Indie Wonderland: Two Point Hospital

A few hours in

So, here on page 2, I’m sure you’re all wondering: What did Jarenth end up doing? Did he move into different levels and different hospitals, tackling the new challenges therein?

A new hospital in a fancy neighbourhood, which may or may not get knocked down in favour of *more hospital*.

Or did he stick with the original hospital, slowly mastering it before finally reaching that vaunted 3-star rating that sets the amateurs apart from the expert hospitaliers?

I know that’s not what that word means, but listen.

The less faithful among you might be surprised to discover that I’ve done both! Several times! Five times, as a matter of fact, over the course of no less than twelve hours — a length of time not unlike going to actual med school, for less than a single day. I found I quite like Two Point Hospital! And since all know that enjoyment is a fungible commodity, I can cut the review here early, and then go play it some more. Those career goals won’t reach themselves.


Okay, okay! No need to get all *frowny* with me.

Interesting bit of symmetry here: In my Molecats review two weeks ago, I mentioned that Molecats ‘just wasn’t for me’: My personal dislike of it was rooted in factors the game had no control over, making me and it a bad fit. Two Point Hospital is sort of the opposite; this game might be too ‘for me’. I was too young when playing (and being impressed by) Theme Hospital to really understand what it was I was doing, how anything worked or what the reasoning behind or impact of my decisions was. Theme Hospital took on almost mythical proportions in the small of my subconscious — and as I’ve mentioned, Two Point Hospital is basically a Theme Hospital remaster, or maybe a reimagining. I can’t help but have fun: I’m essentially retreading the unknown grounds of my childhood here.

If you are not me, and the phrase Theme Hospital doesn’t make your dopamine centers light up, there are two ways of looking at the Two Point Hospital experience: You’re either playing for fun, or you’re playing to win.

Without wishing to spoil, the impact of both is succinctly visualized here.

If you’re playing Two Point Hospital with the intent of having fun, you’ll find it’s a cool, interesting, lighthearted, colourful experience. The cartoonish aesthetic, the goofy writing (both in text and audio), the relaxed pace, and the forgiving mechanics all exude and try to convey this tone: Don’t take Two Point Hospital too seriously, it’s just a goof. Relax. Have some fun with what you’re doing.

Unsurprisingly, that works! Even from the introduction onwards, it’s clear that Two Point Hospital is not going to be a serious hospital simulator. This starts with the ‘diseases’ your patients bring in: Most of them are invisible, only expressed in goofy text descriptions, while the visual ones are flat-out ridiculous. You’ve got people with pans stuck to their domes, people covered in small animals, people who compulsively dress like Freddy Mercury, and you’ve already seen the lightbulb heads. It doesn’t matter how seriously ill anyone is, it’s all played for a laugh. Even death is treated as a hilarious goof, up to and including the vengeful ghosts of former patients being vacuumed up by bored janitors. A lot of Two Point Hospital‘s tone actually leans on its large selection of visual gags and pun disease names, so expect more of those as the game goes by (as opposed to the more mundane ones, like ‘Grout’ or ‘Potty Mouth’).

They’re not all gut-busters, I’ll admit.

The fun-casual representation of illness and death dovetails nicely with the fairly generous, permissive gameplay mechanics. Obviously you’d prefer to cure patients: You get paid, your reputation goes up, your doctors and other patients get happy, you don’t have to hunt any ghosts. But treatment failure and even patient death aren’t honestly that big of a deal. Two Point Hospital mentions that your reputation goes down if you fail, but that doesn’t reflect in the logs — and even if it does, I can tell you from experience that reputation gain from successes massively outweighs reputation loss from failure, at least in cases where you’re sort of trying to do good. And hey, you get your money either way: A patient that paid for a faulty treatment is still a patient that paid.

See what I mean about the reputation? You’d figure reputation losses should also be in here. And I *know for a fact* I failed some patients in this time span.

Every level has three sets of objectives, and those objectives can get tricky later on — but early on, the first two or three hospitals tend to posit objectives you’ll ‘get anyway’, assuming you keep playing. And even the harder ones, like cure rate or staff satisfaction, are always based on a recent running past: Cure rate is calculated based on your 20 most recent patients. So it’s impossible to dig yourself into an insurmountable hole. And while it’s possible to lose money every month (by having high operating expenses and low patient income) and go into red numbers, it’s really hard to not actually get somewhere over time. Even a negative bank balance only seems to mean you can’t expand or hire new staff, and maybe your current staff will get mad about missed payments. I’m not saying things can’t get so bad that you’d rather just restart. But I don’t think Two Point Hospital ever actually makes you.

