Ward & Budget

Every nurse or doctor can only safely keep track of so many patients at once. This game uses one worker for every four patients as the safe limit, which is in the neighbourhood of many general wards. Push past it and waits grow, small problems get missed, and you pay overtime to keep the doors open.

Hospitals need empty beds as a buffer because arrivals are never predictable. Above roughly 85% occupancy, admissions slow down and patients wait in hallways. The public notices hallway medicine quickly, and your satisfaction score reflects that.

The ER is meant to be a fast in-and-out space. When it fills up, or when inpatient beds are full and admitted patients wait inside the ER, every new arrival waits longer. That is why ER bays are tracked separately from beds, and why they cost more to build.

This is a Canadian hospital, so there's no user-pay revenue: patients are never billed, and treating more of them doesn't bring in more money. Your funding is a fixed weekly operating grant from the health authority, the same whether the week is quiet or overwhelming. Wages and upkeep come off the top. A few times a year a family or a local philanthropist makes a donation, which helps but can't be planned around. You cannot go bankrupt, but if your balance goes negative the province steps in, trims your grant for a few weeks, and the public hears about it.

New staff take four weeks to onboard, beds take three weeks to open, and ER bays take eight. Demand grows a little every week and events like flu season arrive on a schedule. The trick is expanding for the hospital you will have in two months, not the one you have today.

Roughly 40% of arrivals need an inpatient bed and 25% need ER care. Each week rolls a random swing of about ±15% on arrivals, then layers on whatever conditions are active. Satisfaction climbs slowly when all three vitals are inside their safe limits, drops faster when they are not, and takes a hit whenever you cut staff or close beds.