he game is mainly a management simulator. You can treat patients your self, but you can only follow 12 patients. The purpose is to get the automatic treatment of patients so efficient posible.

You earn money by healing patients. This means you get paid by treatment and not by Examination. So ordering a lot of examinations will not mean that you earn more money. Its just a waist of staff and resources.

Your patients and staff will have needs. Most common needs are Toilets, food, drink , not being bored etc. The more you meet the needs of your patients and staff the more prestige you will get.

Prestige is very important in this game. With a good prestige you will earn 20% more. You will need this profit. Prestige depends on various things. Most important is the happyness of patients and staff. However the number of non-treated patients seems to have only litle influence on prestige. We will talk about prestige further on in this guide.

The guide takes you through a sandbox game. I always take an empty field 96x96 without Freebuilding; without unlocking all departments and with "Patients can die"

You can adapt the game to your own preferences. A lot can be changed during the game. But there are also things that can't be changed (or I didn't find it) once you have started your game.

So did I change the names of the insurance companies. However I made a typo in it. In the saved game it didn't correted it. With a new game it had the correct name. So if you want this kind of changes. Do it before you start a new game.

Be aware that the developers inserted some limits to the game to make it also run on low end computers. It's very easy to remove those limits. Look for the tweakables.xml file. It will be in the
steam\steamapps\common\project hospital\ProjectHospital_Data\StreamingAssets\Database.

Make sure you save a copy of the original Twakables.xml file. Right-klik on the Tweakables.xml file and choose "Edit". You can change a lot here. Everything you change here has also effect on saved games. Be aware that with an update this file can be overwritten. So remember what you have changed. I recommend the following changes:

- change ID="TWEAKABLE_EMPLOYEE_LIMIT_EXTENDED"> <Value> from 250 to 400.
This will change the maximum number of employees to 400. You will not need them all. But it can't hurt to have set it to the maximum number.
- change ID="TWEAKABLE_MAX_INSURANCE_COMPANIES"> <Value> from 3 to 5. Normaly you can only contract 3 insurance companies. When set to 5 you can contract all in-game insurance companies. You don't have to, but now you have a choice. Be aware that the more insurance companies you contract the more difficult the game will be. However you can always end an insurrance contract.
- change <GameDBTweakableInt ID="TWEAKABLE_MAX_FLOORS"> <Value> from 4 to 9. With this you can build 9 floors high instead of 4.

With the new patch (1.1) there are more shared rooms :
- The Laboratries are placed in a seperate department, just as Radiology already was. So you don't need to build a laboratrie for every department. However you now have three seperate laboratries.
- Common rooms. So staff will rest in the nearest staffroom. Even if its not from their own department.
- Restrooms were already shared between departments

Cleaning closets are not shared. However when a janitor is ready with his department, he will help the other departments (see the chapter about cleaning).

Let's take a quick look at the UI. For this I started a new sandbox game with an 96x96 field :

In your top left corner you have your Game modes. With these butons you can switch between the different game modes. The first one is called "Game Mode" in this mode you play the actual game and you can pass the time.

The second one is the building mode. This one should be clear.

The third game mode is the management mode. In this mode you can asign rooms to departments. and you can hire and fire staff. In this stage of the game the most important of this game mode is that you can plan your building with it. This we will handle in the next chapter.

Below your game modes butons you have your Event butons. With these butons you can manualy start events. In game you have two kind of events. The ones you can manualy start, and the random events wich some times randomly happen during the game. By the way , you can decline random events when they show up. With event you can earn great money and prestige.

Below the event butons, you have your insurance objectives. When you forfill an insurance objective you get a reward. There are various kind of rewards. Most common are the one where you get money and more patients. Always keep track of the insurance objectives.

In the left botom corner you will find your department butons. With these butons you can switch between the various departments. This is important in the building mode and the management mode. At the moment the butons are greyed out. This means that no department is open yet. When you have build the obligated rooms and hired enough staff the department will open and the buton will get a color.

Below the department butons, you will find some statistics butons. Just look at them. At the right of them you see various information :
- Your money
- how many patients you have treated this day.
- How many patients left the hospital untreated today
- How many patients you can expect today
- The number of staff you hired / the maximum number of staff you can hire.
- Your prestige. The higher your prestige, the more patients you get. If your prestige is at 23:59 higher as 89% (4.5 stars) you get 20% more money for each treatment the next day. So prestige is very important. Later on more about prestige.

With the butons at the right of prestige you can view the above or below the curent one.

In the top right corner you have your ingame help. (very usefull) and your game settings.

