Suggestion: Department rework

While playing the game for over 200 hours, watching let's plays (especially thanks @blarla) and taking part in the discussions on this forum I want to present my ideas about reworking what we have currently. I hope, I do not touch stuff already internally covered, but some mechanisms are a bit opaque to me - I will mention it, when it comes to this.

General ideas:

- One reception for all clinics
I am still not quite sure why we need to have several of them. I understand them as a kind of big waiting area, people go first when entering our hospital, then are triaged and sent to the corresponding departments with the receptionist skill of the nurse determining the speed of the process and the error ratio thus sending patients to a wrong department (ER by default). The nurses working there are 3 star specialist nurses. Nurse skills are not related to any department so basically spoken, any nurse can work at any department. So I do not see a reason to have more than one reception at the entrance of the clinic. The number of nurses just is in accord to the patient intake. This could streamline the personal needed a bit and make bigger receptions possible with facilities for personal needs like toilet and sofa and coffee machine in the back. I note that a nurse at reception does not leave it during shift. Is this a wrong perception on my behalf or are they glued to their seats?

- pharmacy's revenue is tied to medication prescribed
I must admit that I am a bit in the dark about how this works. Patients go there after treatment and buy medicine. I would ask: what determines the amount? It would be logical if this is directly correlated to medication prescribed by the docs and related to the relative cost of the medicine. Thus a saline nasal spray is cheap while beta blockers or complex medications might result in higher costs.

- pharmacies could serve passers-by
Pharmacies do not only sell prescribed medicine but in my country you also can buy herbal teas, skin lotions, some medical hardware like thermometers, blood pressure devices, band-aids for home use and certain drugs like painkillers for headache or nasal spray which you can always buy even without a doc's prescription. So having a pharmacy could attract a number of people walking by and shopping at the pharmacy without the need of being a patient first.

- New job class: Orderlies/Porter
A job that will do menial jobs like hauling patients and doing errands for labs. They could gain "Dexterity" as only skill which affects their movement. They need a kind of closet like the janitors with lockers, have low wages and then can be toggled to the jobs "transfer patients" and "transfer samples". For the first, nurses are still allowed to move patients but will have their hands freed up a bit. For the latter, let the doctor's offices have an object to store samples while the orderly will come fetch it and transport it to the correct lab.

- Acquire certificates for Docs at learning room to broaden your Doc's abilities
Imagine that the treatment 'diet modification' could only be prescribed with a doc having a certificate in oecotrophology. Or exercises after having a certificate in sports medicine. Open up skills and treatments by schooling your personal. Imagine a tech in Radiology could only operate a CT when having a certificate for it. This enables a bit more roleplaying and personal management on the player's behalf as they could tailor their own staff to their needs. Maybe level 4 and 5 doctors can teach other docs at the learning room (I imagine Theme hospital doin something similar) but in reality those department heads also have responsibility in training the interns. Maybe courses are possible to remove bad traits and gain good ones like work-life balance to remove 'depressed' or gaining positives like 'comforting' because the staff member did some training on patient-doctor interaction

Department reworks:

PATHOLOGY DEPARTMENT

- merge laboratories with pathology department
Pathology as it is treated now is a rather dead horse as it only springs into use after we effectively failed thus lost a case. It is nice to recycle some money from a dead one but there are some quirks I am currently not happy about.
Pathology specializes in uncovering symptoms by analysing tissue, blood and other specimens taken from the patient. That this can lead to a forensic diagnosis for a deceased is only one facet of pathology.
We have the anatomic/forensic pathology covered with being able to do autopsies.
We also have the clinical pathology covered with out 3 labs that evolved from the STAT labs.
I would suggest the following course of action in that regard:
1. merge the departments under pathology
2. the pathologist's office now will gain another use. A doc stationed here can be the chief supervisor of the whole department lending his bonus to the associated techs
3. generate a new job for orderlies: fetch sample. Sample transport should not be done by the techs
4. remove waiting rooms but replace procedure by this:

