Publisher: Victory Point Games
Designers: Scott and Anna Nelson
Artist: Chelsea Autio
Genre: Cooperative hospital management game
Players: One to five players
Playing Time: 60 to 90 minutes
TGG Outside the Box
Plenty of gamers out there still seem to have a misconception Victory Point Games only produces wargames and conflict simulations. In reality, although VPG still cranks out great wargames, they’s been quite few releases over the last three years which completely destroy the myth “the little company that could” just produces historical battle/consim titles. With the release of Healthy Heart Hospital, gamers will one again be reminded VPG tackles a lot of different genres and usually does so with aplomb.
Healthy Heart Hospital (HHH from here on out) simulates the operation of a down-on-it’s-luck healthcare facility as it aims to re-establish itself as a premiere provider in the medical community. Up to five players cooperate together to cure patients, increase profitability, and boost the prestige of the hospital. Some may wonder if this is a heavy hospital simulation but, truth be told, I’m not sure how you could pull that off in a board game in the first place; that’s much more in the realm of PC/Console games to crunch those sorts of numbers and models. HHH is more a game looking to provide a feel of operating a hospital while focusing on those three core goals previously mentioned.
Upon opening the box gamers will be pleased by the component quality as the cards, cubes, and counters are all top notch. The game board is attractively laid out and really drives home the hospital flavor of the game. I’ll mention I do wish VPG had gone the way of their jigsaw cut, heavier game board here as opposed to just thick card stock. Then again that probably would have boosted the MSRP of HHH a bit higher than the company wanted to go, so they went with the card stock is my guess. Maybe VPG will offer a heavier game board in the future?
The cards represent doctors, administrators, expansions or improvements to the hospital, as well as incoming patients to the hospital waiting room. A variety of counters are included for the different game board tracks, training available to hospital staff, employees who may be brought on board, ward abilities, hospital beds, and more. The rules clock in at twenty pages and are clearly presented with plenty of examples of play.
The driving mechanic behind HHH is drawing different colored cubes, which represent the patients who being treated – or waiting to be – as well as the success or failure of said treatments. At first glace gamers might assume HHH falls squarely (no pun intended) into the realm of Eurogames when they see the cubes. Actually the cubes simply replace dice to provide randomization while also allowing for a set number of possible results without being utterly and completely random. The colors represent infectious disease, psychiatric, internal medicine, cardiology, and trauma. There are also black cubes which, for the most part, actually worsen the condition of patients already in wards or expansions.
Players begin the game by randomly assigning abilities to wards, randomly selecting five bed tokens (indicating patients already admitted) and setting them in the wards corresponding to the token color, selecting four doctors and an administrator, setting the money and prestige markers on their appropriate track positions, randomly placing the training and hiring tokens on their tracks, and creating an Ambulance draw deck with eighteen cards. Finally place all the rest of the tokens and markers to the side for later use.
It’s important to look at the patients who have already been admitted before choosing your doctors since not having staff who can immediately provide bonuses to treatment can put you behind the eight ball early on. Granted some doctors and administrators work better together than others so you might want to temper your desire to tackle all the types of admitted patients will who might work alongside each other best. On a side note, I found it interesting that much of the retro style artwork for the doctors and administrators is modeled on famous actors from the 1960s and 1970s. I can’t tell you why Maggie Smith, Marty Feldman, Terry-Thomas (the actor from It’s a Mad, Mad, Mad World who’s name I couldn’t remember in the video above), and even Bruce Lee are represented but it is kind of funny.
There are quite a few moving parts within the design so rather than simply rehashing the rules (which you can download here) let’s focus on the main gist of HHH.
Each game consists of nine rounds which are broken into three phases: Ambulance Phase, Player Action Phase, and Housekeeping Phase.
During the Ambulance Phase players will draw two Ambulance cards, one for each side of the waiting room/triage and colored cubes are drawn to indicate new patients arriving as well as the worsening condition of patients who are still waiting to be admitted. The cards will show you how many cubes to draw for each side. The cubes of each color don’t represent individual patients but the severity of a patient’s ailment; i.e. three blue cubes aren’t three trauma patients but a single trauma patient with a illness severity of three. Illness levels run from one to six. Normally level five means death, unless the patient is in an operating room, whereas then level six means they buy the farm.
Additional cubes drawn on subsequent Ambulance Phases will be added to existing patients in the waiting room. If you don’t admit these patients eventually they’ll die so it’s in your best interest not to sit there and allow patients to stack up in the waiting room..
Players also make their rounds with the patients in the wards and a cube is drawn to see if their conditions have worsened.
Once the Ambulance Phase has been completed it’s time to move on to the Player Action Phase and this is where the real meat of the gameplay lies. Doctors and the administrator may now perform a variety of actions including hiring additional staff, assign staff, build upon or upgrade part of the hospital, perform research, train a doctor, transfer a patient from one area of the hospital to another, use a special action unique to a doctor or administrator, or – of course – try to cure one of the patients. Doctors have two actions while administrators normally have one action and a chief of staff token which can be used for particular actions. You may also have shared actions which the players need to agree upon before performing. If players can’t agree on how to use a shared action the administrator player makes the final call.
