This guide is intended as an intermediate-late game guide, which assumes that you, the reader, have a basic understanding of how the game works, including construction, staff management, and how to run a department, as featured in the in-game tutorials, or in the handy guide below.

Beginners Guide by Blue_Bug
https://psteamcommunity.yuanyoumao.com/sharedfiles/filedetails/?id=1559509863

Blue_Bug's guide is out of date now, but since the fundamentals haven't really changed, it should get you up to speed.

My job, and the job of this guide, is turning you into a hospital administrator so good, that Johns Hopkins is renamed after you.

I have been lucky enough to speak to some fans of the guide, who have given me some very positive feedback and I will include their testimonials below in order to boost my ego number of readers.


"We choose to play Doctor Mode on Specialist, not because it is easy, but because it is hard."
- President John F Kennedy


"If only I had read this handy guide, I could have been playing Project Hospital, instead of getting it on with a Moldovan dancer on the bridge of my ship."
- Francesco Schettino, Convict and (former) Captain of the Costa Concordia


"I'm sorry, Dr Fauci is unavailable for comment at the moment, can I take a message?"
- Lady from The White House switchboard


"I think it's great but don't you have your thesis to write? You should listen to your Dad."
- My Mum


"You are a disappointment."
- My Dad


"I can't believe you can actually have elevators that don't go all the way to the top! This completely changes the way I will play Project Hospital from now on!"
- Ariana Grande


"Jesus Christ Liz it's him again! How the bugger did you even get in here?!"
- HRH Prince Phillip, Duke of Edinburgh


Hopefully, endorsements from these many notable figures should put your mind at ease, that I do know what I'm talking about.

Before we get on with the guide, you should be aware, that this guide assumes you have all the DLC for Project Hospital (get them, they're great).

There are also a list of recommended mods at the bottom of this guide, some guidance on which mods you should avoid and for what reason, as well as some star ratings for the DLC, in case you cannot get all of them, and need to prioritise.

I would encourage you to read the DLC and Modding section if you are new to Project Hospital, and haven't touched the mods before. None are particularly complex, but some department mods can change base game procedures and processes, while map mods older than mid-2020 are likely to be out of date, or have issues upon loading them.

Feel free to ask questions and suggest some improvements, I take constructive criticism well I promise.

© Me, I thought those on the forums in residency might appreciate this.

"I attribute my success to this - I never gave or took any excuse I followed Project Hospital: The Guide and memorised everything it said."
- Florence Nightingale


This game does not have very good documentation or tutorials. There, I said it.

It is a Lovecraftian hellscape of hidden features, quirks, bugs and finnicky systems.

But underneath it all is one of the best management sims of the last decade, not to mention the only semi-realistic hospital simulation game.

It is for exactly this reason, that I have put more effort into this game, than into my last decade of schooling.
It's also probably the reason there are so many doctors here on the forums that play this game; compared to the intensity of their work, this game is positively comatose (unlike their IRL patients hopefully).

The wiki is out of date, as are most of the guides here on the Steam Community, and many mods will change the way the game functions, without you realising.

If you are new to Project Hospital, then I hope to make this guide a moderately bad/decent place to start, and I will be including general hospital design theory, as well as some pointers, tips and tricks, that should expand how you can use build mode to its' full extent, and thusly, design efficient and effective hospitals. Then, and only then, you too can have a meeting with the Dean of your college, to discuss your failing grades, because you have put every waking hour of the last two weeks into curing videogame NPCs.

In all seriousness, this game is complicated and not well explained, I am still learning new things 300+ hours in, and I wish I had known many of these when designing my first hospital.

This guide will start with a few sections on my general philosophy for playing the game, what your main aims should be and some design techniques to help with creating an efficient floorplan.

The later sections will focus on some individual departments, and tips for them.

The department setup route the game wants you to follow is as thus:

Emergency (Clinic) -> Labs -> Radiology -> Internal Medicine -> ICU -> Emergency (Hospitalisation) -> General Surgery -> Other Clinics

By following this pathway, you shouldn't become overwhelmed too quickly, as well as having time and the insurance objectives to aid in setting up and furnishing departments, without endangering your bottom line.

