Royal Hospital Rulebook

Table of Contents

Table of Contents

• Components
• Game Board
  • 1 Round track
  • 2 Ambulance track
  • Helicopters
  • 3 Quality of Care track
  • 4 Prestige track
  • 5 Victory point track
  • 6 Insurance company tracks
  • 7 Resources Tracks
• Composition of the Cards
  • Cards from the Medical Deck
  • Patient Cards
• Symbols
• Hospital Board
• Game Setup
• Game Play
  • Preparation Phase
  • Action Phase
  • Patient Treatment Phase
  • Cleanup Phase
• Patient Treatment Phase Example
• End Game Scoring
• Solo Mode
• Summary of the Round

Components

• 1 Game board
• 4 Hospital boards
• 19 Facility cards
• 19 Insurance company cards
• 15 Referral cards
• 15 Outpatient clinic cards
• 15 Clinical Trial cards
• 12 Supplier cards
• 13 Medical direction cards
• 16 Resident program cards
• 23 Specialist cards
• 19 Research project cards
• 4 Starting cards
• 109 Patient cards
• 1 Round counter
• 4 Victory Point counters
• 4 Prestige counters
• 4 Ambulance counters
• 4 Quality of Care counters
• 16 Insurance Company counters
• 32 Resource Production counters
• Resource Tokens: Diagnostic, Healing, Research, Staff, Time and Congress Doctors
• 1 Starting Player Token
• 20 1-Credit Coins
• 10 3-Credit Coins
• 12 5-Credit Coins
• 14 10-Credit Coins

Game Board

1 Round track

This section shows the number of game rounds.

At the start of each round, players draw cards as indicated on the space.

2 Ambulance track

On this track, players will mark the progress of their ambulances. Each time players move forward on the ambulance track, they gain the benefits shown. If players move forward several positions in one turn, they gain all the benefits they have passed.

This scoreboard is endless; once players reach space 0, they continue advancing by returning to space 1.

Ambulance rewards are as follows:

1. Advance 1 on the treated patients track
2. Increase your credit income by 1
3. Gain 1 prestige
4. Draw 1 card
5. Gain 1 diagnosis
6. Gain 1 healing
7. Send 1 helicopter
8. Gain 1 research
9. Gain 1 Staff
10. Increase your quality of care by 1
11. Gain 1 congress doctor
12. Advance 1 on any insurance Company track
13. Send 1 helicopter

Helicopters

When a player sends a Helicopter, they can choose to perform one, two, or none of the following options:

• Discard one of their patient cards.

or

• All players (including the player who activated the helicopter effect) have to draw a patient card.

3 Quality of Care track

In this section, players will track the quality of care in their hospitals.

At the end of the game, players will gain or lose victory points depending on their final position on this track.

4 Prestige track

In this section, players track their prestige.

In the final phase of each round, players gain half their prestige in victory points (rounded down).

5 Victory point track

In this section, players use their victory point counters to keep score.

6 Insurance company tracks

The players will mark their progress in the various insurance companies in these four sections.

Each time players advance on an insurance track they will gain the benefits shown.

Blue Insurance Company (1)

1. You get 1 staff member or 1 research. You get 1 ambulance.
2. You get 7 credits. Increase your care quality by 1.
3. You get 1 ambulance, 1 staff member, and 1 research.
4. You get 2 ambulances, 1 diagnosis, and 1 healing.
5. Increase your diagnosis production by 1 and draw 1 card.

Purple Insurance Company (2)

1. You get 1 staff member or 1 research. You get 1 prestige.
2. You get 2 credits, 1 staff member, and increase your care quality by 1.
3. You get 1 prestige, 1 staff member, and 1 research.
4. You get 2 prestige, 1 diagnosis, and 1 healing.
5. Increase your healing production by 1 and draw a card.

Green Insurance Company (3)

1. You get 1 staff member or 1 research. Increase your credit production by 1.
2. You get 2 credits, 1 research, and increase your care quality by 1.
3. Increase your credit production by 1 obtaining 1 staff member and 1 research.
4. Increase your credit production by 2, obtaining 1 diagnosis and 1 healing.
5. Increase your research production by 1.