Now it's time to start building.

I start with making a building plan for the ground floor. For this I go to management mode (thirth buton in the top left corner. With the department butons (botom left corner) I choose the department I want to plan the rooms. Don't let your self fooled by the greyed out butons. You can plan all the clinical rooms already. In future my ground floor of the hospital will look like this :


A few remarks about this. This plan is for a big hospital. That will mean that all insurance companies will be active (in future). This hospital will treat about 160 patients a day. I prefer to have all my clinics on the ground floor. This is a personal preference. There are no realy big disadvantages in doing differently.

If you switch between departments you will see different parts light up.

This planning mode has one big disadvantage. You can't plan for locked departments. In this case I couldn't plan for the hospitalization part of the Emergency department (see right side of the picture). I solved this by planning it by using the corridor room button. Thats why you see a lot of planned corridors in the south - east part of the picture. Please note that planned rooms aren't visual in the game mode. So don't be upset when you load the saved game and miss your planned rooms. Just switch the game mode into bulding- or management mode.

I like to have my doctor's office big. How ever its posible to have the equipment in a smaller room. Again this is a personal preference. In this case bigger ain't better.

You will see that my ellevators are planned partly in the coridors. This is because the first section of an elevator isn't realy build. By doing this the elevator is build in continue of the walls.

I don't plan long corridors. I split them up. This is because only one janitor works at the same time at one room/ corridor. With shift changes your corridors will get very dirty. Dirty floors means a penilty on your prestige. Lower prestige means less money. So I want as many janitors work on the corridors as posible after a shift change.

Please note that I didn't touched my parking. This is meant for your ambulances. You need to place the ambulances on this spot. Futher more you can't destroy the total parking. So leave it alone. Otherwise you will get in trouble.

Look at the road at the botum and you will see some the yellow squares. This is where the ambulances will stop to unload patients. You will want your emergency hospitalization department close to that spot. Don't worry about that too much at the moment, just keep space there for your Emergency hospitalization department.

Please take a look at the left side of the picture (The emergency clinic information pannel). Behind the different rooms you will see a zero in red or green. A green zero means that you have 0 of that particulair rooms, but that room is not neccesary to open that specific department.

So to open the Emergency department, I need to build :
- a waiting room
- a rest room
- a doctors office

Futher more I need to hire one doctor.

So let's realy build something.

I start building somewhere in the middle of the field. I always use the big map, so I don't have to worry about space. First I build some foundations.

After that I build the required rooms. (see above). As extra I build a cleaning closet and a common room. I do this to forfill the needs of the staff and patients so that I will get a higher prestige. For the same reason I already decorated my rooms.

In the doctors ofice I place a watercooler. This will avoid that the doctor will leave the room to take a drink. This will save time for the doctor and within the saved time he treat more patients.

Asign every space within your building, even coridors to the emergency department. Not asigning coridors to a department will cause that they will not be cleaned as much as you want. (read more about it in the chapter about cleaning)

Connect the entrence to your building with the pavement of the road.

Please note that I like to build big. It's not neccesairy to build this big. It's only a personal preference.

Hire a doctors. and start playing. I immediately hire also a doctor for the night shift. This to prevent patients leaving your clinic at 20:00 hours.



Keep in mind that the game uses a simple path finding system. For example if someone needs to go to a restroom it goes to the closest free toilet measured in a straight line. This isn't always the closest in walking distant. Another example. Some one is thirsty. There is one watercooler in the same room. Another watercooler is in the next room behind the wall. If the watercooler in the other room is the cosest one in a straight line , the person would leave the room to go to the other room even if it passes the other watercool on its way.

When playing it is important to keep track of your insurrance opjectives. So lets take a look at those. Klick the small button with the umbrella on your left bottum corner.


You will see that only one insurrance company is unlocked. To unlock another one, we need to treat 3 patients. That ain't difficult. When this insurrance company is active , we will get 10 extra patients a day.

After treating one patient we will get a reward of 20.000 dollar. Great time to start playing.

So close the insurance window and start the time. It takes a litle while, but soon the first patient will show up. Doctors are capable to do everything them selves. When they need help , you will get a message on your screen. However it's more fun to help the doctor. A mayor advantage of this is that it will cost you less capacity.

My second patient gives my doctor some trouble. So I click on the patient to view the patient card :



At the top of the card you can see the needs of the patient valued with stars. The more stars the better. You can hoover with your mouse over the stars to get more info. The most important are the bottum two criteria. Discomfort and Satisfaction.

