Two Point Hospital’s developers “can’t help” the dad jokes


Many mourned when the legendary British studio Lionhead folded in April 2016. But, within months, three of its former employees had co-founded a new company and set to work on Two Point Hospital, news of which would later delight PC gamers who’d grown up with the particular quirky brilliance that marked the work of Lionhead, and Bullfrog before them. 

We got to play Two Point Hospital the other week, and to speak with two of those three co-founders: design director Gary Carr and technical director Mark Webley. The elephant in the room is, of course, Theme Hospital, which Carr himself helped to make back in 1997. But what new features are they bringing to the table? And what are their plans for the future of the Two Point series?

PCGamesN: People have already made plenty of comparisons to Theme Hospital. What are you doing to differentiate Two Point Hospital?

Gary Carr: As a way to revisit making sim games, Theme Hospital was an easy starting point for us. We didn’t feel we finished everything we wanted to do back then – we had some more ideas – and it does give a new studio a bit of a helping hand. But the game does differentiate dramatically when you get to things like the marketing, the expansion into Two Point County, the R&D, training…

Pixelation and mummification are among the many silly diseasesWe didn’t want to make a reskin, but some of the mechanics we already had are just the right mechanics, and we wouldn’t change them for no reason. In a platform game, you platform. In an FPS, you have a reticle and you shoot through it. There are certain things that are just staples of these type of games.

Ben Hymers:Yeah, there are certain expectations. You want to make it familiar. We’d also be foolish to not draw on a little bit of our heritage, but we’re keen to stress that it’s not a reskin, not a sequel, it’s its own game, just heavily inspired by the original.

Carr: And if somebody makes something, there’s going to be an element of that in their DNA that you can’t scrub away. It’s the way we think; it’s just second nature.

Hymers: That’s just how Mark and Gary are. Still got the same sort of jokes…

Carr: Dad jokes! Can’t help that.

Hymers: But there’s a load of other stuff going on. There are systems that are either completely new, like marketing, or that have been expanded on, like training. In Theme Hospital, training was basically a progress bar towards consultant, but in this staff get training slots for bespoke skills. They’re sometimes stat boosts, like ‘better at diagnosis’, or they’re about interaction with other characters.

A huge, probably late-game, hospital

How will you ensure Two Point Hospital is easy to pick up, without over-explaining things? Part of the reward in a management sim is to solve problems yourself, rather than have the solution spoonfed to you.

Carr: That’s our dilemma, isn’t it! There’s a fine line between too spoon-feedy and too nanny-statey. Right now we’ve finished the game itself – we’re feature-complete. So where we’re at now is purely balance and bug fixing, and that is the next ‘X’ months of development. These are the important months – it’s finding out what information we need to convey, and what would actually piss people off because we’re telling them too many things they can find for themselves.

Another aspect of that process from the player’s perspective is seeing how long a solution takes to work. What’s your goal there?

Hymers: The nature of the game is that it’s a sandbox simulation – it’s less ‘do stuff and see an immediate reaction’, and more ‘fiddle around with some things in the simulation and see how it pans out’. So you’ll never have an immediate ‘bang, I’ve fixed it all’.

Carr: To be honest with you, I’ve played the tutorial many times myself to three stars, and one of the things I haven’t got to the bottom of yet is that the longer you play, the happier people can get, and yet the more broken hearts [an icon indicating treatment has failed, and a patient is still unwell] you get. I suspect there’s a balance bug in there somewhere, because really that tutorial is only meant to teach people to build, move rooms around, use the camera, and navigate the menus. Then we give them a big fat star and move them on to something else.

So I suspect that level just run of feedback time from us, because we’re going ‘yeah, these guys are only going to play it for 45 minutes’. The fundamental problem is still there, we need to make sure that we keep playing, working out how much feedback is the right amount of feedback.

The receptionist, heart of your hospital

Do you have any unique challenges that we might not have seen in Theme Hospital?

Hymers: One hospital is like a state-run hospital, like an NHS company. Which is a crazy thing for balance, because it’s a whole different mechanic – there’s no money coming in!

Carr: You have a budget. Here’s your money – spend it wisely!

Hymers: We’re trying to get a whole bunch of variation in those scenarios and the illnesses you get in the different climates, the restrictions in build space, all of that stuff.

Carr: And these are massive differences. When you initially see the game, there’s kind of that resemblance to the original, but the original never went this way. The original’s just rinse-and-repeat, harder, rinse-and-repeat, harder, with a few more plates to spin. The state-run hospital is set in a fairly deprived part of Two Point County, in an industrial area that’s just been closed down, and we’re building story behind it. You’re not gonna get senior rockstar consultants coming anywhere near you because you can’t pay them enough. Or, you can, but that’s your budget, and then you can’t afford the machines they need.

A consultant gives a lecture during a training session

So if you can’t afford these people, and your job is to turn this around into a productive, maybe even profitable organisation, what you do is training – that’s the obvious answer. You train your juniors to be more efficient. Eventually they’re gonna move on anyway, because they’re going to say ‘well, now I’m a rockstar’ and leave, and that’s the real world. So we’re trying to put in these scenarios that change it up so you don’t think ‘this is the same game’.

