Played on Windows
Also Available on Linux and macOS

In 1997, Bullfrog Studios develop something special. It was a follow-up to their very popular Theme Park game, but this time they tackled a new topic: hospitals. The game’s name was Theme hospital, and it developed a cult following. We fast forward a little over twenty years and we now have a spiritual successor to the original game, including some of the same people at the helm. This time it’s called Two Point Hospital, is it as good as the original?

A big driving factor to the original Theme Hospital’s popularity was due to it’s rare and dry British sense of humor, that was unique in gaming at the time. In addition, the business simulation genre was ripe for a big spark of innovation, and Theme Hospital delivered it. Two Point Hospital tries to do both a second time, returning to that style of humor and again planting a flag in the simulation genre with a similar game. What I find interesting is that the simulation genre appears ready for the same game a second time around, and while it’s become a more populated field, the genre itself is still lesser known.

Two Point Hospital looks very good. There is a fantastic aesthetic to the game that combines a relatively realistic looking environment, with caricatures of people, and outlandish treatments, and they all mesh well together. The whole game revolves around trying to run a hospital efficiently while making a profit, but the cartoony experience really makes the game enjoyable to watch.

Note: There are frame rate issues in this video caused by the recording process, not the game.

One major factor that helps the game is the animation system. It’s enjoyable to just watch characters move around and watch them interact with each other. While most of this is done as part of the hospital experience, the characters shine. It helps that some of the treatments are extremely outlandish, such as a “De-Lux O-Luxe” machine, that cures lightheadedness, a condition symbolized by having a lightbulb for a head. The machine unscrews the lightbulb and replaces it with a newly created head.

There are also simple scenes like janitors catching ghosts with a dustbuster from a decade ago, that’s funny to see. It’s this style of humor that makes it a joy to keep exploring and seeing new actions and animations.

Those old Dustbusters really suck!

While the game does sound like a cartoon, a big part of the game is designing a hospital, and the hospital’s look itself is rather realistic but somewhat wonderful. The game is very clear what each room is for, and there are a number of visual clues, without being garish. Whether it’s a placed machine, the colors of a wall or something else, it’s easy to detect what each room is and what it is used for at a distance and it’s a clean UI that does so. It makes two point hospital visually appealing, while not hindering the gameplay.

Two Point Hospital doesn’t have a full story running throughout the game. The player will be given goals and tasks to complete in each hospital/level, and while there is a theme to each hospital and some unique reasons for you to take over each hospital, there’s not an overarching story. Some Hospitals teach you a new function, others have a new disease or a new type of room, even a couple of the goals focus on temperature control, but these are more thematic goals to the game, the story being mostly flavor text.

Most hospitals (or levels) build upon what was learned in the previous hospitals, adding a new feature in. The first half of the game is almost all set up like a “tutorial” level, in that the game introduces something new to the game, and gives you an entire experience tailored to teaching you that feature, along with specific goals for it. The last couple of levels become focuses on mastery of the entire game, giving longer-term goals, and small twists to the formula.

The humor in the game is great, and while it’s not a full story, Two Point Hospital has great light-hearted humor in the game in the British sense. You can watch people interact as mentioned above, and see a decent amount of character and life to each character. Some diseases will show their affliction on the characters that have them. For instance, there is a disease called Premature Mummification with a character wrapped up like a mummy but still walking around and moving in the normal mummy shuffle, and I love watching them in the game. Though, I will say that I find the doctors unconvincing in the number of examinations they need to figure out what is wrong with such a person.

Something is clearly wrong with this patient. Perhaps we should send him to the tailor’s

The only real issue is that not every malady has a clear sign of what’s wrong with them. By the end of the Two Point Hospital about half of the patients do seem to have a visual deformity, or really half the illnesses, but many of the others are lacking. Verbal Diarrhea could be hilarious to see. There’s not a visual representation of Bed Face from what I’ve seen, and the lack of hair on a Lycanthrope (werewolf) is a shame. I understand the time it takes to make these look as good as they do, but they look so great that I want more. The description of every illness is so fantastic, but the visual illnesses stand out even more.

Two Point Hospital does have extremely good illnesses though. Turtlehead, 8-bitter, lightheadedness, and my personal favorite is probably “Mock Star” where the character walks around looking like Freddie Mercury and acting like him. The game goes further with some like Animal Magnetism, where a character walks in with cats attached to their body as they walk around. This is solved by doctors shooting the animals off their body with a special sonic gun and the cats get caught in the back of the machine. It’s silly, funny and entertaining to watch at least a few times.

At the end of the day, Two Point Hospital is about building functional hospitals and running them efficiently. You’ll design, layout and staff buildings, hiring doctor, nurses, assistants, and janitors, and even dealing with minor issues such as marketing or balancing the budget when necessary.

Hiring staff is critical, but I love the flavor traits for this guy.