With the buton above the text "controlled by doctors" you place the patient under your own controll. You will be making every treatment and diagnostic decisions for patients who you have placed under your controll (there are some exeptions for it, but that will follow later). Unfortunately you can only have 12 patients under your controll at the same time. Ofcourse you can switch between patients.

On the card you can see that there are 5 posible diagnoses. In this case I want more info on those.So I click on the detail buton to get some more info.

Every Illnes has some posible Symptoms. Every symptom has a certain chance to show up. However every illness has at least one symptom that is always there. Hoover with your mouse over the posible symptoms to find them. When you hoover over the posible symptoms you will get a discription of the symptom. You also get information on how to detect this symptom.

In the examination part of the patient card you see the Available examinations. Some are greyed out and you can't do those. Hoover with the mouse over over the examninations to see the reason for it.

The game doesn't send you patients with illnesses who belong to a department you didn't open yet. So I can exclude those illnesses. Now I have to choose between two posible diagnoses. Just before I took this screenshot I did an skin allergy test. No current symptom showed up. There could be two reasons for that. My doctor did the test wrong or the patient don't have this symptom. I think that with the Diagnoses "Contact dermatis" there would be an allergic reaction. As the test shows no reaction, I exclude this Illness. Now I have only one posible diagnoses. So I choose Athlete's foot. After that I order the treatment to cure the patient.

After treating three patients I get an message that I can contract another insurance company. I do that in the insurance window and get another 10 patients a day.

I also hire another doctor for the day-shift.

After the first day I hire a janitor.

Keep in mind that at the night shift you will get far less clinical patients as with the day shift. So you can hire much less doctors for the night shift.

With the former insurrance objectives I advised people to open first all clinical departments. With the new insurrance objectives it's totally different. Just open one other clinical department. It's not very clear, but you can open other cleanical departments. Just build a doctors office and a waiting room for that department. As you need to open only one specilised clinical department to get another 10 patients, for now only open one specialised department. It will make your live easier later on.

Hiring the right staff is a bit of a pain in the ass. With the new patch it became better, but its still annoying. To hire staff selctgo to the management mode (short-cut F7 for PC). Select the right department. And click on a free workspace. You will get a screen like this :



In the picture is an explanation. Hoover in game over the the screen for extra explanation. If you klick on a specialisation you will only get candidates with that specialisation. In the clinic you will want at least one doctor with advanced diagnostics. However this is a level 4 skilled doctor so they are expensive. With the EMS you problably want also some cheaper doctors.

The higher a doctor is skilled the quicker the doctor works and the less mistakes he/she/it makes. remember you can asign another doctor to a patient on its patient card. A staff member will gain experience with each treatment. So in time a low level doctor will level up. With gaining experience the cost of that employee will rise. However it will cost you less as when hou hire a high level doctor immediately.

The higher a doctor is skilled the more treatments and examinations a doctor can do/order.

A staffmember can have positive skills and negative skills. For $ 1000 you can see all hidden perks of the batch of candidates. In my opinion its worth it.


On the staff card you can select the allowed roles for your staff. Standaard all roles the staff member is capable of are active. You will want to change that. For example : Surgeries are a real money maker. So you want your surgecal teams to do as many surgeries as posible. So only allow your surgery teams to do surgeries.

A surgery team excists of one surgeon ; One Anestheolist; one asistent ; one surgecial nurs and one clinical care nurse. For some reason you can't set a clinical care nurse to do only surgeries.

Be aware that you need to have a thirth nurse for surgeries. This nurse transports the patient to the operation room. I love low skilled nurses. I limit their roles to patient transport. When you don't have enough nurses for transporting patients it can lock your hospitalization department. One time a doctor was locked for hours. This doctor was reserved to do a procedure, but I had too few nurses with the transport role active.

You can set your scientist staff to trat only clinical patients of only hospitalized patients. Standaard they treat both. With this you can manage the patient flow within your hospital. Remember when you also treat clinical patiets you need a waiting room nearby. When you only treat hospitalized patients, you don't need a waiting room.

After the start just follow the insurance objectives. Start with the first three insurrance companies. The last two insurrance companies are for the end game.

At the start you can open all clinical departments. Don't do that. At that time you don't have enough patients for that. For now just open just one extra clinical department. The rest can follow later when you have enough patients to finance those.

I started with the General surgery clinic. I even build a Sonography unit. However this unit seems to be used very litle. For the clinic it seems a waste of money at the start of the game.

Again stick to your insurrance objectives. Get as many patients as posible. Practice with diagnoses, you will need it in future. At the beginning it will be a bit dificult, but you will learn it quickly. The more patients you have, the more dificult it will be. Also the more departments you open , more dificult it will become. So don't make the mistake to proceed too fast. Just go slow and steady.