a) Patient is treated by a MD in a department. Upon selecting a test related to the pathology department like a blood draw, ELISA or stool collection, the doc places the sample into a new object "sample storage". Patient will be examined further and then send back to waiting room, send back home if waiting for multiple test results to return next day (prevents clogging up waiting rooms and prevents bad ratings for bored patients) or sent to ward to await their fate...
In case of an already hospitalized patient the ward doctor will take this to his on-call room and deposit it there.
b) Orderly/Porter with 'fetch sample' job enabled is dispatched to doc's office and collects all samples waiting there. Maybe on hourly schedule and takes them to according labs.
c) Lab technicians will analyze samples
d) Test results are sent via PC to pathologist's office where the doc will take a look at the data and do a diagnosis. Specialization to clinical pathology helps getting results faster and removes error margin. (So a pathologist can have the roles perform autopsies and diagnosis enabled). OPTIONAL: add Toxicology specialization and move related trauma/inner medicine cases there like CO poisoning, chlorine poisoning, spider/snake bites, ingestion of chemicals to that department.
e) when pathologist is ready, test results will be sent to doc prescribing treatment thus being added to patient file. Making a diagnosis takes some time so a pathologist can be overwhelmed with jobs if he does not get help.

- make autopsies/clinical tests possible for clinic-external cases
The department of pathology could generate income by handling samples from medical practitioners outside the hospital like a clinical GP could have blood draws analyzed but his office would not warrant his own labs for that thus the hospital could do such things as a service. Same for forensics performed in all cases, where the death of a person was unclear and in most countries an autopsy is mandatory in that case to exclude a crime. So we could have corpse intake from the police coroner (people found dead) and maybe from retirement homes (passed away because of several reasons but not limited to old age). Of course the latter should not be a money printer but just give them some more use instead of idling most of the time and as an incentive to hire more than one.

RADIOLOGY

X-Ray versus CT
As written in the bug report forum I generally question a forced and arbitrary differentiation between both out of balancing reasons. Both make an X-Ray scan of your body and the only real difference is that the CT can generate a 3D picture while the conventional X-Ray produces 2D images. Nevertheless both should be capable to diagnose fractures or highlighted organs (via barium swallow). The result is that they are put into concurrence with each other and once you have built a CT you won't need the X-Ray rooms. From the dev's perception this is bad. My gamer self says: well, CT is more advanced and will eventually replace X-Ray. If you want to have both, then give reason for both coexisting. The biggest difference is that a CT costs a multitude of an X-Ray scanner. I did some research and found X-Ray devices ranging from around $30k-$150k while this is the area used CT devices start so I reckon price tags of $400k+ for one of these. So basically spoken, you can start off with an X-Ray easily and most specialized clinics like odontologists have these. Hospitals have far larger funds and can buy a CT while this is not economical for a GP with his own little clinic. Then I asked myself, whether an X-ray is a good idea with unconscious patients that might have to be moved for doing the scan. In that case for an emergency room/trauma enter the CT is clearly the better option. Could we differentiate here by limiting the X-Ray scanners to 'awake patients only'? So we might have a reason to have X-Rays for ambulant clinic patients and CTs for hospitalized/critical cases? What if we could have X-Ray rooms directly belonging to clinic departments? Imagine the Emergency clinic would have their own X-Ray room but somewhat more limited. You cannot use it for hospitalized patients, you could only do the limb/head/torso X-Rays and no barium swallow there. Maybe the machine could be handled by a nurse with proper skill (not unusual in my country that nurses or medical assistants will perform these for the doc) and the patient will just wait in the department's waiting room with no reason to build another for another department?
That said, I am o.k. with CT replacing X-Rays at some point - they are more advanced but much more expensive but basically do the same stuff. You could and should find the same symptoms regardless of which device was chosen.

Radiology rework
Radiology needs a similar feature as the pathological labs mentioned above. We might need to have Radiologist's offices to interpret the scans taken from the patients and give rise to a department head thus chief radiologist.

Enable external cases for Radiology
As with the labs, external GPs could send patients to take imaging of their bones (and will preferrably want USG or X-Ray so bread and butter scans). Those will go to the waiting room, wait for their scan, wait again at waiting area and then fetch the images from the radiologist's office and leave clinic after payment. While I understand, that payment per case is somewhat related to work put into making the diagnosis and cure this is fine for the department as hospital only - But I cannot see why we cannot offer services for external docs if our reputation is high enough? Also, this will take some strain from the above mentioned CT vs. X-Ray dilemma as X-Rays will still keep their use - external GPs 'rent' it from you

EMERGENCY DEPARTMENT

It could be great to have an integrated small scale STAT lab for preliminary examinations like urine testing (sometimes done with indicator sticks), blood type determination, blood sugar value or leucocyte count. These could double up to find results also being possible at labs but can take out the strain on these a bit. Also they could give raise to indications of more advanced tests as follow-up. I mean, it is not quite reasonable to test urine for sugar (diabetes diagnosis) by sending to another department and back. Such small things can be done at a clinic. A full ELISA or full blood draw is something else. Rule of thumb: if it could be done in a backroom lab with just a sheet of indicator paper or liquid test (add some drops, shake and see results), we should be able to do at a clinic without the need of building or straining the lab infrastructure.

