Bullfrog’s classic management sim is still a breath of fresh air in the gaming industry – an addictive, hilarious masterpiece.
World-building & Story
In Theme Hospital you play as a manager who oversees a stream of hospitals with the goal of working his or her way up the bureaucratic chain to earn the big money at the top. Aside from this, there’s really no actual story as you’re simply tasked with ensuring the profitability and reputation of each job you’re assigned.
What makes Theme Hospital special to so many gamers is the world that’s constructed here – 90’s Bullfrog were absolute masters of biting satire and that’s fully present here. Right from the opening cutscene of a super-doctor operating on a patient before dumping his body as the procedure goes wrong, you’ll know you’re in for a treat – this permeates through every other aspect of the game from the humorous receptionist announcements to the bonkers diseases you’ll treat such as Bloaty Head and Transparency (caused by licking foil yogurt lids).
It gives the game an identity and a larger than life feel that seems somewhat unmatched to this day – no other developer has quite managed to match the political incorrectness (a bank manager with dollar bills popping out of his suit), quick-fire jokes and social commentary like this since.
Presentation & Sound
Hardly a looker in its day, Theme Hospital has managed to hold up over time thanks to its solid sprite-work and simple environmental design meaning it’s easy to look at today, if a little rough around the edges.
Staff members all share the same sprites between their types (i.e. Doctor, Nurse etc.) and there’s only a handful of patient models, but the way they busy around the hospital about their business means you’ll rarely be staring at them for long (and allows you to easily identify them at a quick glance). Things like little pixel-y mouths move when they’re chatting in the GP’s office which is a nice touch and watching them fall flat on their faces during an earthquake never failed to make me laugh (with a fitting ‘splat’ sound to boot).
Each hospital you’re given is a blank slate for you to build on, so typically environments are just dull purple corridors with green grass outdoors. As you slowly fill them out though they can fulfill whatever desires you want – I tended to build tight corridors of rooms to maximise efficiency, but you could equally build an open hospital to give it a light airy feel. Either way the areas tend to look good from the isometric viewpoint.
The hospital rooms have some interesting quirks too – in keeping with the larger than life feeling you’ll get everything from decontamination showers that whirr as you wash off the radiation to inflation rooms which treat Bloaty Head by literally popping the patient’s skull then re-inflating it (don’t worry, not as graphic as it sounds). The pixel graphics might look a little blurry at times but they always get the picture across and often in a particularly humorous way.
The user interface is probably the thing I’d have most criticism for – it’s a bit fussy and hard to navigate at first, aided by things like colour-coded menus but let down by a general lack of cohesion to everything. Personally, as I’ve played the game numerous times in the past I didn’t really have any issues getting around and placing rooms or staff, but if you’re a newcomer I can imagine it’s definitely a little offputting to get used to things and Theme Hospital offers little in the way of help aside from the odd speech bubble from your adviser.
Sound is an interesting one – there’s no music which is a big negative for me, but even if there were any it would be drowned out by the receptionist’s voice which is something you’ll either love or hate. She’s shrill but says some of the funniest lines I’ve ever heard in videogames (“patients are reminded not to die in the corridors”) meaning that regardless of your tolerance, her quotes will stay with you for a long time. Aside from this, you get amusing sounds like patients straining in toilets or hairyitis patients being zapped with electricity, meaning the game always has a lot going on in the audio department.
Gameplay & Content
Part building sim, part business sim, part micromanagement – Theme Hospital blends a lot of ideas exceptionally well to create an experience that is as unique now as it ever was (particularly so on Vita) and is wholeheartedly worth revisiting, a few minor niggles aside.
The game is level based and at the start of each you’re given a blank hospital to build up how you like with a set sum of money. Balancing the books is your first concern – you have to pay staff wages and build new rooms and although you can borrow money from the bank this attracts interest, meaning your income has to be generated by curing patients. This means you’re going to want to get as many through the door as possible, which relies on your reputation being high which is increased by – yep, curing patients.
Your first port of call should be hiring the staff to run your hospital. Doctors are needed in the majority of cases while nurses run specialist services like the pharmacy and the ward – although doctors can have specialities such as psychiatry or surgery. You’ll also need handymen to fix your machinery, water your plants and clean up puddles of vomit while a receptionist will check patients in and out of your establishment.
