Rhine Hospital — Guide

First steps

Three things, and you are in business:

• 1. Buy the licence (12,000 €): Without the health-insurance licence the hospital stays closed — no patients arrive, but your reputation does not suffer either. The state simply rests.
• 2. Hire a doctor: Nobody treats without a doctor. There is always at least one doctor among the applications that you can afford — if need be a modest country doctor at 8 €/hr (hiring fee then only 192 €). Important: assign the doctor to a room, otherwise he earns nothing.
• 3. Patients arrive by themselves. Each one brings a treatment plan (e.g. consulting room, then lab). Tap them in the waiting room and send them to the room. You only get paid on discharge — so always discharge finished patients!

With the licence and the cheapest doctor you are looking at roughly 15,000–16,000 € in start-up costs. Keep some reserve for wages and supplies.

Practice rent

From the moment you buy the licence, the practice rent of 150 € per day is deducted, second by second, around the clock — even when nobody is on duty.

Reassuring: you can never go into debt. If the cash box is empty, deductions stop at 0 and you only get a warning. The same applies to wages — your team then waives part of their pay. Still: an empty cash box is not a state your reputation deserves.

Staff: doctors, nurses, cleaners

Three professions, three jobs:

• Doctor (wage 60 + 120 × speed, i.e. about 120–234 €/hr): treats everywhere. In some rooms (consulting room, orthopaedics, psychotherapy, operating theatre, intensive care, emergency room) only a doctor treats.
• Nurse (35 + 70 × speed, about 50–70 €/hr): cheaper and slower; in doctor-only rooms she just speeds things up, in all other rooms she treats patients herself.
• Cleaner (13 + 1.1 × hygiene points, about 19–27 €/hr): keeps hygiene up and thereby prevents losses.

The one-off hiring fee is hourly wage × 24 — a 150 € doctor costs 3,600 € up front. New applications arrive every 20 minutes on their own; re-advertising immediately costs 200 €.

Character traits matter: a “rookie” is cheap but slow — ideal for the start. An “old hand” is expensive and fast. “Good with kids” and the “clinic comedian” bring extra reputation, “grumpy” costs some, “meticulously tidy” goes easy on hygiene.

Training (3 levels: 3,000 / 9,000 / 22,500 €) makes a staff member permanently faster (+0.15 / +0.18 / +0.22 speed) and slightly better for your reputation. During the 8 / 16 / 24 hours they are out of the building while their wage keeps running.

Shifts: staff every room per shift!

Nobody works 24 hours straight. Every staff member has a shift: early 6–14, late 14–22, night 22–6 or day 8–18. You only pay wages for duty time (including the 5-minute break per hour).

• Whoever is off duty treats nobody — but costs you nothing either.
• If nobody is on duty, the hospital is closed: no new patients arrive, and there are no reputation penalties. Sleeping is never punished.
• A room’s slots count per shift: each shift can hold as many staff as the room has upgrade levels. Two doctors on different shifts therefore always fit into the same consulting room — that is how you cover a room early, late and at night with one person each.
• At night (22–6) only about 35 % as many patients arrive — a night shift only pays off once daytime runs smoothly.

Rooms and floors

Every floor has 4 building plots. New floors are unlocked by level and then purchased:

The treatment rooms (base income per treatment at level 1; 🩺 = only a doctor treats here):

Upgrading pays twice: level 2 gives speed ×1.18 and +8 % income, level 3 speed ×1.39 and +18 % income (treatment time ×0.85 and ×0.72). And: treatment slots = room level AND staff. Each person on duty enables one slot — a level-2 room with only one doctor still treats one patient at a time. Without staff a room crawls along at speed 0.45.

Floor 6 holds pure comfort rooms (café, kiosk, winter garden, mini golf, levels 40–45): no income, but lots of attractiveness and patience. The lift (upgrades 75,000 / 300,000 / 1,000,000 €) cuts the walk per floor from 26 to 18 / 12 / 7 seconds — the higher you build, the more it matters.

Supplies

Every treatment consumes supplies (see the table above: consulting room 1 unit, operating theatre 30, intensive care 45). You start with 90 units; the store initially holds 500 (upgrades to 850 / 1,200 / 1,800 / 2,600 units for 12,500 / 40,000 / 120,000 / 325,000 €).

• Packages: 100 units for 130 € (1.30 €/unit) · 500 for 575 € (1.15 €) · 2,000 for 2,000 € (1.00 €) — bulk pays off.
• No supplies means improvising: every treatment takes ×1.8 as long and earns only ×0.6. That is the most expensive mistake in the game — never let the store run dry.
• Supply contract (25,000 €, from level 3, after 5 manual orders): a permanent −5 % on every order, and the supply service automatically reorders once the store drops below 25 %.

Canteen & supply deal (linked with the farm)

From the moment you own the licence, your hospital has a canteen: every arriving patient gets a little something — 1 egg and 0.26 l of milk, goods value around 0.54 € in total (wholesale base prices: egg 0.30 €, milk 0.90 €/l).