Do not start with a 'heavy' department like Orthopaedics or Traumatology (the severest of all), as your Trauma Centres and ICU will get overwhelmed quickly. Many of the patients require surgery, and unless you have optimised your surgery (see below), or have large amounts of resources, you will drown under all of the guilt from your medical negligence. Oh and some NPCs will die.

.
"People won't have time for you, if you are always angry or complaining losing patients in the ICU"
- Stephen Hawking

Most video games have an enemy. In this game, that enemy is time.

The time it takes to process patients in your hospital, is ultimately what will determine patient and staff morale, the number of untreated patients or deaths, and because of these, how much money you will earn.


This simple equation should help:

Quick treatment = Happy Patient + $

Slow treatment = Don't Dead, Open Inside



The only real way to affect your efficiency in Project Hospital is through time-saving. We do not have many micromanagement tools for finance, and loans are charged at a flat rate. Therefore, the only way to make savings is through reducing delays in the hospital, while making more money by increasing patient numbers.

We can look at delays below, some of which are fixed-costs (we cannot control how long they take), or variable-costs (through good design, we can affect their duration).


*1. A patient waiting for a lab test can be hospitalised to stop them from waiting. This is only possible for walk-in patients.

These events, like most, are all locked in once they begin (appear orange in the patient sheet), and cannot be undone, leading to a huge amount of time before being able to issue other treatments, or changing wards. If a patient has an undiagnosed critical symptom, this might mean collapse or death after they finish.

Because the length of these processes cannot be changed without modding, we must design our hospitals with these in mind.

A similar fixed cost, that any multi-floor hospital will have to deal with, is elevators.

One of the most important elements of gameplay is the placement of departments within a hospital. If you are intending on building a fully capable hospital, with all departments, this becomes especially important owing to the limited space available on the ground floor. When playing with more insurance companies/patients, the large increase in the amount of patients that need to be moved at any given time, means delays can increase enormously.

I will utilise to three levels of layout design: micro, referring to the layout of items within rooms, intermediate is room placement within a department, and macro, referring to the location of departments within the hospital. Each of these levels contribute differently to time pressures, depending on how well or badly they are designed.

While micro-layout will remain important throughout the game, macro-layout is not especially important in the early game, but if you are intending on building a big hospital, then advanced planning with this in mind becomes vital as this is where the biggest gains or losses in efficiency and time can be made.

As we move towards the mid to late game hospital design, we encounter the main problem that critically ill patients have: nope, not their diseases. Time. Patients with serious injuries or symptoms (indicating by pulsing symbols on the patients' card) must be dealt with as quickly as possible, to minimise the risk of collapse, or death. If you have a slow handover between departments, insufficient bed space, or a queue for diagnosis, this can easily kill patients. If you are finding many patients dying in the ICU, it is likely that one of these systems that isn't functioning properly.

This section covers something I call "Centralisation", outlined below.


When starting your hospital plan, you might want to think about the question of 'centralisation'. There are two design philosophies to unpack in this question, that I will term "centralisation" and "decentralisation".

Centralisation is the philosophy, whereby a department contains only the essential rooms that are necessary for function. All shareable rooms (see section below) are 'centralised' and kept together, which allows the minimisation of transfers and the time taken to move hospitalised patients. It can also free up staff requirements, allowing for gains that are not normally possible, since different departments cannot share staff. The departments do not have to physically be at the centre of the hospital in order to be 'centralised', but these rooms are necessary to many different departments, you should look to locate them centrally anyway.

Decentralisation is where a department is largely self-sufficient, equipped to deal with all necessary treatments and diagnostics, usually by fulfilling every listed room on the management menu. I find this to be inefficient, but in large busy hospitals, this might provide extra capacity as well as shorten some trips for patients and staff.

Shareable Rooms

Shareable rooms are rooms that can be utilised by any patient from any department as long as they meet the requirements and are staffed properly. They are as follows:

Operating Theatre:

Operating theatres can be used by any patient from any department, as long as the surgery team is ready to operate. For example, even if you designate a theatre for Traumatology , a patient and surgeons from Internal Medicine can use the room. As a result, it makes little sense to build theatres all over the hospital, as in all likelihood, you will just end up with teams and patients criss-crossing the hospital to reach their assigned room.

