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If we're talking about right now, there's quite a bit QoL that PH could use. From more polish on the ai, to little things like floors not appearing empty through windows, wall and floor colours changing with perspective, etc. There's a near endless variety of new wards, professions, specialties, etc that could be added. In other words, there is no 'ceiling' on the potential for this game, and Oxymoron seems to be the right team to see it through.
What if, in addition to creating a new game from scratch, we made mods to update the game?
With the indicated improvements?
Onthology
Psychology
Gynaecology
ENT