• Without a deal everything is automatic: the bulk caterer delivers at a +25 % markup, i.e. about 0.67 € per patient. Nothing for you to do — the canteen is optional comfort, never a chore.
• What does it cost? A young hospital (reputation 20, ~19 patients per hour) pays about 12–13 € per operating hour via the caterer; with one day shift (10 duty hours) that is roughly 125–130 € per day. Billing is per patient: if only a third as many people arrive at night, you only pay a third. As with rent and wages: no debt is ever created — if the cash box runs dry, deductions stop at 0.
• Supply deal with a player farm (shop tab, card “🚚 Canteen supply deal”): farms offer eggs and milk; you pick a daily amount, after which deliveries arrive automatically every day, paid from the hospital cash box. Sign once and you are done — cancel any time, one deal per good.
• Savings are capped: compared with the caterer you save at most 25 % (at the full need of a 10-hour hospital up to about 32 € per day). If the deal price is even lower, the difference goes into the kitchen’s own effort — the deal stays a bonus, never a must.
• Cash box empty on booking day? The deal is suspended (clear notice in the game, the caterer steps in). As soon as there is money again, the farm delivers on; after 7 missed days in a row the deal ends by itself.
• Bonus: if the deal covers the full daily need of both goods, you get +0.04 reputation per discharged case (0.16 instead of 0.12) — reputation grows about a third faster. Buying more than you need achieves nothing: the surplus goes uneaten.
• 🥐 Breakfast service (optional, since 30 Jul 2026): a switch on the canteen card — strictly optional, off = everything exactly as before. When on, every arriving patient gets half a bread roll on top (base price 0.52 € each): via the caterer 0.325 € per patient, so about 62 € per day for a young 10-hour hospital (~19 patients/hr). A bread-roll supply deal with a farm makes that up to 25 % cheaper, just like eggs and milk (saves up to ~15.60 €/day) — and, as long as the service is running AND the deal covers the need, adds another +0.04 reputation per case: together with the canteen bonus +0.08, reputation then grows at 0.20 instead of 0.12 per case.

Reputation: your star rating

You start with reputation 20 (one star) — nobody knows your hospital yet. Reputation decides three things at once: how many patients arrive, how much they pay (payment factor 0.85 to 1.20) and how patiently they wait.

How it rises: +0.12 per treated case (staff like “good with kids” add extra, good hygiene +0.05). How it falls: a patient walks out −0.8 · waiting room full, patient turned away −0.25 · waited too long −0.10 · poor hygiene −0.12 per case. A single walk-out eats the reputation of almost seven treatments — waiting times are more expensive than they look.

High reputation also attracts the heavier, more lucrative cases.

Hygiene and cleaning

Every treatment makes a mess (−0.26 percentage points). If hygiene drops below 50 %, treatments take 10 % longer; below 30 % it is 22 % — and your reputation suffers on top.

• Your own cleaner: permanently adds +5 to +13 percentage points per hour — the long-term solution.
• External firm (“deep clean”): 0.65 € per missing percentage point, paid on ordering. They do not work magic but clean their way up at 5 percentage points per minute while the hospital keeps running.

Waiting room

You start with 2 seats; every additional chair is bought individually and gets more expensive: 500 → 1,000 → 1,750 → 2,750 → 4,000 € and so on, up to a maximum of 16 seats (the last chair costs 120,000 €).

If the waiting room is full, new patients turn away — every rejection costs 0.25 reputation. Each additional seat also makes the people waiting a little more patient (+4 % per chair).

Self-intake and reception: the hospital without you

Without any upgrades you assign every patient yourself — and while you are away, the hospital only manages a minimal 5 % of its output. Two upgrade paths change that:

• Self-intake, 4 levels (500 / 1,000 / 2,500 / 5,000 €, from level 1 / 2 / 3 / 4): your team picks up waiting patients on its own — the higher the level, the faster it reacts, and the more keeps running in your absence: 10 / 20 / 30 / 40 % output. Note: as long as you are watching, YOU keep assigning (adjustable grace period).
• Reception assistant (12,500 €, from level 2): requires fully upgraded self-intake and 20 manual assignments of your own. She sends patients off by herself whenever exactly one suitable room is free — and keeps the hospital at 70 % while you are offline.
• Experienced receptionist (45,000 €, from level 8, after 150 total assignments): full automation — sorts by urgency, picks the fastest room, discharges on her own. Offline: 100 %.

Offline rules: the first 12 hours of absence run at full (automation) output, after that only the night crew at a quarter; nothing beyond 7 days is simulated. Nothing is ever lost — money, supplies and rooms stay untouched. For anything to be treated offline, staff must be on duty and assigned to rooms!

Patient patience

Every patient carries a patience clock. When it runs out, they leave — taking 0.8 reputation with them. Patience depends mainly on reputation (6:50 min at one star, 13:30 at five), plus small boosts from waiting-room seats and above all from decoration:

• House plant (2,250 €), magazine rack (4,500 €), radio (8,000 €), kids’ play corner (21,000 €), aquarium (32,500 €), coffee machine (45,000 €), art (80,000 €), indoor fountain (140,000 €).
• Decoration adds attractiveness (more patients) and patience (they stay longer). Buying the same item again costs ×1.7 more for each one you already own.

Tips for starting out

• Cheap doctor first: a “rookie” in the consulting room is plenty. Expensive “old hands” only pay off once the patients are streaming in.
• Reputation is your growth engine: from 20 to 100 takes about 667 happy patients — that takes days. Above all avoid walk-outs and rejections; they cost many times more.
• Never fully empty the cash box: wages and rent keep running. There is no debt, but an unpaid team and an empty supply store slow you down twice over.
• Do not forget to discharge: the money only arrives on discharge — the “discharge all” button is your friend.
• Collect the tasks: the task list pays decent bonuses (250 € to 40,000 €) and walks you through the game in the right order. Nothing expires.
• Smaller businesses first: with around 15,000 € to get going and 150 € rent per day, the hospital is not for your first day of play. Earn the cushion in the farm, the haulage firm or the apartments — then move up. A bank loan for the licence works too, but wants to be repaid (see the “Current account & bank” help).