Patients who are in a ward or expansion to the hospital may be treated; patients in the waiting room may not since, well… they’re waiting. Trying to heal patients should be a major priority and is done so by drawing cubes. The active player will draw a total number of cubes based upon where the patient is located plus and bonuses which may be associated with that area or doctor providing treatment. For every cube matching the color of the illness drawn the illness level is reduced by one. Each black cube drawn negates the curative effects of a single matching cube and, in a worse case scenario where no matching cubes were drawn, worsens the illness by one. The hospital collects money for every level improvement while completely curing a patient earns cash and prestige.
Once all the players have used their actions the round moves to the Housekeeping Phase. In effect this is mainly a reset phase to prepare you for the next round but, depending on certain staff and doctors, you might have some additional special actions available. Also patients who are in an operating room, and were not treated this round, will move one step closer to death.
Play continues through nine rounds unless A) you run out of money or B) you have no place left to “hide bodies” – more on that in a second If you’ve made it through the rounds, which means you have no Ambulance cards left, you’ll calculate your victory points to see what level of success you’ve achieved. If you’re out of cash then you’re out of luck and you lose as a new medical team will take over operation of the hospital. If you can’t sustain any more fatalities you might sort of win as you’ll calculate those VPs but take a substantial hit on the total.
Here are a few thoughts to keep in mind as you play Healthy Heart Hospital:
It’s important to understand what constitutes a patient. Newcomers to the game sometimes have to take a few moments to wrap their heads around the fact cubes in the waiting room are patients, bed tokens are patients, and EKG monitor tokens in the hospital expansions are patients as well. Since you’re juggling a lot of decisions and actions your team’s focus should be on treating patients in the add on rooms, then the wards, then admitting those in dire need in the waiting room.
Death! Yes, this is a hospital and people do die in hospitals. Every time someone dies in HHH you’ll take a monetary and prestige hit. You’ll track these with tombstone tokens and, as the track fills up it, the hit you take becomes more costly and even more so depending on where the patient is at the time they expire; someone passing on to the great beyond in the waiting room is bad but if they do so in an O.R. it’s much worse. Strangely enough this fatality tracking is considered to be “hiding the dead.” There are also ways to increase the number of tombstone markers you can sustain but calling it “hiding the dead” seems a bit silly and a touch morbid. Regardless of what it’s called just consider it to be damage control from the hospital’s P.R. department.
Pay attention to the cubes! HHH is not an easy game to win by any stretch yet the difficulty increases tremendously if you don’t pay attention to how cubes are discarded or returned to the draw cup (or bag) when treating patients. During the healing action players are allowed to return a number of cubes to the draw equal to the number of bonus cubes they were allowed. Let’s say for an example you have a single blue (trauma) patient you want to treat early in the round. Your doctor is attending to that patient and was able to draw eight cubes, including a bonus of four cubes. You hit a stroke of good luck and pulled four blue, one black, and three non-applicable colored cubes. The patient had an illness level of three and, once you allow for the black cube negating one of the blue, you’ve been able to cure the patient. Hooray! Collect your money and prestige. Now you get to put four cubes back into the draw so what do you do? Obviously, you discard the black cube and three of the blue cubes and put the other four back into the draw; you don’t want to pull blue cubes anymore, since you don’t have any more trauma patients this round, and black is nearly always bad (outside of a hospital chaplain praying for a miracle) so you don’t want to be drawing that again either.
Tracking cubes which are discarded, or sitting in the waiting room, and what you’re returning to the pool is crucially important as each round progresses. Since there’s so much randomness built into HHH players need to try and shift the odds into their favor wherever possible in order to make a go of things.
Lastly, HHH is a cooperative game and it’s mighty important the players do cooperate. Upon first sitting down to play don’t be surprised to find yourself muttering “Homina, homina, homina…” under your breath as analysis paralysis kicks in; there’s so many things to do, and only so many actions available in a round, so much so where it becomes easy to feel overwhelmed. You need to cure the sick, while improving the hospital, while making money, while building prestige and it’s a very interesting balancing act as you try to pull it all off. I recommend just getting a feel for the rules during the first couple of playthroughs or, at least, having one player tackle the game solitaire so they can explain HHH to everyone else.
Because the players have so many things on their plates at one time, and a lot of randomness and luck are built into the HHH design, some gamers might get a little frustrated when the wrong cubes get pulled or another player spends an action on something the group doesn’t want. It’s nothing to get worked up over and it’s the right of everyone to do their own thing with the actions allotted to them. Truthfully, every single player is going to hit streaks of good and bad luck in HHH and taking the wrong action at the wrong time usually isn’t going to make or break the game. Plus, I’d rather take on a co-op where the players make their own call from time to time as opposed to one where a single player is trying to call the shots for everyone.
Keep in mind HHH is easily played solo (and works extremely well too) for those who aren’t especially keen on cooperative games.
I happen to like HHH quite a lot and the theme of taking on the operation of a struggling hospital really shines through. I can’t say you’ll play the game and then instantly walk into your local medical facility to take charge (you’d have to stay overnight in a Holiday Inn Express to do that) but you might find a new appreciation for healthcare professionals you never had before. Strange as it may seem as you play you’ll start looking at those cubes, bed tokens, and EKG monitors as more than simply markers. Sure, there’s tons of luck involved but that tends to be a fixture of VPG titles. There are a lot of challenges to overcome every time you play and even a marginal victory always feels hard fought.
Can you manage a hospital back to the heights of medical excellence or will you be forced to shutter the doors as protesters and national media call for your heads on pikes? Pick up Healthy Heart Hospital and find out!
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