At the beginning of every level, you will have to build out the initial rooms that every hospital requires. You’ll need a reception area for patients to check in, a general practitioner’s office to start the examination process of a patient, and usually a pharmacy to treat the initial illnesses of each location. From there Two Point Hospital’s gameplay grows, and each hospital does something different with what needs to be done. The early game is mostly about earning money at a steady but relatively slow pace, eventually, though you’ll need new diagnostic approaches, and treatment options, as not everything can be fixed by a simple drug from the pharmacy.

Once the player has a decent hospital, they can quickly move to the point where they’re building what’s necessary and the goal is to lay it out in a usable format. The better the layout, the more profitable the hospital can be, and it’s a challenge, but an interesting one to tackle.

The staff though is just as important, and you have manually hire everyone. As mentioned before, there are doctors, nurses, janitors, and assistants. Every potential staff member has abilities and attributes, and the player has to decide which ones they are looking for. There are obviously good ones, like motivated, high energy, or healing hands, but there are bad ones as well, such as litterer, evil, and wants more money.

Each staff member can also start with special skills or abilities. Eventually, in the game, the player will be able to train the staff to get the abilities they value, though the traits are randomly selected for each character. In addition to all of this, there are flavor traits for each staff member. While these flavor traits don’t do anything in the game, they’re usually quite humorous, two that I remember is “Distributes a comic strip amongst, and featuring, their friends” and “Spent a summer as a sheepdog” While they don’t change the gameplay, I do find them humorous.

Two Point Hospital does require a decent amount of micromanagement of the staff, but the game alerts you to when most of it is necessary. It’s mostly hiring new staff, promoting them when it’s time, and training them so they can be promoted.

From that point, it’s mostly about running the hospital and improving the efficiency of the hospital. As the hospital grows, the hospital is run well, and certain events will cause the hospital’s level to grow, and that causes more patients and a new variety of them for the player to manage. This will add new challenges such as a new disease, but the game also has a limit to how many people can use each location or resource, and ultimately, the player will have to deal with lines at the general practitioner’s offices by adding more or having new treatment options for new maladies.

The hospitals always feel active, and there’s always something going on.

Two Point Hospital doesn’t really have a lot of downtime. The time controls in the game are solid, allowing faster and slower than normal speed, but there appears to always be something going on where I never felt that I had to wait for more than a couple of moments for a new task to look into. While some of my time would be spent examining the efficiency of the hospital, there’s always something to do for the player. If the hospital is well built, there should be enough money rolling in that you will never have to sit around waiting for cash.

Money can become an issue at some point but the game also employs interesting tricks that will help set up a smart player to succeed. A big piece is the emergencies in the game. Novice players will accept emergencies, or reject them without thinking about them, however, they’re wonderful benefits to a smart player. A surgery emergency gives you 5 patients, each surgery session gives $22,000 whether successful or not, and a surgery room only costs $24,000 dollars to build, and is a permanent addition to the hospital. Accepting the emergency creates a quick influx of cash, and the player can quickly build two surgery rooms to deal with the new patients, having a better hospital by taking the emergency on.

Two Point Hospital has a couple of clever little tricks like these emergencies that offer essentially free money to smart players allowing growth without significant economic risks.

Similarly, the UI for building the hospitals is wonderful and set up to encourage experimentation. Two Point Hospital allows players to move entire rooms, and sell almost any addition for a full refund of the original price. Being able to move a room and place it somewhere else for free is great, and resizing the rooms also costs almost nothing. The ability to change and experiment with the hospital at will makes it a less stressful experience and it’s wonderful, something that the park building genre could really learn from.

Sometimes bad things happen, like lightning storms and earthquakes.

In addition, the ability to just clone a room that you feel is well laid out is another fantastic addition to the game. This is again something I noticed a number of management games struggle with as they want to incentivize choosing the right layout the first time. Two Point Hospital correctly understands that experimentation is the lifeblood of their game, and encourages fixing mistakes instead of worrying about making them in the first place by removing the economic penalties for it.

Two Point Hospital also has a wealth of tooltips informing you of more information about almost everything in the game. Every mission and goal in the game will give you hints on how to achieve it. But it goes beyond the simple goals of the game. Everything in the game gives you an explanation of what it is, or what it’s doing so almost nothing is confusing. The UI might be the best part of the game, which is high praise because a lot of Two Point Hospital are well designed, developed and polished, it’s just that the UI is so well thought out that I have to give it a high amount of credit.

Not everything is flawless in Two Point Hospital. The game does have some issues with how it deals with errors, the most frustrating piece of the game to me was when I realized I couldn’t place a new plant in the lobby. It turns out that the game will lock a room from getting new objects if the pathfinding is broken. If you place a plant in front of a trash can so you can’t reach the trash can, you will lose the ability to place any additional object in that room, or location. The game doesn’t give you a clear indicator of what’s wrong, but the inability to add objects becomes frustrating as you search for your mistake. Once you know of the issue, you can quickly pick up the object and fix it for free as well.