Every time you get more patients, you need to fine tune your hospital. Check the capacity of every department regulairy. Also keep track of your prestige (see seperate chapter).

I started with the Emergemcy hospitalization. I expected patients to colapse now. This didn't happen yet. As I treat all my patients manually there was litle use for the emergency hospitalization department. So I used it as an extra doctors office, for patients with litle symptoms but a high number of posible diagnosis. Luckly I started with a very small Emergency Hospitalization department.

If you let the doctors control your patients they will start sending patiets to your observation room.

After the emergency hospitalization I was in doubt. Would I first build a small Intensive care Unit ? or would I first build my general surgery hospitalization department ? Or save enough to build them at the same time.

Not building the IC first would mean that if an diagnosed patients collapses it would be transported to another hospital. But having it first would not generate any money. Building it at the same time will cost a lot of money and takes a while saving it.

I decided to stick with my own advise and follow the insurrance objectives. Which says to open hospitalization at any specialised department. An IC unit only accepts diagnosed patients. Patients who are not diagnosed and collaps are taken to the trauma room. So if a diagnosed patient collapses at a hospitalization department , I could always remove the diagnoses to prevent the patient to be transported to another hospital.

At some point you will want to let the doctors take controll of your patients. It just takes too long to do everything your self. This will impact your capacity. Doctors who act on there self order much more examinations at the labs and radiology. So keep track at your capacity at those departments. If neccesairy hire more staff or build more radiology rooms.

At the same time you should track your capacity at your specialised hospitalization departments. Check if you have enough rooms for your patients and that you have enough diagnostic units.


By now I have a serious problem, I have one specialised Hospitalization department open, I have 6 regulair rooms and 4 HDU rooms. I have one surgical team (at day) and litle money, According to my insurrance overview, I will get 10 patients brought in by ambulance a day. For this I need to find room in my Hospitalization department, So I have to increase the capacity, However when I open another hospitalization department a part of those patients will be for that department. So even if I had the money, I would create an overcapacity. Luckely the regulair rooms and ADU rooms are the same between every hospitalization department. Parts of the extra diagnostics units can also be used. However I suspect that I will have to fire some staff in time.

I also I suspect I Need to increase the capacity of my Hospitalization emergency department. Trauma rooms are very expensive.

I could have prevented this by going slower and buying less ambulances. Every ambulance has a standaard maximum capacity of 3 calls a day. At the moment I have 3 ambulances. Good for nine calls. I don't have the money to raise the capacity for nine ambulance patients.

I was thinking of selling one ambulance and with the money I have left I wanted to raise the capacity of my specialized hospitalization department. I Expect that my reputation would get a hit over this.

In the end I took a total other route. Iplayed the day and treated 60 patients, which gave me a grant of $ 50.000. More as 30 patients were treated on the emergency department. So that objective was also met. The next objective of the 2nd insurance company was: " reach a prestige of 90% at the emergency department", for a grant of $ 100.000,00. Despite that my prestige on the other departments were bad. I met this objective for the emergency department. So I had $ 150.000 money extra which solved my money problems partly.

After that I disabled the acceptance of the first insurrance company. This costs me 30 patients a day. 5 of them would be brought in by ambulance. However with the met objective of the 2 nd insurrance company I gained 10 patients. With the money I bought two extra ambulances. and unlocked the 4th insurrance company for another 10 patients (with much better pay as the first insurrance company). With the rest of the money I increased the capacity of my General surgery hospitalization department and bought one extra traumaroom.

Now it became fun and hard work. With the 2nd objective of the 4 th insurrance company you unlock the event butons. With this you are almost home free . To do this I had to succesfully finisch a random event. (see next chapter).

Doctors round
Between 9 and 11 AM your doctors will make a round on your hospitalization departments. During these round the doctors will order examinations for your hospitalized patients. Even if these are under players controll and even if there are no hidden symptooms. I advise you to check on your patients around this time and cancel the useless examinations.

In this game you have two big moneymakers. The first one are surgeries. The second is finisching events succesfully.

You have two kind of events :
- Random Events (who come up randomly. You can decline those).
- Events started with the event-butons

The random events seem to appear after you unlock the 4th insurrance company.

To unlock the 4th insurrance company you have to buy 5 ambulances. This is harder as it sounds. A single ambulance costs $ 35.000, so you need to invest $175.000 in ambulances. But that ain't all. To unlock the ambulances , you have to unlock the ICU department. To unlock the ICU department you need to unlock Hospitalization at a specialised department. To unlock Hospitalization you must have treated one patient at a specialised clinical department. And don't forget that you don't have a use for ambulances without a working emergency hospitalization department.

