Michael Eckenfels, 9 May 2019
The idea of running a hospital might not sound like an exciting one. Dealing with things such as insurance, billing, costs, pharmaceuticals, and of course those pesky dead patients, doesn’t exactly scream ‘fun.’ (Just add the so-called “Affordable Care Act” to the mix and see how unbalanced your enjoyment could possibly be.) Hospital games aren’t exactly new, of course (Theme Hospital, Emergency Room, and so on), but most of the ones I’ve heard of are all for playing on a computer, not on a tabletop.
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When a copy of Healthy Heart Hospital by Victory Point Games became available, though, it was intriguing to me not only because I hadn’t heard of too many games along the lines of running a hospital (and yes, I know, just search BGG with the term “hospital” and several pop up – I just hadn’t heard of any of them), but also because I worked as a paramedic many years ago and had spent a lot of time in a lot of different hospitals, care centers, nursing homes, and other such places.
click images to enlarge
Healthy Heart Hospital (hereafter referred to simply as HHH) is a game where one to five players get together to take on various doctor or administration roles in an attempt to turn around a failing hospital. Each player (or just one player, as it supports solitaire play just fine) can either randomly draw a character card or choose one, and prepare themselves for the onslaught. This game pretty much is in line with how it is in an ER when there’s a full moon out – it can get crazy sometimes.
HHH is made up of several sections, along with possible expansion ‘slots’ along the side. Patients enter the hospital one way – through the Waiting Room/Triage area – and can exit one of two ways. One is after being cured, which nets a cash reward and a Prestige improvement, while the other results in a body bag and possible payment for damages and loss of Prestige.
The entry point to the hospital is here, where you draw two Ambulance cards each turn (one for the Left Triage Entry and one for the Right Triage Entry). These cards determine the number of colored cubes you draw, and the cubes you draw are assigned to the colored chairs next to them.
Each chair color (yellow, blue, etc.) represents one patient with a specific malady (yellow is infectious diseases, blue is trauma, and so on). There are five different Wards, though they are also referred to as an infirmary, but this isn’t made really clear in the manual. There are a few things that aren’t exactly explained in the manual, which made me go to BGG or YouTube to find my answers. There were not many instances of this, though. The manual also has a LOT of white space on the pages, and the font is small, which doesn’t really make sense; it would have been better to make the font type larger, making it easier to read, and also make the manual look like it’s not wasting a lot of space.
The more cubes assigned to a chair, the worse off that patient is. If a patient is associated at any time with five or more cubes, they die, which results in bad things for HHH. Get enough dead people in your hospital and the game will end. So, your main goal is to do your best to move patients to where they can be treated, hope like heck you can heal them, and get them out the door so you can get paid and gain some Prestige for your hospital, which already has a reputation as being a place people go to die.
You know, kind of like a real hospital.
When you start a game, you have $5, no Prestige, and five Wards (I’ll just call them that for now). Each Ward is color-coded and has space for four patients. Moving patients from Triage to a Ward (or anywhere else) costs Actions. If you move a patient from Triage to a Ward, their cubes are discarded into a cube discard pile, and a bed numbered from 1 to 4 is selected (the number matching the number of cubes). The Wards will, incidentally, only accept a patient that has three or four cubes’ worth of illness. The ones and twos are just going to have to suffer for now, at least until you can expand your hospital later. You can’t do that in the first Turn, because you just don’t have the money.
Besides doctors (up to four can play each game) and administrators (only one can play each game), you can hire others to help out around the hospital. The Job Line in the image above is where counters go for exactly that purpose. Spending $5 and an Admin Action (more on the types of Actions in a bit) will get you a face-up marker from the Job Line that you can use. Sometimes, this can be a specific person, such as a Chaplin or Lawyer. Each one provides a minor boost to your hospital. You can only ‘hire’ counters from the Job Line that are turned up, however, and the number of counters that are turned up depends on your hospital’s Prestige. The more Prestige you have, the more hireable folks will come visit looking for work.
Prestige is an important thing, because it serves as your score. The higher your Prestige, the better in that regard, because it also translates to more options in the game itself (such as from the aforementioned job line). You can gain it by curing patients in Wards or in Areas you’ve added on, and the amount you get is multiplied by a Patient Value (PV) of the area they were cured in. The PV value of Wards is 2, which is the first line of defense of your hospital. Other Areas that you can add, such as an Operating Room in one of the five colors, add much higher PV values to this multiplier, giving you bigger rewards (and motivation to save up to build them).