Hymers: Each level is different, so you’ve got some variation in gameplay. And within each level, too – we don’t want it to be that you just build all the rooms the way you like, hire the people you like, and then hit fast-forward and leave it to play itself. We’re putting in all these situations within each game – the staff might be unhappy with their pay, for instance. There are all sorts of things for you to react to.

Carr: In fact, you can’t leave it, just because of the new personality traits. If you were to leave a game auto-playing, that just gets out of hand – you have situations where people get into fights with each other, or waste all their time chatting in the staff room together because they like each other, so you have to pull them apart and put them back to work.

Lightheadedness is an epidemic

Is that the main way we’ll deal with personality clashes on staff – dragging and dropping them apart?

Carr: It’s one way to deal with it. We’ve only unlocked minor traits in the scenario you’ve been playing, because we don’t want to overwhelm people with rows or romance in the tutorial, but they’ll crop up later in the game.

Hymers: You can restrict staff to rooms, stick them in separate rooms…

Carr: Keep one in one completely different building…

Hymers: …or have different staff rooms so they shouldn’t end up near each other. That’s a longer term solution.

Carr: Personality traits affect interaction with objects, too. I’m not convinced we’ve got the best solution for this, but you could have an absolutely brilliant surgeon who doesn’t wash his hands. We had this one amazing player – just really awesome, making loads of money, really efficient – but she kept putting the visualisation mode on, and all the staff were just filthy, flagged red for unhygienic. She said ‘why are my people down?’, and I said ‘well, you’re kind of killing them with your filthy staff!’

At first we were thinking ‘is it a bug? Have they all got the unhygienic trait?’ But she’d built this toilet, and it only had two cubicles, which is way too few. Even worse, she’d put no sinks in there, so we put visualisation mode back on and said ‘can we just put a sink in this room?’. Then all the staff just dropped what they were doing and ranto the toilet, and queued to wash their hands, and they all popped to green straight away.

But that’s the sort of stuff we want to do in the game, and when there are more levels and bigger levels, there is more machinery, so there’s more equipment that does different things, and it all interacts with the simulated characters. That becomes the challenge as it unlocks – we start with a few things, then we layer more and more on.

A large hospital under construction

Recent management sims have coped with the service model really well, with Planet Coaster and especially Cities: Skylines staying relevant for years by expanding with community content and official DLC. Is this your plan?

Hymers: Certainly we want to support the game with more content post-launch. We’ve not got firm plans to project what’s that gonna be, but we have ideas, and we’ve got analytics and telemetry in the game to tell us what people are doing, so we’ll monitor what people like. A hospital is an obvious choice, but almost anything can make a decent sim game.

Carr: And the more mundane, the better. Sometimes when fans say ‘hey, why don’t they think of these ideas’, and they’re all really sexy ideas, but they’re almost too sexy. You almost want a really dull idea, so you can really spin it.

Hymers: I keep mentioning that I’d like to do a Two Point Service Station. It sounds stupid, but service stations are good, they’re interesting!

Carr: If something’s already sexy and interesting, like a spaceship, all you’re gonna do is get people arguing about what spaceships are or should be like. But with a hospital, people have a more fixed view on hospitals, and then we’re really amping it. I think our world will be a bunch of potentially mundane things that we twist into something interesting or quirky.

It is a challenge. The challenge is going to be do you keep adding more to the one idea? We always had a plan to do more to it, but we want our world to feel like a world, not just a hospital world.

Hymers: That’s the idea of Two Point County. At the moment it’s a weird place because it’s mostly filled with hospitals, but it’d be good to have some other stuff.

Carr: The big idea is an integrated world of simulated concepts. That is what we want.

A cute little detail: janitors use dustbusters to bust ghosts

There are loads of great little details, in animations and humour, that you’ve said you’re keen for players to notice. Are you concerned that they might not have time to ‘smell the roses’, as it were, when the rest of the game demands so much of their attention?

Carr: There is a pause button! It doesn’t help you smell the roses, but it does give you that breathing space to look at the UI, maybe read stuff and sit back.

Hymers: It’s a hard balancing act. We’ve talked about how if you just let it run it will eventually descend into chaos, but we don’t want everything to explode if you just nip to the loo. We don’t want it to diverge so rapidly.

Carr: It’s all in the final tuning. I’ve left it running overnight and it’s been chaos, but equally, you don’t want to be able to come back next day, see you’ve made millions, and think ‘well, I didn’t need to do anything’. Maybe the sweet spot is somewhere around two stars, where you should have that moment to breathe, but if you’re going for three stars it is gonna be a bit full-on.

Hymers: Yeah, it’s as difficult as you make it. If you’re into micromanaging everything to a super level of detail, if you take your eye off that then you will see it decrease.

Carr: The more things you put in the world, the more the simulation reacts to those things, and thus more things will happen – both positive and negative – that you need to manage. Some people will just put down what they can cope with, but if you can cope with more, then put more things in! See if you can deal with it.

Again, it comes back to balance, and it’s down to Ben [Huskins] and Mark [Webley] to get those numbers right. So if we fail, it’s their fault. Print that!