheat' events to spawn more patients although this can be risky. I have seen more than once that a patient is stuck at a lab and then the clock runs down for $ penalty and prestige hit. This is even more annoying if I have identified the disease but the doc think, well, lets take a blood draw just to be really sure. I cannot even stop the analysis.

Second: Keep an eye on your ICU! The more ambulances you buy, the more critical cases you will get and it gets worse if you unlock departments with dangerous symptoms like cardio or general surgery. If a patient is critical and without ICU bed, he will be removed from your hospital and you get nothing for him. I think 2 beds per ambulance are a good average and you might want to have more just to be sure. Remember to hire another ICU doc, especially one with anesthetist skill unlocked as patients survive resuscitation better if treated by one of those. If someone is critical, a free doctor from the nearest vicinity will dispatch and try to stabilize them - in my case pathology as it is the next one to ICU. Well, if it does not work, he can take the patient away into his department at least...
But for regular treatment in IC a dedicated person is better. Also, you will need enough nurses to haul the patients and as far as I observed, the nurse will be dispatched from the department the patient is going to. So ICU nurses fetch critical patients, orthopedy nurses fetch patients destined for orthopedy and so on. Having many ER nurses will not help getting them elsewhere. More nurses in a department helps treatments and diagnoses within the department.

Third: Not every department has the same demands for wards and special rooms. Take orthopedy for example. It is a good department to start specializing since money is your limiting factor. This does not mean, it is cheap, but there are other dependencies to keep in mind. Orthopedy mostly brings in patients with broken bones or contusions, mostly at the upper and lower extremities. This will mean, that you will most likely have many patients waiting for an X-Ray and one room can prove to be not enough so you will need more than one which can prove very shaky for your fledgling hospital's finances. For more complicated cases a CT should be built ASAP and this is also useful in other branches. The hospitalization unit offers you to build a sonography unit, but in my experience this is not used often. Maybe, if the player controls the docs, you might get more out of it. I cannot remember an injury, where sonography is essential and where you cannot get along with a CT or X-Ray currently. I might be wrong, however, but this room has a low to medium workload and you will only need one of them. Once you have ambulances you should keep ramping up your HDU and surgery theater capabilities. You will get many cases that way that first need a surgery and second are somewhat unstable and tend to collapse. 'Complicated fracture of...' would mean blood transfusions, antihaemorrhagics and possibly collapsing patient incidents for which you need ICU beds available. And boy, those things smart in the wallet. Modern bed+life support+ventilation+sensors can put a single bed way over 10.000$ - and you will need them.
As a rule of thumb: if it is a contusion or simple fracture, put the patient into regular ward and use the diagnosis units to cure them. If it is more complicated like hip replacement, dislocated shoulder, then you need surgery and most likely HDUs. Most patients visiting your doctor's room in orthopedy clinic will either leave after treatment or go regular to get their arms and legs cast. Most people coming with the ambulance would need the HDU. Keep in mind, that you could use orthopedy HDU rooms to hospitalize patients from overcrowded sections of your hospital and enable certain treatments. E.g.: some poor guy has methanol poisoning and needs ethanol therapy ASAP, but no inner medicine HDU is free. Send him to orthopedy instead. He can have his bag of booze IV there as well.

General surgery almost exclusively uses HDU hospitalizing. Life-threatening cases with dangerous symptoms hard to find are here and many patients will also visit ICU. So get a grip for the number of beds required.
Also keep in mind, that for patients in bed you need nurses to haul them around. If a patient is transferred to another department, the receiving department will dispatch the nurse, so you can encounter bottlenecks where you cannot get your hands laid on. Having 1-2 Nurses exclusively for stretcher duty is advisable. A good nurse team is in my book:
- 2 surgery spec nurses (without, no surgery possible). Disable all other jobs, if you want a dedicated team in the surgery theater.
- 2 special care nurses to service the beds and sometimes they reveal symptoms
- 2 generic nurses on level one with stretcher duty exclusively

Complementary, you might add:
1-2 Doctors with orthopedy spec for manning the diagnosis units (disable assist at surgery) per shift
1 Doctor with surgery spec per shift (no other jobs)
1 doctor with orthopedy spec (assist at surgery only)
1 Anesthetist (this job only)

You might add another surgery team of 3 docs and 2 nurses, if you build another surgery theater and get in more cases that need surgery.