Red Insurance Company (4)

1. You get 1 healing and 1 diagnosis.
2. You get 2 credits, send 1 helicopter, and increase your care quality by 1.
3. You get 1 prestige, 1 ambulance, and increase your credit production by 1. You get 1 diagnosis or 1 healing.
4. You get 3 victory points, 1 diagnosis, and 1 healing.
5. Increase your staff production by 1.

7 Resources Tracks

These tracks represent the resources produced available to players: diagnosis, healing, research, and staff.

When the player reaches certain level of production on each resource they gain a special reward:

• The first player to reach the square 4, obtains the congress doctor resource on that square.
• The first player to reach the square 7, obtains the congress doctor resource on that square.

Composition of the Cards

Cards from the Medical Deck

1. Cost: The resource(s) cost to play this card. Cards may require credits, research or healed patients.
2. Color: Indicates the 11 types of cards: Starting cards and Research projects (blue), Specialists (grey), Consultations (pink; the components list calls these Referral cards), Outpatient clinic (red), Facility (yellow), Insurance companies (black), Resident programs (green), Medical direction (orange), Supplier (purple), Clinical sessions (light blue).
3. Rewards: The benefit(s) the player gains by playing the card. There are 3 different reward types:
   • "Immediate Rewards" take effect only once, immediately after playing the card.
   • "Prolonged Rewards" have a continuous effect.
   • "Action Rewards" can be activated once each round.

Patient Cards

Patient cards are two-sided and must always be drawn from the bottom of the deck with the healing side hidden (facing down).

Diagnosis side:

1. Diagnostic difficulty.

Healing side:

1. Healing difficulty.
2. Reward for curing the patient.

Symbols

The symbol key shows these icons: Diagnostic, Healing, Research, Staff, Credits, Congress doctor, Medical deck card, Insurance company, Quality of care track, Time, Ambulance, Helicopter, Prestige and Victory Point.

The patient card symbols are explained as follows:

1. Healing difficulty.
2. Reward for curing the patient: Each time you heal a patient, increase the track of healed patients on the board. The healed patients from this track can be used to play clinical trials.
3. Priority type: The illustration on each card represents the severity of the patient's condition. There are 5 types of patients depending on their severity:

Priority 1 (Critical patients): These patients are in critical condition and need urgent treatment. Unlike normal patients, critically ill patients have the same information on the diagnosis and the healing side.

Priority 2 (Severe patients): The condition of these patients is severe and they need to be treated before they have 2 time tokens or they will die.

Priority 3 (Patients with chronic illness): The condition of these patients is not serious. However, their treatment will be more complicated the longer it takes to treat them. The healing difficulty of these patients is equal to the number of time tokens the patient has. Patients with no time tokens when diagnosed are automatically healed because their healing difficulty is 0 and no resources are required. Prevention is the key.

Priority 4 (Non-severe patients): The condition of these patients is not serious and they can be treated without urgency.

Terminal patients: Terminal patients do not occupy 1 space in the hospital. They must be treated with 1 healing resource in the round they arrive at the hospital or they die (decreasing care quality by 1 only). Unlike other patients, the terminal patient, even when treated, never leaves your playing area. This patient doesn't need a room in your hospital. Unlike normal patients, terminal patients have the same information on the diagnosis and the healing side.

Hospital Board

You will need to treat terminal patients each round by adding 1 healing resource to them.

If successfully treated, remove the resource used to treat them and note the rewards for treating them. This patient does not increase the track of healed patients and the patient remains in your playing area.

The hospital board has space for 4 patients. During the game, players can use outpatient clinics and clinical trials (types of medical cards) to increase patient capacity. Each outpatient clinic and clinical trial adds 1 additional space for patient cards.

If a player has no spaces available when a patient is drawn, the following actions must be taken:

1. Discard the Patient card. Discarded Patient cards are placed on top of the Patient deck. If players place several patient cards at the same time, they can choose which to discard and which to place.
2. Decrease your quality of care track by 1 for each patient card you have discarded.

Patients cannot be moved once they are allocated on your hospital board or an Outpatient Clinic.

Even if you don't have space in the hospital when you go to draw a patient, draw from the deck in case it is a terminal patient (these do not require spaces).

If you draw multiple patients in a round and do not have space for all of them, you decide which patients to admit and which to reject.