And this is not to say the moment-to-moment gameplay doesn’t ever get challenging, because boy howdy. Two Point Hospital‘s kindness actually works against you here: The nature of reputation means that curing patients increases your reputation, which draws more patients into your hospital, which means you’ll probably cure more, which increases your reputation… over and over in a positive feedback loop, until the number of patients in your hospital taxes your staff and facilities to the breaking point. Remember how I mentioned that every patient must see a GP at every other step of their diagnosis process? Now imagine diagnosis processes that take three or four rooms, and all of the dozens of patients in your hospital go through those steps.

The game gives visual indicators whenever the queue outside a certain room reaches six people or more. It will tell you this *a lot* for GP’s Offices. It doesn’t matter as much as you’d think how many offices you have.

You can’t really control your staff’s day-to-day activities beyond ‘rostering’ them, allowing or disallowing certain activities for certain people on a case-by-case basis, and you can’t really influence the flow of diagnosis and treatment directly. But you can build more. Make sure you have the right facilities, and the right number of those facilities, to keep everything moving smoothly. Have enough food and drink machines, and enough benches, and enough temperature regulators of choice. New diseases show up over time, based on the hospital you’re in and the star level you’re playing at, often requiring new facilities and doctors/nurses with particular skills. You might want to train your existing staff, too, and schedule research into new treatment options, and design marketing campaigns, and buy new plots to expand even further…

It’s fun, in a controlled-chaos way, to constantly balance and adjust to this constantly-shifting set of demands and requirements and options. It’s systems optimization on quicksand. And that’s before you throw the occasional random encounter into the mix: Maybe your staff have requests, or the mayor wants to visit. Or, commonly, you’ll get a request to deal with a certain epidemic outbreak. You can really feel the gears turning in your mind whenever those popups show up. Hmm, this epidemic has six patients who require pharmacy access. But I only have the one right now. Maybe I should build one more? And maybe make sure that only the good nurses can work in there for the time being. Or maybe just wing it? Or decline the opportunity? That reward is a lot of money.

My four patients in *dire* need of psychiatry assistance are being chased across the hallways by a ghost. This is probably fine.

Oh, and if you start thinking you’re doing well and getting full of yourself, don’t worry! Two Point Hospital is more than happy to show you your friends’ statistics at a moment’s notice.

Damn you, Muse! Again with this!

It’s just fun to expand, and build your hospital. It’s very free-form, too. Rooms can be of any size and shape over the minimum size (generally a 3×3 or 4×4 square). And you can add tons of items to that room, assuming you hit the mandatory ones. Or put them in the hallways! Your building options start a little limited, but grow steadily over time. You can earn new rooms and items by progressing through levels and earning stars, or you can unlock them with ‘Kudosh’, a special currency you get from completing levels and career milestones. Mix and match, make what you want! Put bins in the bathroom, make a row of plants to guide patient movement, put the super-salty snack machine and the pricey drinks machine on opposite ends of the ward. Obviously, all items have effects and there are cost-benefit considerations you could be making, but you do always have the freedom to just do whatever you want. Live your best life, go wild.

As you can see, I blended a few rooms together here, for no other reason than that I wanted to blend some rooms together.

Probably my biggest piece of criticism when it comes to ‘casual’ play like this is the way Two Point Hospital paces stars and levels. Six levels in, it’s obvious that one design intent was to slowly introduce new concepts. So the second level teaches you about psychiatry and new rooms, the third level teaches you about staff training, and so on, and so forth. This is a fine approach on paper, if you expect players to go through levels somewhat quickly. But while you can move on from each level after one star, they all have three. And the general flow of play seemed to encourage me to keep playing the same level to get more stars, rather than branch out. The game tells you you can move on, but… my mind is in this hospital right now. I know what it looks like, I had development plans. I leave now, and I’ll have to refamilizarize myself later. Whether intentionally or accidentally, Two Point Hospital encourages you to play tall, not wide — I’m twelve hours in and I just now reached the sixth level, which introduces marketing campaigns. I have no idea what other mechanics I might eventually get.

This isn’t just me grumbling: Mechanics you unlock in later hospitals become available in earlier ones too, which can be really helpful. One particular things that jumps to mind is… You can do hospitals ‘4’ and ‘5’ in any order, needing one star from both to go 6. If you go to Tumble first, the alpine hospital, you’re given the Fracture Ward, a new type of room that treats fracture-based injuries. If instead you first tackle the university hospital, Milton, you’ll gain access to the concept of doing research. Which, among other things, lets you develop the X-Ray, a diagnosis room that’s particularly good at diagnosing fractures.