Paid DLC Hospital Services addendum: You might want to reserve space for a lounge. Lounges make patients happy, if they get visited AND a gift, so build a gift shop as well. This can help you raise the prestige of your hospital and this will attract more patients and pays off better as the insurances pay around +10% bonus.

This is all for the time being. Next I will talk about inner medicine and the experiences I made there.

Having the 100th day ingame some more things, I found out.

- Differential diagnosis might help after you have done some diagnoses and still got several possible diseases shown. It will sometimes remove wrong ones, so this is a very good skill for clinical doctors and at some point as well for doctors serving in TC.
- You can have a single trauma center with several beds at once. There is no need to assign every room to a single bed although this might look stupid, if putting all into one.
- Pathfinding is odd - very odd. I built a second building next to my first one and what happened? Now everyone and his little brother comes from building A to visit the toilets on building B. Which leads to:
- Toilets are the worst thing to build. You need for each person visiting it the following things at once: toilet, sink and hand dryer. I tried to build 'realistic' toilets with a 2 toilets, 2 sinks and a hand dryer only to have people complaining that they could not wash hands, because hand dryers do not queue people. What works is a really big toilet on each floor like 10 toilets + sinks and hand dryer mounted above them. This keeps people from running errand.
- The longer you play the more lucrative your diseases to cure seem to become. Even in ER clinic I had some diseases worth 1000$ although I just think, that the ER doctor has successfully realized this is a disease of another department and he just has enough info and treatments to cure it.
- Neurology can be very lucrative. The things I treated this far are infections of the eyes or minor eye injuries as well as bacteriologic or autoimmune diseases affecting the nerves. I have yet operations to do.
- Your administration department counts towards the 9 departments to open for getting Overcure patients. My current hospital sports all departments but cardiology.

Diagnosing diseases
When controlling a doctor, which is a very fun thing to do or auto-control all patients of a unit you are presented with the problem that you can pick out of many, many diagnosis tools. Keep in mind, that some are more general than others and some others cause discomfort, so torturing your patients with needles and probes will lead to them being disgruntled and giving you bad rates.
Playing in doctor mode and especially in specialist mode where you do not see the number of symptoms and how many are dangerous, you need to be efficient and careful at the same time.
A good thing to start is to do the interview first, if the patient was not triaged at the reception. Some patients can give you already a good hint at what you might encounter. There are some patient traits that give you more information and others that will hamper progress. Shy or tourist are such traits. After interviewing the patient you might reveal some obvious symptoms that might lead you to other consecutive diagnoses. Body examination is the best second pick as it will reveal many symptoms at once like wounds, bruises, coughing patient and what not. Depending on what you find and to a certain extent on the diagnosis skill (I have the feeling, that sometimes the docs miss a symptom although the test was the right one - devs, please explain whether this is possible). Also keep in mind that having a certain department will unlock cases native to those. If you only have ER you will never get a meningitis. If you have a neurology running, you might have to take this diagnose into account as well.
Let us get practical:
A patient comes in and the interview or body examination reveals coughing. This mostly has something to do with problems in the respiratory system i.e. an infected lung, larynx or nose. If you have inner medicine open, this might have more serious causes like a pneumothorax which can be lethal. If the hidden symbol pulsates this is a good indication of something grave at work. Then you should do stuff like ECG and chest X-Ray or MRI ASAP to reveal and stop the possible life-threatening symptoms.
If not, you try to find out a kind of infectious disease like the common cold, influenza or tonsilitis. The next good advices would be to do an chest ausculation or check oral and nasal cavities next or take the temperature. There are some harder nuts to crack that might need additional rooms to diagnose. An X-Ray unit can reveal anomalies in the lung via chest X-ray an a microbiological lab can reveal presence of bacteria and virus. These procedures can take a lot of time, especially the lab tests and you might lose cases from leaving patients. A good counter-strategy would be hospitalizing the patient, which needs a working TC unit. Hospitalized patients are immobile and you will need nurses for hauling them to X-ray. I have yet to make observations who does e.g. blood draws on a hospitalized patient. I had a dedicated lab only for hospitalized patients, but for 3 days not a single patient showed up and the techs were playing solitaire all the time. Not working as intended.