1.1 Feedback and Suggestions for Streamlining Hospitalization

First and foremost, this is going to be a fairly long post so I'll leave a TL;DR at the end. I'm going to preface this by saying that as a life long gamer and a real life doctor I have to say this hospital simulation that you guys have put together is nothing short of fantastic. This is the game I've literally been wanting to play my whole life. The level of detail (and accuracy!) when it comes to the different diagnoses, examinations and treatments is SUPERB. Skimming through the forums and steam reviews I can tell that there are quite a few medical students and doctors alike who play this game that appreciate the time and effort put in to making Project Hospital as close to the real deal as possible. I've already showed this game to many of my colleagues and at least two of them have started playing. It's extremely engaging and I would argue it's a fun little teaching tool for medical students; mousing over all the different icons gives very short and concise descriptions that almost act like revision flash cards. I can't overstate how amazing, fun and interesting this game is to people who are interested in medicine. I've been recommending it to everyone. Well done!

I've been playing on and off since release but I recently managed to sink in a good amount of time in the game since the 1.1 patch. I'm glad you guys took your time squashing all the bugs; the game has relatively few of them and the experience is much, much smoother.

Now onto the meat of this post. Hospitalization is definitely in a much better place than what it was before 1.1 but it still has some glaring issues. At the moment, nothing breaks the immersion more than seeing ARMIES of nurses going back and forth between the wards and examination rooms. This doesn't happen in real life. The reason is, doctors see their patients at their beds. The funny thing is, Project Hospital already models this in the ICU department. All patients in the ICU are seen by their doctors at their beds where all the examinations are carried out. So if this mechanic exists for the ICU, why is it not also the case for the other departments? It's very unnecessary for the game to make it mandatory for all examinations to be carried out in the diagnostic rooms. History taking, physical exams, heart monitoring and even obtaining blood samples for labs (the list goes on and on) are all things that can and should be performed at the bedside. The diagnostic rooms should only be reserved for the more invasive procedures like biopsies, lumbar punctures, ECGs etc. I think this makes sense from a gameplay perspective as well and not just from a realism/sim standpoint. Everything gets bogged down and things begin to run very slowly causing patients to collapse if you don't hire a very big number of nurses for every ward to constantly transport patients around the hospital. Allowing more exams to be done inside the wards without constantly moving patients around would be a huge quality of life improvement for the game in my opinion.

I'm going to throw some numbers at you. I started a hospital in patch 1.1 that now has all the departments fully functioning except General Surgery and Ortho. The Internal medicine, Cardiology and Neurology departments in my hospital have roughly 25 - 30 beds each (HDU and Regular combined). I have 8 nurses on the day shift for each of these three departments meaning every nurse is responsible for 3 to 4 patients on average.  At full capacity (like when I purposefully flood my hospital with event patients), when all the beds are occupied, these 8 nurses are almost always at critical workload throughout their shift. That means my nurses almost never have time to fulfill their needs (low satisfaction means poor performance) and by the end of their shifts they're absolutely physically destroyed. They finish work at 8 pm and walk out of the hospital like zombies - it's actually hilarious; each nurse is responsible for only about 3 or 4 patients on average yet they can't keep up. I know it's a video game and it's stupid to try and compare it to real life but there's a very simple reason that is the root of this problem. Patients no matter what their condition is, HAVE to be transported by stretchers pushed by nurses. Ofcourse hiring lots and lots of nurses, smart room placement, good planning of corridors and elevators and placing stretchers in strategic locations definitely alleviates the problem. I don't know how code intensive it would be but I think it would make things runs so much smoother if patients who aren't in critical condition (so in game terms: low hazard/not collapsed) should be able to walk to where they are required while being escorted by a doctor or nurse. The stretcher shouldn't always be necessary - having the nurse pick it up first, transport the patient and then return it is very time consuming and is literally causing patients to die because of how long they have to wait for things to get done. This is a sim game and we all know that immersion is a huge part of what keeps many people playing. So my suggestion is to allow stable and mobile patients to walk to examination rooms rather than forcing them to be transported by stretchers.