Game Setup

1. Shuffle the Patient and Medical decks separately and place the decks beside the game board. Remember that the Patient card deck must have the diagnosis side up.
2. Players choose a colour and place their quality of care counters on space 6. And place their Prestige, Ambulances, Insurance Companies, and Victory Points counters on space 0 of each track.
3. Place the Round counter in the first space on the round tracker.
4. Give a hospital board to each player. Place a resource production counter on the 5 space and 10 space of the Credit production. Place a resource production counter on the 1 space of each other resource production track.

Place a resource of congress doctors in the following positions:

• On the prestige track, on spaces 7, 14, and 21.
• On the diagnostic, healing, staff, and research production track, on spaces 4 and 7.
• On the credit production track, on spaces 21, 27, and 33.
• On the insurance track, on space 5 of each insurance company.
• On the ambulance track, on the starting space.
• On the care quality track, on spaces 9 and 12.

During the game, the first player to reach those positions earns the congress doctor token.

The first player to reach the square 4, obtains the congress doctor resource on that square.

The first player to reach the square 7, obtains the congress doctor resource on that square.

The resources of congress doctor can be used by players as a staff or research resource.

5. The starting player is chosen at random, and the order will continue clockwise.
6. Deal one starting card to each player.
7. Place the resource tokens to one side of the board in easy reach of all players.
8. All players draw 10 cards from the medical deck and choose 5 to start the game with, discarding the other 5.

Hand of Medical cards: The hand of cards remains secret from other players. However, the other players are allowed to know how many cards you have. There is no limit to the number of cards players can have in their hands.

Game Play

Each round is divided into phases: Preparation, Action, Treatment and Cleanup.

Preparation Phase

1. In player order, each player draws as many cards from the Medical and Patient decks as indicated by the round tracker.

   Additional cards are taken based on staff and research production (as many cards as the sum of your staff and research production). These cards are extra cards that you catch, but you have to choose to keep as many as indicated by the round counter.

   e.g.: In round 3, 3 cards are received. If a player has production of 1 research and 1 staff, he would draw 2 extra cards, you would take 5 cards and choose to keep 3 of them.

   All cards from the Patient deck are drawn from the bottom of that deck and placed on a hospital board or on an outpatient clinic card. These cards are placed without revealing the back (healing) side. Patients can be turned over in a later phase when successfully diagnosed.

2. Players gain Diagnostic, Healing, Research, Staff and Credit resources determined by their player board productions.

3. Players rotate all action cards to their starting position.

Action Phase

In turn order, each player must perform one action or pass. Players continue taking actions until all players have passed.

Available actions:

1. Play a card from your hand: To play a card, pay the resource cost shown (discard the tokens to the general piles) and place the card face up on the board. Implement any immediate reward(s) of the card. If the production of diagnostics, healing, research, staff, or credits is increased, you also immediately obtain those resources.

   e.g.: If you increase staff production by 2, you obtain 2 staff resources.

2. Activate an action card: Previously played Medical cards may be activated only once each round to perform their effects (i.e. gain Action reward). When you activate a card, rotate it sideways to show that it has been used this round.

3. Discard cards or research resources: On your turn, you may also discard a card from your hand or 1 research resource to receive 3 credits. This may be performed as many times as desired: it does not count as an action.

4. Pass: When players cannot or choose not to perform more actions, they pass and cannot perform any further actions that round. The rest of the players may continue taking actions until all players have passed. Then the next phase begins.

Patient Treatment Phase

During this phase, players will be able to allocate their resources to diagnose and heal patients.

This phase can be carried out simultaneously by all players; however, if there are beginner players it might help to take this phase in turns.

Diagnosing a patient: To successfully diagnose a patient, you must pay the number of Diagnostic resources indicated by the card's difficulty. Then flip the patient card over to reveal the healing side.

Healing a patient: To successfully heal a patient, you must pay a number of Healing resources equal to the difficulty shown. Once the patient is healed, gain the credit rewards and victory points shown on the card, and then discard the card to the top of the patient deck.

Critical patients: Critical (Priority 1) patients are more difficult to heal. However, these patients do not need to be diagnosed or flip the card, as all the requirements needed for healing appear on both sides of the card. To cure them, pay the resources shown on the card as with all patients. However, if critical patients are not diagnosed and healed in one round, they will die.