To stop this from happening, I typically do not build an operating theatre for each department, even though the hospitalisation menu in Department Management will list one to build. I normally build all of my Operating Theatres in a central location, with offices nearby for the surgery teams of each department. I use the General Surgery Department to support these rooms, as it feels most appropriate.

Examples of Decentralisation vs Centralisation in this context:
Decentralised:


Centralised:


In the Centralised hospital, once the patient is operated on, the room becomes free, while the Surgery Team return to the office far quicker. They can then prepare for the next patient if a theatre is free, while patients from the previous theatre are removed. If you have a high number of patients awaiting surgery, simply moving the surgical team closer to the operating theatre, can increase the turnaround by a large margin. This assumes good logistics around your hospital, with an adequate supply of nurses and stretchers to cope.



Cardiography and Sonography

These rooms are normally part of Radiology, but are normally listed alongside every other department in some form or another. This one is entirely up to you, but I tend


Choosing whether to 'Centralise' or not will inform the rest of the layout of the Hospital, at both a Macro and Intermediate level.

My Proximity Plan:

This plan is based on some attempt at being 'realistic' as well as balancing location for the relative severity of cases coming into each department in gameplay. This map is positioned from the perspective of a patient entering the ER, so the Emergency Clinic is not on this map. I would design a slightly different process for walk-in patients, as Labs are much more important, as well as facilities like the Pharmacy.

The plan assumes 'Centralisation' as well with operating theatres being close at hand to the more severe receiving departments.

This map works vertically in-game as well as horizontally, so placing Traumatology or Ortho above the ER in your hospital works too. This map is just about minimising travel and wait times.

Apologies in advance to anybody with colour-blindness, my ability with 'Paint.nét' is most accurately described as "seriously lacking", much like me in general.




Traumatology and Orthopaedy are situated closest, as they tend to have the bulk of hospitalisations in my experience, and Traumatology patients with injuries like Abdominal Blast Trauma or severe burns, must be seen to as a priority, as they can require as many as 3 surgeries (excluding complications) and several other procedures to fully treat. Several of these symptoms can lead to further issues as well, all of which could prove fatal. It is vital that they are serviced quickly at all times, and travel is kept to a minimum.

The ICU should be relatively central, but still closer to the ER, patients from any department could need it's use, but if the rest of the hospital is working efficiently, that should be rare.

For more information on Trauma Room/ER and ICU, see the section Trauma Room Management or OH GOD THERE'S SO MUCH BLOOD below.

This section will refer to the layout of rooms within a department.

Rooms are divided into two sections in Project Hospital: Clinic and Hospitalisation.

Clinic rooms deal with walk-in patients, while Hospitalisation rooms deal with, you guessed it, hospitalised patients. Note that some rooms like staff rooms and toilets from the clinic section, should still be located near Hospitalisation rooms as well.

Most players seem to put departments together on the same floor. Right the way from Reception through to wards and treatment rooms. While I used to utilise this same approach, I now put all Clinic functions on the ground floor of the hospital, if at all possible, since this will minimise the time before patients are triaged, or assessed by a doctor. For late game purposes, this can drastically reduce the time before critical patients are diagnosed and treated or hospitalised, which can reduce deaths and collapses.

To be completely honest, this isn't the most important set of decisions you will make in the game. As long as the Clinic/Hospitalisation rooms are close together on the same floor, there isn't going to be a huge change between an inefficient, and efficient layout.

"Two pints of O negative and a packet of crisps please."
- an actual doctor relayed this joke to me, while I was locally anaesthetised with a camera halfway up my colon. I snorted at the joke, but the pain from the camera meant I had to be put on oxygen. This is actually a true story.

Padme: Ani? Elevator? My goodness, you've grown.
Ani Elevator: So have you, grown more beautiful... for a senator hospital architect, I mean.
Padme: Ani Elevator, you'll always be that little boy method of transport I knew on Tatooine in the alpha.