Next, I'd like to talk about surgery. I've found that the best way to get patients to surgery quickly is to have dedicated surgery teams for each department. Having said that, surgeries still get delayed much too frequently and I'll explain why in a moment. In my most recent hospital I have all my operating theaters on the top floor and have on-call rooms for each department nearby staffed with doctors that don't see patients on the wards; they only perform surgeries. Likewise, I dedicate a nurse with the surgery specialty to only surgery. The problem is as follows: the 5th member of the team is also a nurse  but there currently isn't a way to change their role to 'surgery only'. So currently I can have 1 surgeon, 1 anesthesiologist, 1 doctor with 'assist at surgery' and 1 surgical nurse all dedicated to work in operating theaters and nowhere else. The second nurse cannot be set to surgery only. I've found that this second nurse is typically the cause for delays in surgery since nurses are always super busy pushing around stretchers! The solution in my opinion is to add an option to lock both nurses to 'surgery only' roles and not just the nurse with the surgery specialty. Nothing is more frustrating than having 4 members of your surgery team completely ready and waiting to do that emergency craniotomy on a collapsed patient with a penetrating head trauma while the last member of the team is too busy pushing a patient with a tape worm infection from their bed to an examination room.

Last but not least, doctors in this game can be serious jerks. I'm looking at the ICU people in particular but the problem I'm about to talk about can happen in other departments too. When a patient enters a department, they're automatically assigned a doctor. If this patient happens to collapse while their doctor is fulfilling their needs, a lot of times (not always) the other doctors who happen to be idle in the on-call room wont do anything about it. However this issue is inconsistent and sometimes idle doctors do actually come in to cover for their colleague who is taking a shit for example. From my experience, this happens much more frequently in the ICU. A patient collapses, their assigned doctor is in the common room fulfilling needs, and you have to hold your breath and hope that they survive the collapse until their assigned doctor comes back while another doctor is playing solitaire on their computer in the on-call room. Ofcourse you can manually take over things in these situations and reassign the patient to a doctor who is free and the problem is solved. It's just very tedious and it would be great f the game could automatically do this for the player. Patients collapse frequently with idle doctors on standby just watching it happen. Very, very frustrating! Something similar happens when patients are assigned to radiology examinations. Let's say I have 2 CT scanners in my hospital. Both are empty and one of the technologists  goes for a bathroom break. A patient that is assigned to the CT room with the technologist on break will continue to wait until they come back from their break instead of being reassigned to the other CT that is currently staffed with an idle technologist. This scenario happens fairly frequently and can really hurt the efficiency of large hospitals with multiple floors and departments. I know that you're constantly looking at increasing efficiency and properly prioritizing procedures so I thought I would mention this issue.

All in all, 1.1 has been a huge step forward for this game and I'm very excited to see what future updates hold for us. I love all the different suggestions that have been posted on the forums and fully trust the Oxymoron team to keep delivering.

TL;DR

1. Allow doctors to perform the appropriate examinations at the bedside instead of exclusively in diagnostic rooms. This reduces the amount of nurses required to push stretchers around.

2. Allow stable hospitalized patients (low hazard who haven't collapsed) to walk to the appropriate exam rooms escorted by their doctor or nurse. This further streamlines things by eliminating the need for a nurse to find a stretcher, transport the patient and then return the stretcher.

3. Allow both of the nurses required for surgery to have a 'surgery only'  role enabled in the UI. This gives the player the ability to have a full dedicated surgery team at all times.

4. Reassign collapsed patients to an idle doctor if available to prevent hold ups in examinations and resuscitation particularly in the ICU. The same thing applies to patients waiting for radiology technologists on break.

Hi, thanks very much for the support and writing such detailed feedback!

(Having read through the whole text) these are very good suggestions, we'll go through them with the designers. Of course there are always reasons (technical or design or both) why the rules work the way they do, but we can consider making some changes, especially as we finally have a bit of extra time to go back to some of the core systems.
I'll have a quick look at the collapses at ICU first, both the collapse itself and then the stabilization stage should be actually choosing any free doctors, regardless of the doctor assigned to the patient.

You are most welcome. Thank you for taking the time to read the entire thing and for passing it on to the team!

Hey Butch,
your suggestions sound very good and I would totally agree to them!
These are issues I came across too and your suggested solutions suit my thoughts.

Thank you. Jan already mentioned that in the upcoming patch the third suggestion in the post is being implemented. Surgery now requires two nurses with the surgery specialty which I think will make the whole surgery process much smoother.