Terminal patients: These patients do not need to be diagnosed or flip the card, as all the requirements needed for healing appear on both sides of the card. To cure them, pay the resources shown on the card as with all patients. However, if terminal patients are not diagnosed and healed in one round, they will die.

Note: Staff resources can always be used in place of Diagnostic or Healing resources in this phase!

Cleanup Phase

Once all players have completed their patient treatment phase, the following actions are carried out:

Add time tokens: A time token should be added to the following patients:

• All patients who have not been diagnosed.
• All patients except those with priority 4 who have been diagnosed but are not fully healed.

Check patients: After adding the time tokens, check to see if any patients have died. Only severe or critical patients can die.

• Critical patients (Priority 1): These patients die if they have any time tokens.
• Severe patients (Priority 2): These patients die if they have two time tokens.
• Terminal patients (Priority 3): These patients die if they have 1 time counter. They only reduce the quality of care by 1 when they die.

Note on the source: this section labels terminal patients "Priority 3", while the Symbols section above labels Priority 3 as patients with chronic illness. Transcribed as printed.

If any undiagnosed patients have two or more time tokens, you must reveal their healing side to the other players to check their priority. You are not allowed to acknowledge the difficulty and type of patient it is.

If the patient is severely ill (Priority 2), they will have died. All other patients remain at your hospital and should be flipped back to the diagnostic side.

Deceased patients: When one of your patients dies, you must perform the following actions:

• Discard all the counters and resources on the card to the general resource piles.
• Place the deceased patient's card on top of the Patient deck (diagnosis side up).
• Decrease your Quality of Care track by 2.

Prestige scoring: Each player gains half of their prestige as victory points (rounded down).

End of round: Move the Round Token one space forward, pass the starting player token clockwise and start a new round.

Patient Treatment Phase Example

Let's see an example of how to treat patients:

e.g.: Our hospital has 1 critical patient and 3 undiagnosed patients. We have 4 diagnosis tokens, 3 healing tokens and 3 staff tokens (remember these research tokens can be used either to diagnose or to treat your patients). We won't be able to know our patients' prognosis until they are diagnosed.

It is convenient to diagnose our patients as soon as possible to know what we are dealing with. The most urgent patient in our hospital is number 2, because they will die in the next round unless they we treat them.

We assign them as many tokens we need to cure him: 1 Staff token, 1 Diagnosis token and 1 Healing token.

Next, we will use the remaining Diagnosis and Research tokens to diagnose the rest of the patients.

The first patient does not imply any gravity, so it is not urgent to cure them. Given the fact that we have scarce healing tokens right now, we will wait for the next round to cure them.

Our third patient is a chronic patient; this kind patient has as much healing difficulty as the number of time tokens they have. In this case, no time tokens are on this patient card because we diagnosed them as soon as they arrived at the hospital.

Our last patient is a critical one, and they will die if we do not cure them in the next two rounds. Therefore, we must prioritize their treatment over patient number 1.

We managed to cure 3 of our patients and we obtain the following rewards: 9 victory points and 8 credits.

End Game Scoring

1. All players gain or lose Victory points according to their position on the Quality of Care track.
2. All players earn 1 victory point for each player they surpass in the following counters: Quality of care, Insurance companies, Prestige, Credit production, Diagnosis, Healing, Research and Staff.

The player with the most victory points is the winner.

In the event of a tie, the player with the highest Quality of Care wins. After this the player with the highest prestige wins. Then the player with the least patients in his hospital. If the tie persists, the player with the highest value reached in the counter of healed patients will win. If the tie persists, the highest credit production will be consulted. If the tie persists, it will be the highest sum of diagnosis, healing, staff, and research. If the tie continues, the highest number of insurance companies that have reached 5 will be consulted. Finally, the last tiebreaker condition will be the card played with the highest credit value.

Solo Mode

Work in progress.

Summary of the Round

1. Preparation phase

• Draw Patients and Medical deck cards
• Produce resources
• Rotate used Medical cards to starting position

2. Actions phase

• Play a card from the hand
• – or –
• Activate an action card
• – or –
• Pass

3. Patient treatment phase

• Diagnose patients
• Heal patients

4. Cleanup phase

• Add time tokens to patients
• Check patients
• Score prestige
• Check for the end of the game
• Move starting player token clockwise
• Move the Round token