Each player starts their game at level 0 and will only have access to a very limited amount of actions and mechanics, giving them a slow pace to get started in but also an inefficient business to run. However, players gather XP by treating patients or putting money into their facility and will therefore by the nature of the game level up soon just by playing, working their way up to new, added game content.

The quality of staff will determine how well of a treatment success rate and treatment time the hospital holds, which directly impacts revenue. All staff have two variables, type and level. Type (ex. Family Physician) determines which Treatment Room type they can operate in, and level (1-5) determines their treatment success rate, speed and hourly rate. 

Staff of higher levels bring in more revenue to the hospital but are also more expensive on duty. Staff level is determined by numbers of hours on duty and will automatically level up as playtime goes, raising their wage. Players may hire staff that start out on any level—however—staff that are hired at higher levels will have a higher rate than staff who were hired at low levels but trained to equally high levels. Different types of staff also have different rates.

The more money players earn, the more resources they have to improve their hospital. Money is earned simply by playing, but the amount earned differs greatly by player choices. Player earnings are affected by treatment success rates and waiting times as well as costs of staff, expansions and upgrades. 

Players have two ways to expand their facility.

Treatment Rooms. Once a Treatment Room type is within a player’s available content, they may buy as many units of it as they like (as long as they have resources in terms of money and facility space). Every unit holds only one patient at a time, so obtaining several units of the same type of Treatment Room means that the player are able to care for several patients of equal type concurrently. Obtaining different types of Treatment Rooms means that the player are able to care for different types of patients. 

Facility Areas. Once an area is within a player’s available content, they may buy and gain access to that one area. By doing so, they obtain more room to build on and are therefore able to hold more units of Treatment Rooms.

The research tree will carry upgrades and advancements for the player to buy. It’s restricted to players current available content and will therefore expand its own content as player level increases. Buying and unlocking research tree parts will improve  business efficiency or profitably.

The research tree will not have to do with availability of Treatment Room types, staff types or facility areas, only the advancement of them.

Reputation has an effect on treatment fees. Gain a good reputation by high treatment success rates and short waiting times and gain a poor reputation by the opposite. The greater reputation a player’s hospital possesses, the greater pay for each treatment.