Cash is also an important thing. You need it to hire counters, to build Areas to help you serve your patients, and to cover your rear when they end up dying, among other things. You get $1 for each level you heal a patient (so, healing a four-cube patient means $4 added to your coffers), multiplied by the PV value of the Area they are healed in. In the Wards, that PV is of course 2, so a four-cube patient healed of all four levels means $8, a tidy sum.
Note the Cemetery in the screenshot above. There are six tombstones labeled with costs on them. Each time you add a Tombstone to one of these spaces, you have to pay that much cash…which might not seem all that expensive, but this cost is multiplied times the PV value of the Area they croaked in. If a patient dies on the operating table in an Improved Operating Room, that’s a PV of 4. If you already have three people buried in your Cemetery, the next one costs you $10, and multiplied by 4…yeah. It can clean you out fast.
You can cash in Prestige to cover costs like this, but only involuntary ones (not for building Areas), and it nets you $1 per two points of Prestige you trade. So not only can you run out of money fast if you don’t manage things rights or luck is against you (or both), your Prestige can drop like a stone, too.
Your hospital isn’t entirely empty at the beginning of the game. A random number of bed counters are drawn and placed according to their color, already filling in your Wards. Keep in mind that if a Ward is full, you can’t put new patients in there, which means you’d better have other Areas you can put them in. Otherwise, they might die in your Triage area.
As mentioned, patients are rated from one to four. They can actually have a fifth level, if they’re in an Improved Operating Room. If they’re not in one of those, or in another area, a fifth cube will mean their death. You’re always confronted with patients getting sicker, and deciding how you can shuffle them around the Wards and Areas to best accommodate incoming patients, while hoping you have enough Actions to heal patients so they can get out the door and make room for new ones. It’s a juggling act, one that will ultimately work against you, because the challenge ramps up quite a bit the further into the game you get.
Oh, yes. Wards aren’t just plain vanilla, for the most part. Each one gets a Ward Ability at the start of the game. These can be helpful, or a royal pain. And you’re stuck with them, for better or worse, unless you have the one Administrator that can change one. Otherwise, a bad Ward Ability can ruin your game if you don’t stay on top of it.
Let’s talk a little about your staff. While hospitals can be a hotbed for drama (though in my experience, hospitals are a lot more like Scrubs than they are something silly like Grey’s Anatomy), in HHH, they all work together well…at least, as well as they can when you have multiple players around the table.
If you play solitaire, you don’t have to worry about arguments or bickering…and you only ultimately have yourself to blame. When you have more than one player, though, the game is technically cooperative as you’re all working for the same goal. There is no individual scoring nor is there an individual winner – you either win the game, or lose it. There is a scale that you can compare your Prestige score to, to see how well you did, but ultimately, it’s a win/lose proposition. I say ‘technically’ when it comes to multiplayer games, because the player with the Administrator is one that can make decisions to break deadlocks that might come about among the other doctor players during gameplay. These usually revolve around where to assign a Training counter, which helps enhance a doctor’s ability.
Sometimes, players might not agree on the best use of resources, so the Administrator will find themselves making the final decision in some cases. Playing solitaire means you can argue with yourself to your heart’s content.
You can select whomever you want to play from the cards at start, though that might itself entail arguments over who gets to play whom. The rules allow for random drawing of cards too, to determine where roles go. I think this also makes the game even more luck-based, as some of the character cards can provide good bonuses.
For instance, there’s a doctor card for each of the five colors, and they have a special ability that helps them heal patients in those Wards (or Area). They can also make it a lot cheaper to build an Area for a particular Operating Room for that color. For example, the aptly named Doctor Aorta makes a Cardiology Operating Room Area cost only $6, instead of the normal $10. And she gets bonus draws when trying to heal Cardiology (red) patients.
There are some doctors that are not aligned with the Ward colors, such as Doctor Lucky, whom can build a Morgue for a discount, and can hide one dead body for free (though, only one, and there’s a space on the board for that dead person’s Tombstone marker, so once It’s filled, that’s that).
The game begins with 18 Ambulance Cards, which are randomly chosen from a deck of 25, making each game a bit different. Since you draw two of these per turn, you’re playing nine turns total if you’re lucky to get that far in the game. The rules aren’t terribly clear with how many you draw; the Sequence of Play says to draw one Ambulance Card, while the rules explanation says to draw two. The latter makes more sense since there’s two Triage areas for these cards to go in, so I think maybe they meant to say that this first part of the Sequence of Play should be done twice.
There’s quite a bit of tension with pulling cubes from your opaque cup. You draw cubes to fulfill the incoming patient requirements from the Ambulance cards, of course, but you also draw cubes during Rounds. You have to complete Rounds immediately after you add cubes to your Triage area. This is essentially the part of the game that can really mess you up. You go to each admitted patient (not the ones in the Triage area, but the ones in every other area), and draw one cube for each patient. If the cube matches the color of the patient, their illness level increases by one. Patients in a Ward with a ‘4’ that get a similar cube drawn immediately die.
