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It SOUNDS like a good idea on paper because it leads to a bigger hospital. But what you actually are doing is raising how complicated the game is WHILE also disconnecting the player from the hospital itself... All for something that doesn't serve the gameplay and doesn't serve the aestetic. In fact it takes away from the gameplay.
If they add Z-Levels I swear to you, you will find the game lacking but be unable to put your finger on why... There is just something less charming.
And I assure you, you don't mean SMALLER levels... but with extra Z-levels.
Then you are probably right now thinking of the levels in Theme Hospital where your hospital was split into peices and are going "Well, what if instead those were different levels of your hospital"... but your forgetting that Z-Levels are not a tangible distance in the game. The levels with your hospital split up were part of thinking how to organize your hospital to overcome this challenge.
Z-Levels' challenge isn't Spatial awareness, it is memorization... It wouldn't have the same challenge.
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For examples of this there are two games in particular:
-Mall Tycoon: Adds Z-Levels but when you play the game, the extra Z-Level seriously detracts from the gameplay. There is just no purpose to a second level beyond just the ability to have a second level (segregating your mall is pointless).
-Dead Rising 3: Adds an entire city! but because it is a city and not a mall it means not ONLY are you not as intimately involved with the locations, but they have to put weapons everywhere because they cannot really personalize every location (So, they can't just have you visit weapon stores... because that might be at the other part of the city... So they just put huge guns and weapons in the street)
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I will agree with the Radiators though not to your overly complicated solution. (Just let people build Radiators and have them take care of themselves... If you want to add difficulty to radiators just make the hospital in the North Pole or in a Desert). The usual key in the regular game was to just turn it into a barely acceptable level and keep it there.
2) yea i love to have the ability to rebuild a demolished room after earthquake.
eathquake rarely break any machine if i maintain everything well (repair AND replacement). and in case i expect a room cannot survive an earthquake, there is a button which to evacuate people inside that room. or grab the medical staff out, whcih will make patients leave as well (except ward)
i consider this micromanagement as an essential part of a business management simulator. i like it and i dont like it :))
3) will be great if this game is going to have a survival mode without level objectives like what we have seen in Theme Hospital. i always want to build a very large hospital but land resources are so limited. In the old game, objectives are always achieveable without utilizing all lands so i am not sure if i will use a 2nd floor even if z level was implemented at that time.
4) err...i cannot recall how long a patient usually stay in ward in second, but they do stay for 1 in-game day before surgery, which is quite realistic. (of course patient can walk out and be discharged from hospital right after a critical surgery is kind of a joke, which is also the central theme in Theme Hospital XD)
I see walking distance as another macromanagement in the old game.
Z-levels can potentially create logistical challenges. E.g. a patient in a hospital bed or wheelchair is forced to use an elevator.
Also... if you want to get a spatial challenge, 3-D buildings can potentially be much more confusing in layout. For example, many municipal services in older (e.g. European-style) cities are cobbled together in several repurposed monumental buildings. With different floor heights and highly bureaucratic fire department and labour laws.
The result of that is chaos and illogical layouts. Like having floor 3 be floor 5 on the other side of the building, or having a wall in the middle of a hallway so in order to get to a room on the other side you have to walk to a staircase and use a different staircase from another floor to get there. Staircases that don't cover all floors, the list goes on. There's plenty of maze-like buildings IRL.
The problem with walking distance dominating everything else in a tycoon game is that many of the game's variables become meaningless. Who cares how fast a doctor diagnoses if 1 second is spent in the diagnosis room for every 2 minutes spent walking?
About the radiator thing; Having radiators individually placed isn't too bad either, just more important is that it's a little more involved.
1) Not have to manually control radiators (it's tedious). Instead, just set a target temperature.
2) Having other heat sources/sinks means good radiator placement is affected more by hospital layout. A hallway with lots of outside windows should need more heating there. That cryogenic chamber you built should heat the surrounding area quite a lot, and so on.