Base game elevators are absolutely awful.

They're bad. Really bad. They always go up to the roof. No consultation, no consent or even a notification, you place one down, and it just goes right up to the roof.

Bastards.

Maybe I don't want you to go to the roof. Did you even consider that?
Maybe I want an express ride from the ICU to Orthopaedy.
Maybe I want you to just stop on the third floor, so that my recent lobotomy patients don't spill out onto the helipad and plunge onto the pavement below.

Fortunately for us fearless hospital architects, we have bugs and programming oversights to take advantage of.

If you clone or copy an elevator (make sure to get the 4x4 including the 4x1 in front of the elevator doors), you can place it anywhere. By placing one directly above another on different floors, it will function like a normal elevator, only you can choose where it starts and ends. How cool is that?

Also, if you're a Halloween enthusiast, then there are spooky things going on with these copied elevators too. You can even miss a floor!

Just miss an elevator between floors, and as long as two elevators are vertically aligned on different floors, your patients and staff will automagically appear on their desired floor, just like they would with an old crappy default elevator. They will miss the floor where there isn't an elevator, meaning you can use this method to create express elevators, if you don't want patients or staff of certain departments using them.

Or you can rotate the elevator 180 degrees, so it faces the opposite direction to the corresponding lift on the floor below!

So you didn't get into medical school? Didn't do well enough on your MCAT or Pre-Med track?

Fear not, for Project Hospital can let you live out your dreams, and you still get to pretend to use your textbooks, as well as not having to actually deal with coded patients in real life!

Hurrah!

We don't care about medical negligence round here.
(Pro-Tip: See if you can work "death" into the name of your hospital, this covers you for liability should any of your valued patients do exactly that.)

"Gosh this play is so dull, I think I'd rather be shot."
- Abraham Lincoln, shortly before discovering that 19th Century trauma medicine was quite bad.

If you follow the blood trails splattered across your expensive tiled floors, you will probably find that they lead to one of two places:

A. That bastard James Smith, who is currently sat in Neurology, with a nosebleed that, quite inexplicably, has not been treated yet, despite the fact the man is on his third round with the clinic doctor.

B. The Trauma Room.

If you do not like the blood there is an option to turn it off in the settings. This way, you can pretend that your ER isn't actually filled with critically ill patients, and that deep down, you are actually a very competent digital doctor, well versed in how to handle a hospital.

In truth, the Trauma Room is the most difficult and time consuming part of the game.

Stop reading this now, and go and turn on "Automatically Take Over Patients" in the Ambulance menu. This is completely necessary unless you enjoy watching your intern Trauma doctor misdiagnose a gunshot wound to the arm as Carpal Tunnel Syndrome.

Everybody that arrives at the Trauma Centre is going to be critical, and you need to work fast. Once the setting above is turned on, any new ambulance or helicopter arrival will be conveniently deposited at the bottom of your screen to keep track of.

Once they have been transferred into a station, your goal is thus:

Diagnose the critical injuries and treat as many as you in the centre.

If you have a particularly small Trauma Centre, you might wish to move the patient to a ward first, to ensure adequate space for new arrivals. This is a mistake. Upgrade your Trauma Centre, trust me, you do not want to handle these cases on a ward. Any delays here will eventually lead to collapses and possibly an abrupt trip to heaven, if not the ICU.

To finish, and at the insistence of my parole officer, I wanted to take this time to formally apologise to His Royal Highness Prince Phillip. I am deeply sorry.

I did not mean to cause you and her Majesty any distress, I honestly had not intended to enter via the bedroom window. But you left me no choice.

I was more than polite with your secretaries, the people at the Palace press office, and the police officers who came to my house, but sending a Restraining Order, after only my 5th time of asking for your review, was below the belt, completely unnecessary and quite frankly ungentlemanly. I think this whole affair reflects much more on you than it does on me.

Encyclopedia of Diagnoses
https://encyclopediaofdiagnoses.wordpress.com/2020/12/01/examinations/

Contains all diagnoses and treatments, department statistics and general information, including for modded departments. Last updated at the end of 2020, but there isn't a better site that I know of for this information.