In the game’s defense, I don’t know if my staff *would* be able to use an X-Ray to diagnose fractures. If they can’t even diagnose this on sight…

All in all, Two Point Hospital is a fun, creative experience, that allows for either varied play over multiple different hospitals or deep-dives to get all stars in one. It’s honestly fun to play either way… if you mostly play for fun.

If you play Two Point Hospital not to have fun, but with the intent to win, you might notice that it starts chafing sooner rather than later. It’s not a game that really supports deep strategic play: Its various design idiosyncrasies make it poorly-suited to players who want to race to the finish line. I myself was mostly playing for fun, but trying to hit the third star in later levels occasionally put me in the ‘okay, enough messing around’ mindset that highlighted these weaknesses.

For instance, Two Point Hospital can — at will — provide you with a ton of information. Patient records, hospital attractiveness, cleanliness, and temperature, staff satisfaction with pay, prices of different cures and treatments. You can set which percentage of every staff group can go on break at the same time, that sort of thing. But that information is not often presented in a useful or actionable way. It’s just there.

This is what I would produce if you asked me to parody bad information literacy.

Or as another thing: I’ve mentioned you can ‘roster’ people, allowing or disallowing them to work in certain types of rooms. Maybe your nurse with good diagnosis skills should never work in the pharmacy, and the one with the Pharmacy Management skill should probably not be in the ward, that sort of thing. This is fine. But the controls are just not granular enough to really be useful. You can say that three thirds of all nurses can be on break, for instance, but not ‘I always want one nurse with Ward Management to be active, in the Ward’. The AI just takes the wheel on this, and it is more than happy to make terrible sub-optimal assignments — or just let rooms lie empty. The only solution I’ve found is to over-hire staff, which you pay for at the end of the month. It’s something that I would want to manage further, I just can’t.

Then there’s research, which — I won’t go into details, but you should know that research towards any given topic is shared between hospitals. That’s fine, it means you don’t have to stick around in a ‘done’ hospital to get a cool thing. But that also means that you could, say, start a research project that pays out cash money in that ‘done’ hospital, progress it to 99%, then go into a hospital that’s struggling and complete the last 1% there. Then go back and start it up again. This feels like cheating, but all the same it is possible. And later levels do get tight on the cash. Is this what I was supposed to be doing?

But the biggest stickler is room design. You remember how I mentioned you can make cool fun rooms, put stuff in them, express yourself, all that? Yeah, it turns out rooms actually have a success metric: A ‘prestige level’, from 1 to 5, that determines how much staff and patients like being in it. If you try to be optimally efficient, you’ll want that prestige level as high as you can. And you raise it by… having a lot of items in that room. But space is at a premium, so you can’t just make giant rooms for everyone — you’ll have to get creative instead. Tetris creative. Every empty square in the room is a potential place to put a file cabinet or a coffee maker. Every spot on the floor where there is no rug, is an option to put a rug. And you know what you can put high up on a wall, out of the way of everything else, that gives you a nice chunk of prestige? Clocks. Clocks are nice. Everyone likes clocks.

The net result can be something not unlike this:

Just need… one more!

It’s actually gotten to the point where I don’t design GP’s Offices anymore. I have a set 3-by-3 layout in mind now: Desk goes here, then file cabinet, medicine cabinet, two trophy cases, book case, a heater or airco unit, and then two rugs side by side, and that hits level 3 exactly. I’d love to get more creative, but creativity takes time, space, and mental effort. And I need so many GP’s Offices, you guys. Here’s a fun game: Go back through these screenshots and see how many of the dang things I’ve already built. I promise you the actual hospitals have tons more.

It’s possible to be creative! It’s possible to make cool, fun, nice rooms that also happen to hit a high prestige level. It’s just difficult to do so while also juggling the demands of several high-level objectives — which is what you’ll have to do if you’re playing Two Point Hospital to win.

Honestly, I don’t recommend it.

Final thoughts

I’ll summarize my review like this: My worst times in Two Point Hospital were spent actively trying to beat certain objectives. I’d agonize over metrics outside my control, slowly watching time go by and money come in while hoping that the fluctuating goal markers stayed where they needed to be. That Two Point Hospital is a game I’m not in a hurry to get back to.