ADMINISTRATION
Add an orthopedy shop selling crutches, anti-thrombosis socks, wheelchairs, boston braces and orthopedic shoes - the works. Let a janitor (shop vendor) work there. Patients from Orthopedy and to a certain amount General Surgery will go there to buy stuff for a home.

Suggestion for possible departments:

Department of TOXICOLOGY
Treat snake/spider bites, CO poisonings or Chlorine poisonings here and other unfunny conditions related to chemical's intake. Enable antidotes, oxygenotherapy and dialysis. Traumatology and inner medicine seem a bit 'wrong' for this. Maybe hospitalized only as the patients are likely to be connected to an IV stand, dialysis machine, stomach pump or generally under observation for collapsing like HDU only with special treatment unit and specialized pharmacy dealing with antidotes. Maybe own toxicology lab for treatment 'tox screen' and 'drug screen'. New diseases like drug abuse (overdose), chemical indigestion, animal bites, smoke gas inhalation, chemical accidents

Department of OPHTALMACY
Clinical purpose is measuring of eye pressure, cornea, red/green blindness, measuring eyesight and prescription of glasses as well as small stuff like removing small foreign object in the eye like an eyelash not going away. Diagnosis of green star and gray star and inflammatory diseases of the eye. Special rooms could be used for measuring eye data, office could do advanced eye tests and a small room for treating eyes like washing out foreign objects or administering eye drops. Hospitalization could give raise to surgeries like cornea treatment, grey star, lasering away turbidities, implanting new eye lenses or remove severe cases of foreign objects as well as treating severe infections of the eyes. Takes some strain from neorology. Could also come with the need for a shop to buy glasses (can use janitor: shop vendor) and technician (specialization ophtalmacy) repairing glasses or making lenses.
Patients could go there and leave the prescription, the tech will make the glasses and then on the next day they return to get their glasses.

Department of ODONTOLOGY
Clinical purpose is treating teeth and gums. Caries, Paradontosis, Need for bracers, Implantments - the works.
Hospitalized purpose is removing third molars, restorative surgery to mandible like broken mandibles go here instead of orthopedy, treatment of mandibular bone inflammtions

Hi! James here, I'm already planning on making the Toxicology Dept and I'm pretty sure Ophthalmology and Odontology is already in development. Most of your suggestions would be awesome in game but it will likely need a major rework of the game to include most of these suggestions. Especially such as an Orderlies or External Radiology Cases. Here are some things I would like to address, Pharmaceutical Income isn't determined by the game and what events could occur, but rather set up by the Developers or Modders. They will be the same regardless, of any event. Only the diagnosis price will be increased not treatment. CTs and X-rays, removing X-ray rooms would be simply unrealistic because most hospitals and clinic have X-ray rooms. CTs also can provide more advanced diagnostic clues such as in Ulcerative Colitis or Crohn's Disease. STAT lab exams can be that simple if they were structured that way, as of now it is possible to change which equipment lab technicians would use. Expanding knowledge of doctors can be done via code modding or by the developers, but if that were to be implemented, it would be simple unrealistic that only doctors that are specialised in Nutrition Medicine to only prescribe Diet Modifications, as in the real world, your GP can simply give you a Diet plan without them being specialised in that field. This is also possible with basic modding. Other than that they would be nice to have ingame! They would still take alot of time and reworking to implement this

Yeah, I admit, the diet modifications were a bad example. But you get the idea, right? Regarding X-Rays versus CT I would like to have them both uncover some same symptoms as an alternative to each other but let them work differently to not make one of the two obsolete. Medication prices is a bit strange - I always thought, this was coupled to treatment and would be logical that way. Saline nosespray is cheap, a beta-blocker or experimental antibody is not. I have thought about another kind of patient coming in: persons wanting vaccination. Could be done right quickly but will net not much $ and tend to clog up waiting rooms but still bread and butter for GPs and infectious disease dept. clinics.

I do get the idea, this is possible. Medication prices are indeed weird, so is examination prices. As of now, Examination prices obsolete and are not applied but may return soon if the devs wanted to add them back