Each staff member will have a competency level which indicates how good they are – a consultant doctor will be able to diagnose better than a junior, while a high level nurse moves between rooms more quickly. Obviously, this has an effect on the amount of money they’ll ask for which again comes back to managing your budget – although sneakily you can train up lower level doctors while keeping them on the same wage.
With staff out of the way you’ll need rooms to treat your patients in – these come in the form of blueprints that you place and then edit to your liking, stretching the edges and placing furniture like desks and chairs as you see fit. You’ll also be able to place things like benches and drinks machines in the corridors of your hospital to keep patients happy although as previously mentioned, the layout of this is entirely up to you.
A variety of rooms are needed to treat the bizarre ailments that will come through your doors – some like pharmacy and psychiatric can treat multiple illnesses from king complex (a compulsion to always dress like Elvis) to invisibility (self-explanatory), but others like broken bones require a specialist fracture clinic to remove the casts. These tend to be the funniest part of the game as you watch a guillotine chop off a slack tongue or a hair restoration clinic give a bald man a new head of hair. Not all of these are available from the start, meaning you’ll also need a strong research lab to discover new technologies.
The main bulk of your time playing is spent micromanaging your staff – it’s not cost effective to have a different person to cover every room (and they wouldn’t be happy stuck in one place anyway), so your time will be spent ensuring that the right doctor or nurse is in the right place at the right time. This involves physically picking them up and placing them and brings me to my first issue – as a port from PC, the controls aren’t perfect on PS1 (and by extension, Vita) and there were times I struggled to grab a staff member or place an object where I liked – it was never bad, but just slightly frustrating (helped by the fact that you can slow down time if you’re really struggling).
Part of the game’s challenge therefore comes from stressful situations you might find yourself in – I ran a skeleton staff that involved surgeons working in other rooms, but then I’d get a spree of patients with spare ribs meaning I’d have to source doctors from elsewhere while my surgeons performed operations non-stop. Things like emergency patients (requiring quicker than normal treatment), earthquakes (which damage your equipment) and VIP visits contributed to this too, but I found it really fun to manage all these elements to try and keep my hospital’s reputation up.
You can of course take a more hands-off approach if you prefer and things will continue to tick over, but there’s a large emphasis on managing things as efficiently as possible with targets to hit and compete with other hospitals in the area. This may make the game actually sound rather dull and like hard work but believe me, it isn’t – once you’ve set up a successful hospital it’s incredibly addictive to watch it flourish while making the odd adjustment here and there, knowing you helped get everything to this point (it’s very amusing to read all about the diseases like broken wind and gut rot as they get diagnosed too, which always keeps things funny).
A couple of further PS1 port annoyances exist – one is that saving and reloading causes all the patients to leave your hospital (a minor frustration since it’ll just take a few minutes for them to come back), but more irritating is that staff and patients sometimes get stuck for no good reason. I had a surgeon glitch in the operating theatre which meant the whole room couldn’t be used and I had to build a new one, which you could do without if you’re trying to run a tight financial ship.
It’s also worth noting that this is absolutely the kind of game that’ll either click for you completely or not at all – I grew up on the likes of Command & Conquer, SimCity and Theme Park so have a natural love for managing resources, planning strategies and carefully building up bases, cities or parks. Theme Hospital allows me to scratch that management itch in a portable format and so is like a dream come true for me – but for some people, the thought of looking at numbers and carefully changing the size of a room will sound too much like boring busywork, in which case the game probably isn’t worth checking out (although that’s a real sham, because there’s so many fantastic elements here).
None of these issues do anything to diminish Theme Hospital‘s achievements though – it’s a hugely addictive strategy simulation that offers hours of fun and a large amount of replayability (even without a free play mode) and is a testament to Bullfrog’s brilliance in the 90’s that it’s just as brilliant (and unmatched) now as it ever was.
Theme Hospital is a rarity in the modern gaming landscape – a bitingly funny satire focused on tight micromanagement gameplay and building up a hospital empire to your liking. There’s nothing else like it out there and it’s still extraordinarily fun to play (despite a few PS1 control quirks) meaning you should definitely check it out if you get chance.