So to unlock the 4th insurrance company takes a while.

The money
As already written, with events you can earn great money. For starters with the treatment of the desease you seem to earn more as with your own insurrance companies. For succesfully finishing an event you earn an extra $ 5.000. If you succesfully finisch two events in a row you earn an extra $ 10.000 instead of $ 5.000. With 3 in a row $ 15.000 etc. However if you fail the event you get a penelty of $ 5.000.

To do an event takes some planning. Check first your capacity. If you don't have the capacity you can better disable an insurrance company. Some events needs mainly capacity of you clinic (Epidemic). The other needs mainly capacity of your Hospitalization department (crash). The thirth one needs capacity of your clinic and hospitalization departments.

Besides a bit of planning you will need some luck. Sometimes you get too many surgery patients or multiple patients with very few shown symptoms. In such a case you might fail the event no mater what you do.

I started events with only one specialised clinical department and one specialised hospitalization department. That is an advantage. The game will not send you patients for departments you didn't open yet. So diagnoses are easier.

With the events I financed most of my hospital.

Prestige is very important. If you have a high enough prestige level you will get a 20% bonus payout on your treatments. High prestige means also more patients while a prestige below 90% will get you less patients. Often this means the difference between profit and loss.

You can influence prestige very easy. :
- Take care of the needs of your staff and patients.
- Have enough vending machines and watercoolers.
- Have enough restrooms (with sinks).
- Decorate your hospital for the nice environment bonus.
- Have posters in your waitingrooms to avoid patients to be bored.
- Have a coffee machine, a fridge and a dinnertable in every commonroom
- Don't use the cheap beds with hospitalization , use the modern beds.
- Set a head of department, if posible someone with the good boss perk. You can do this in the management mode.
- Some treatments (like blooddraw) causes discomfort. Try to avoid them.
- Dirty floors causes a large penalty on your prestige. So have enough janitors (see chaper about Cleaning)
- Look regulairy to the needs and satisfaction of your staff and patients

You can hoover with your mouse over the stars to get details.

If your staff is too busy they don't have enough time to forfill all their needs. Your radiology and laboratries don't have their own patients. So the satisfaction of your staff is the only factor for your prestige rating. If your prestige is low, some employees will be too busy to forfill their needs. You can also see this in the management mode. The room will probaply a critical workload. So Hire extra staff (laborotries can be staffed with multiple technisions) or build extra rooms.

As written before dirty floors gives you a severe penalty on your prestige. So you want your cleaning as eficient as posible.

For cleaning you need janitors. To Hire Janitors you will need a cleaning room. The only obligated equipment for a cleaning room is a shelf. For every shelf you can hire one janitor for the day-shift and one janitor for the night shift. It's not obligated, but I recomend to place a bucket cart in the cleaning room for every shelf you have there. Bucket carts makes you janitor more efficient.

Janitors will clean first the department they belong too. After that they will clean other departments. So divide your janitors between your departments.

If a part of your hospital isn't asigned to a department, it will get a very low priority for cleaning. So make sure that all coridors are asigned to a department.

Most dirt will appear during shift changes. At the start of the game you will not notice it yet. Departments close to an entrance will need more janitors as departments who are more secluded.

A room is only cleaned by one janitor at a time. A hallway is seen as a Room. After a shift change you want the janitors to clean the corridors as fast as posible. So don't make your coridors too large. You can better split a large corridor into multiple smaller corridors.

The interest rates of loans are very high. So don't use them if you don't have too. I only used loans while I was litle short of money when finishing a department.

So only take out loans when you are sure that you can pay them back in a few days.

Before building up, you might want to finish your first floor. Adding a new floor is for free. However adapting one costs money. So before going up, give your first floor tiles, windows etc. You can copy these things for free to your next floor.

Cheating is very easy in this game. A lot is adjustable. If you are inteested I recommend you to read :

the guide of Zirkumflex

and

guide of Generi

- Be carefull with loans. Interest rates are very high.

- Take care of your prestige. If high enough you will earn 20% more money while a prestige lower as 90% will cost you patients.

- Avoid dirty floors, it gives you a large penalty on your prestige.

- Decorate your hospital

- Follow the insurrance objectives. But don't go too fast. Go slow but steady.

- If you can unlock the 4th insurrancecompany -> do it. Even if you have to disable other insurrance companies.

- Do events, they are great moneymakers.