Theme Hospital starts off with an intro of the kind of backstory usually used for facility/utility management games - the establishments concerned are down and out, and in need of a fresh, steady hand in guiding them out of their doldrums.
The game proper begins with a very simple first stage, with only the most fundamental facilities available to the player. There is the usual drag and drop mechanics often used to allocate space for facities, a mini-screen showing updates and developments in the current hospital under the player's management, etc. All in all, the game does a more than decent job at designing the user interface.
Hiring and managing employees is just as simple; the player gets to see the profiles of prospective doctors, nurses and handymen through pop-ups that are easy to navigate. However, much of what is in this screen is useless info, with the only details that matter being the overall skill of the potential employee and in the case of doctors, any specialty that they have. The useless stuff feels even more redundant when the game frequently recycles descriptions, photos and even names.
Fortunately, despite employees having non-descript in-game models and next-to-no differences in resumé details, the game does have a useful employee manager tool that allows the player to sort their employees around according to their skill levels, salaries and specialties, as well as prioritizing (or de-prioritizing) tasks for them. There is also the amusing option of picking them up and dropping them elsewhere in the establishment, which is very handy when the player needs to respond quickly to urgencies or quickly dump some fatigued employees in the Recreation Room.
Speaking of rooms, unfortunately, the design of the facilities are not as well thought-out as the user interface. Every machine (and its related auxiliary machines) requires its own room to be used. Unfortunately, the game lacks features to notify/warn the player that the room being created is large enough for the machines on hand, or that a machine that has been placed may be out of reach of employees or patients. Re-editing the room is the only solution, but even this cannot be exercised at every circumstance as will be explained later.
Furthermore, where it is possible to place multiple machines in one room, the AI for employees is such that the player's doctors may not be smart enough to make use of the redundant machines to treat multiple patients at once. The only way to treat multiple patients with the same disease is to build multiple facilities, each with its base costs that could have otherwise been mitigated.
There are many diseases to be treated in the game, but only a few have actual symptoms that show on patients' models. Even so, sending these patients to the related facilities for cure/treatment immediately is not a sure way to heal them - there's an odd "Diagnosis Accuracy" rating that prevents players from exploiting any indications that patients have specific diseases; forcing the patients to be cured anyway may result in their deaths, which causes a major hit to the reputation of the establishment and hefty fines. This is especially cumbersome during epidemics (which will also be explained later), where rapid treatment of the afflicted patients are important.
Fortunately, this problem is mitigated somewhat by the wise inclusion of R&D in the game. Doctors with research skills and the right facilities can steadily improve the efficacy of the treatment of specific diseases, even to the point where accurate diagnosis is not necessary for successful curing/treatment. However, this is just about the only benefits of research - for some reason, discovery of the research facility by patients results in a hit to reputation.
All these ingrained setbacks would be completely manageable, if not for the inclusion of unfortunate events during a session. One of the worst events are epidemics, which may occur spontaneously and result in patients getting their diseases replaced with that of the epidemic, throwing diagnosis procedures all over the place. Sending nurses to inoculate patients may stall the outbreak, but eventually players would realize that with the only outcome of this event that has actual reward being reliant on having all afflicted patients removed from the premises, cured or otherwise, players would proceed to forcibly evict every affected patient quickly. It's a very cheap solution, whose main cause is the poor design of such an event.
The other terrible event is earthquakes, which serve no other purpose than to hurl a huge wrench into the works of the player's hospital. There is absolutely no reward for handling this well, and the only thing that the player can look forward to are wrecked machines and facilities. It does not help matters that the game sometimes stacks these bad events together.
The most aggravating occurrence during gameplay is likely the destruction of machines due to earthquakes or wear and tear. It would have been all fine and dandy if these machines can simply be replaced and the rooms that they are in all cleaned up, but for some reason these rooms are rendered completely inaccessible and useless. There appears to be no clear remedy to this, and this reviewer had to resort to earlier save games to prevent the disaster; this was definitely not a fun and intuitive solution, and only served to reinforce the sense that Bullfrog had not been careful enough in its game design.
Make no mistake, Theme Hospital can be a very hard game if the random event generator does not favor the player. Hard-earned cash (from having cured patients or receiving rewards from the authorities) can be vaporized away no thanks to unprecedented mishaps that cause the deaths of many patients in one go. Such disasters often result in the reload of a previous saved game, which is never a nice thing to do as stated earlier.
Animations in the game are decent, and often amusing in the case of the wackier diseases, but the game does suffer from an all-too-obvious lack of facial animations for the clearly human models in the game. This should not matter much, considering the splendid enough animation of other body parts of every model for the all sorts of things that they do, but it is starkly apparent when there are dozens of models on screen, having the same expression and more often than not the same face when they go about their business.
The sounds are perhaps more detailed and more thoroughly designed than the graphics. Every disease that has peculiar symptoms of its own are cured with their own animations and noises, increasing the satisfaction of having cured such patients. The hospital announcer (the Receptionist in this case) is particularly note-worthy. However, the game can become overwhelming if there are a lot things occurring on screen.
In spite of all these flaws, Theme Hospital is a refreshingly different micromanagement game that would be worthwhile to play, though difficult for this reviewer to recommend to others.