My best times in Two Point Hospital were spent building a hospital. Fitting weirdly-shaped rooms together, colour-coordinating benches, laying out snack machines and telephones, training my staff to have cool interlocking skill sets, and listening to the fun radio personalities that babble in-between the music — some songs of which are starting to take a place of honor next to my Theme Hospital memories. That Two Point Hospital, a game about expressing yourself through the medium of healthcare, is a game I don’t at all regret having paid $35 Steam dollars for. I don’t know how quickly I’ll go back, both because I have other games to play and because I am the type of guy to get caught up in systems optimization. But it’s a game I’m glad I own, and a worthy successor to my increasingly distant Theme Hospital memories.

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Jarenth hasn’t actually ever seen the business end of a hospital in real life, bar one unfortunate tonsils encounter at age six. Convince him healthcare is real on Twitter or hang out with him on Steam. And if you dig Indie Wonderland and Ninja Blues in general, why not consider supporting our Patreon campaign?


  1. Even passively through a phone screen, the nostalgia is like a brick to the gut. When I played Theme Hospital, I was young enough that I couldn’t figure out how to get back to the main menu, let alone help these poor, hilariously ill people. To this day I can picture heads being… deflated. Glorious.

    5/5, would Jarenth again.

    1. The deflating heads and the invisible people are probably my two strongest points of visual memory from Theme Hospital. Aurally, of course, I mostly remember the shrill repeating shout of “doctor required in GP’s office!“.

  2. This is one of those curious games where I’ve played for 40+ hours, but it’s hard to say if I was having fun for a lot of that time. As you’ve mentioned, there’s a big gap between playing for fun and playing to win, and I’m definitely the sort of person that plays a game like this to make the numbers go up as high as possible.

    A lot of the things you need to do to play successfully involve making counter-intuitive decisions. Patients need things like benches and snack machines, right? Wrong! You should ignore all of that as it distracts patients, and they’ll wander halfway across the hospital for a snack when they should be entering a room, holding up those behind. With no patient-amusing items, they’ll just line up in an orderly fashion by the door and wait.

    You’d think that having a variety of rooms would be helpful, but wrong again. Once you unlock the Fluid Analysis diagnosis room, you’ll never want to build General Diagnosis or Cardiology again, as they’re less efficient than FA for nearly all diseases.

    Reputation is a good thing, yes? No. Reputation quickly leads to an excess of patients. Long queues and deaths inevitably follow. Here’s what you do – jack up all treatment prices to 100% as soon as you discover new diseases. It lowers patient happiness, but after treatment they’re either going home or dying, so their happiness is irrelevant. The increased income offsets the lower number of patients, and money basically becomes a non-issue. Money being completely irrelevant is not a great look for a sim game.

    There’s some seriously baffling decisions that should have been caught with only minor testing, too. Certain items provide bonuses to diagnosis/treatment chance, and they stack with no diminishing returns. Didn’t the devs realise this would lead to people making huge rooms consisting of 1 GP’s desk, 1 filing cabinet and 90 Medicine Cabinets? The Clock Ward is just scratching the surface. Prestige boosting items are nearly all useless too – unlock the Gold Certificate to hang on walls and every room can be 5 Prestige with no effort. As Prestige increases staff happiness, which increases treatment skill, this means you can either have ugly rooms papered in certificates, or nice looking rooms with lower prestige, meaning unnecessary patient deaths. As a ‘bonus’, these super-GP rooms make every diagnostic-only room obsolete.

    The way research works is bizarre too. All research can be done on any level, so whenever a new treatment room needed researching, I’d just pop back out to the map, jump over to Mitton and my big research wing, and knock it out in 60 seconds. A room that only needs to be built once across the whole campaign is odd.

    Many of my complaints revolve around things that can be changed with tweaks to numbers and such. The stuff that can’t easily be changed, such as the art, music, and general tone of the game, are top-notch. A couple of the main devs worked for Bullfrog for some time, including working on Theme Hospital, so that’s no surprise. ‘Wet Laundry’ is a particularly hard song to shake, and the announcer reminding patients not to die in the corridors is not yet annoying, to my surprise.

    All in all, TPH is fun, but I feel a few months of Early Access on Steam, with a few thousand folks paying to beta test would have been beneficial. The devs are active on the Steam forums and have already released multiple fixes and improvements, such as the ability to copy and paste rooms, so the future looks bright. I hope the game does well, as I’d like to see a whole series of sim games across Two Point County.

    1. This comment reads like a manifesto that eventually resulted in American Healthcare.

      (I agree, of course, with everything — it was difficult for me to not give into the Medicine Cabinets Everywhere urge)

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