The game doesn’t always have the best information to diagnose why a hospital is going wrong. People often will say “I need to use the bathroom” when they’re near a bathroom but make no attempt to go. Why not go? Just go? Stupid NPCs.

There’s not a lot of story, but each hospital/level has a small snippet and a main goal.

I read up on a number of pieces and part of this might be poor pathfinding, where the NPCs have trouble navigating single spaced halls, but even in double spaced halls, NPCs seem to complain about their needs rather than trying to satisfy them. There are a lot of other issues that are tracked, hunger, thirst, heat, and more, and those work well, but the game isn’t clear when pathfinding or something else is an issue.

A similar issue happens with janitors, while I’m almost sure I have enough janitors, it seems that part of my hospitals aren’t getting cleaned, and it’s not clear if it’s that I don’t actually have enough janitors, pathfinding, or if the game is failing to spread them out enough. I don’t want to micromanage the janitors, but it seems like I am forced to.

The main goals of the game are quite good. Each level has unique goals and there is a lot of variety. Most levels are focused on a specialty room or a specific disease but it’s kept me coming back for more. Some hospitals are better than others, and I personally was not a fan of “Hospital Value” as it wasn’t the clearest goal, even though it sounds like it should be. Each hospital has 3 stars worth of tasks, though once the player has beaten the third goal, there is not much more to do. You should have a well-built hospital, though most of the time there’s more room to build into if someone wants to make an even bigger hospital.

While the main quests are well built, there are also procedural quests, that don’t always work. A staff member will say to “Promote 3 staff” can be easy or impossible depending on how many of your staff are ready to be promoted. “Catch 3 ghosts” only works if you have 3 ghosts, which only occur when someone dies, I got the quest in the early game and since no one was dying, it’s a near impossible task.

Another odd one is “No Deaths” And there’s actually an award to go a year without deaths, but I’m confused with the metric. I’m not sure if it’s a good metric or even achievable without cheating. In the early game, it can be a bit simple with some luck, however by the end game you’ll have so many patients in different states, that eventually someone will perish each year. Beyond that, well … there’s a simple solution, send everyone home or just sick people and while that satisfies the goal, it doesn’t make for a better experience for the user.

In fact, there are a few exploitable pieces of the game where you can send people home to avoid negatives, but similarly, that’s not in the spirit of the game. You can “Min/max” a number of pieces of the game as well. If you really want to optimize the hospitals, you can grab staff, and patients and shuffle them to where they are walking and more. Similarly, while the prestige of each room is valuable, to maximize the prestige it’s easier to throw posters on every inch of a wall, and then drop a number of trash bins instead of creating beautiful rooms, the player will ultimately create a very ugly room for some statistical benefit.

Even while there are exploits there are really unique ideas, such as researching new upgrades. The research though is spread across all the hospitals so the game allows you to make constant upgrades. You can just go back to earlier levels to maximize the research but you’ll unlock new elements to research as you play through the game.

The game compares you to your friends, which is nice but has issues.

Finally, Two Point Hospital does have some multiplayer components as well. The game allows you to choose three different challenges per level, and try to compete for a high score. While these are interesting ideas, most of my friends haven’t turned in a score, but the implementation of the high score challenges has issues. You can run the challenge at any point during the level, so there’s no point to start these challenges early if you’re going for the high score. While there are only about three challenges that had scores from my friends, the uneven starting point made me less interested in the feature even if all my friends had participated.

It is a great concept, but it’s just not exactly right for the game as it’s set up. I do like the idea of being able to compare my progress to theirs, pictures can be shared, and more, but I feel the playing field for the multiplayer challenges needs to be fair to all entries, and I don’t have a good answer for that.

I do have to admit, I didn’t beat every level. While I completed about half the levels with 3 stars, completing all the objectives, I did play 12 out of 15 levels in the game, a decent sum and there’s still a ton more to do. I do want to go back and play more, but I’ve seen most of what the game offers by this point and I can honestly say, I’m quite impressed.

Yes, Two Point Hospital clearly has a few issues with the game, but this is a revival of a 20-year-old game and there have been huge improvements made here. Two Point Hospital reminds me of why I like Theme Hospital, but it also doesn’t make me have to go back and forgive the poor designs of the original game. It’s a fresh new take on the hospital management game, and I’m excited to see what comes next from Two Point Studios because I’m a believer after this game.

Two Point Hospital gets a

4.5/5

Final Thoughts: An excellent spiritual successor to Theme Hospital, Two Point Hospital also stands on its own. A unique style of humor, a mostly wonderful UI, and a great experience fills out the experience.

Stats: 36 hours played. 11/26 achievements earned.

Disclosure: I reached out to SEGA to request a copy of Two Point Hospital and they provided one for me, thank you to SEGA for giving me the copy, however it has not affected my review or score. I am disclosing it as you, the readers have a right to know and make your own opinions on it.