DLC Ratings:

Doctor Mode (free!): ★★★★★
Hospital Services: ★★★★★
Traumatology: ★★★★★
Infectious Diseases: ★★★☆☆

If you have to pick between Hospital Services and Traumatology, pick Hospital Services, adds a lot more design options and general management tools to the game. Gift shops and Pharmacy are good early game income sources, and help to spruce up your hospital.

Traumatology is really and truly, an endgame department. All of your systems have to be functioning effectively before taking somebody in with the level of trauma that can be seen in DLC patients. Some require 3+ surgeries, a tough ask for any hospital. The helipad is a nice addition too, and adds something to put on the roof that isn't a satellite dish.

Infectious Diseases isn't really worth it, most of the objects are decorative, and no, you cannot have an outbreak like in Theme Hospital. A difficult and finicky department, it really is only good to fill the space left over in a large hospital.


In this section I will detail some mods which I consider to be worth your time. When modding Project Hospital, it is important to note, you cannot load a save without all mods present. If one of these breaks, don't come crying to me, you have been warned. I haven't included some notable mods like Urology and Nephrology, as well as the ENT mod, as both have not been updated (ENT update is in the works apparently) and I have encountered serious bugs with them. Sexual Health as well.

Avoid map mods that are older than mid-2020, many were made before the official release, and elements of them might not work, or cannot be created with the tools in the current version of the game. Several departments and rooms have drastically changed since the Alpha.

To be included, all of the following mods must have been updated in the last year, since some older department mods have bugs, which have not been fixed as of the time of writing.


These mods add new departments, which help if you are planning a large hospital, or have many insurance mods/more patients, since you will need to fill the space.

More Levels by mrgeorgeallison
This mod allows you to build up to 12 floors. Absolutely necessary if you are playing with more departments, patients and insurance companies.
https://psteamcommunity.yuanyoumao.com/sharedfiles/filedetails/?id=1759748430

Department of Gynaecology and Obstetrics by | Mac Hareng |
Adds what it says on the tin. The author keeps this regularly updated too, which is nice.
https://psteamcommunity.yuanyoumao.com/sharedfiles/filedetails/?id=1920731522



These mods are really about offering greater visual choice. If you feel you are lacking for diversity in your hospital, and every ward looks the same, grab some of these, and look at the basegame hospitals for inspiration.

Here are a list of maps that I have found particularly interesting in their design choices, some in terms of building design, others with the layout and function of departments. I will specify for each.

I would encourage anybody looking for inspiration to look at the base game maps too, I have found my own room design getting stale on occasion, and not all wards should just contain 2x3 bed areas and nothing else.

Hospital Clínico Universitario by carlosgal
https://psteamcommunity.yuanyoumao.com/sharedfiles/filedetails/?id=2443221652
This is frankly masterful centralising, carlosgal places most departments' clinics close to or on the ground floor, which leaves hospitalised patients travelling upwards, whilst ensuring walk-ins that do not require specialised treatment or hospitalisation are quickly treated and sent on their way. Also, their building design is very nice too.

This hospital highlights the distinction between Clinic and Hospitalisation cannot be overstated, there are many more options for building, if you can move away from clustering an entire department together.


Sigmund Hospital by aderrahmn
https://psteamcommunity.yuanyoumao.com/sharedfiles/filedetails/?id=2560376036
Very interesting external design utilising walls to create a cube effect around each window. Proof of how one can use the clone tool to put buildings where they cannot be constructed with tools. I love the use of courtyards too.


Hospital Himmelohstr. by Matthias
https://psteamcommunity.yuanyoumao.com/sharedfiles/filedetails/?id=2204504989
Mattias has several builds worth checking out, very interesting and unique building designs for each, that can be mixed and matched.


Hospítal Clinico Universitario by FlacoMortis
https://psteamcommunity.yuanyoumao.com/sharedfiles/filedetails/?id=2203745070
Building a single 'mega-hospital' where everything is contained in one building, is normally difficult to make aesthetically pleasing. This is one of the few that I think gets it right, while still offering an appropriate amount of space, and varied architecture.