After Rounds (and dealing with any patient deaths that may have happened), you can then complete Actions. There are two types of Actions – Medical and Administrative. Doctors get two Medical Actions each turn, while Administrators get one Admin Action. Administrators also get the Chief of Staff token, which can be used as another Admin Action or to use one of their two special abilities. The rules refer to this initially as a “Chief of Hiring” marker, which is confusing, because you’d think it only applies to hiring…though the marker clearly says “Chief of Staff.”
Another Action you can take is to build Areas. This includes Operating Rooms, of which there is one matching each color. These rooms let you draw more cubes when trying to heal patients. You can improve them to be even better, allowing more cubes to be drawn, and granting a higher PV bonus (or penalty, as discussed earlier). There’s also a Morgue, which gives you a little more wiggle room when it comes to those annoying dead patients, a Research Lab, which makes it easier to improve training, a Clinic that you can move 1- or 2-level patients to (those that aren’t as sick as the 3- or 4-level patients in your Triage area), an Emergency Room, and a Break Room.
Another Action type is, of course, healing. This will be the big one as you’re in the business of making patients better (and therefore, making money off of them, and gaining some Prestige to boot to show the world your hospital isn’t just a really large funeral home). Healing means drawing cubes from the cup. If you draw a cube that matches the patient’s affliction color, their illness level drops by one for each such colored cube. However, if you draw a black cube, they actually get one level worse. This is where bonus draws come in handy, because it’s never fun to draw 13 cubes (10 for an Improved Operating Room, +2 for a similarly-colored doctor’s special ability, and +1 for Training) and only get one matching cube to the illness…plus a black cube.
Interestingly, the number of Actions you have might work against you. As you draw cubes from the cup, most are discarded off to the side. These discarded cubes are added back in if either you run out of cubes during a turn, or at the end of a turn. As more cubes come out of a certain color, your chances of healing that color become less and less, since there are less matches. If you don’t pull out a number of black cubes, this increases your chance of bad things happening, as well. The game is driven by the cube draw, and this means a lot of randomness. In the end, it means the game is essentially a luck-fest with you going to and fro, trying to deal with the bad luck that radiates from bad cup draws. Some people might not find this to be their cup of tea, but I enjoy the random nature of the cube draw. Your mileage may vary, especially after you’ve drawn one of those blasted black cubes and only one cube that actually matches your patient’s malady color.
Keeping your head above water becomes more and more challenging as the game progresses. As patients get more and more ill, you’re faced with tough choices – do I try to heal the patients that aren’t as sick to get some quick cash so I can buy a new Operating Room, or do I try to reduce the sickest patients’ illness levels so they don’t possibly die next turn? It’s a tough call sometimes, though most of the time it’s pretty clear what you need to do. As the game progresses, though, this path becomes less and less in focus and more nebulous, because you’ll have more patients in Wards that are getting sicker and sicker, so your choices become much more difficult.
You’ll always want to keep an eye on the bottom line, because going broke will end the game. So too will having a dead body with no space in the Cemetery or Morgue (if you have a Morgue…you built one, didn’t you?). The only other way to end the game is by running out of Ambulance Cards. If you survive this long without losing all your cash and Prestige, you’ve done a pretty decent job.
The epilogue in the rules, though, may beg to differ, as you compare your final Prestige score against it to see just how well you did. This can range from turning HHH into a “beacon of hope for the community, state, and nation,” all the way down to having an “endless parade of protesters, news cameras, lawyers, and other undesirables” besieging HHH and forcing you into an early retirement.
Being Bob Kelso from Scrubs (“Who has two thumbs and doesn’t give a crap? Hi, Bob Kelso, nice to meet you”) might be a good way of being able to deal with things in a real life hospital, such as daily death, sickness, sadness, and despair, along with hope, miracles, and lucky guesses, but in Healthy Heart Hospital, this attitude won’t get you far at all. As a solitaire game, it works very well; as a multiplayer game, it is a good exercise in social activity, as any cooperative game is, which is why I prefer them to competitive games, actually.
Healthy Heart Hospital requires a lot of luck, good management skills, and a lot of juggling and balancing to win, and you certainly won’t always come out ahead. The tension in this game is palpable as it progresses, giving even small victories a force multiplier like you wouldn’t believe. If you enjoy health-themed games and like something that gives you the flexibility to play by yourself or with other players, Healthy Heart Hospital would be a good addition to your game library.
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