In the "first level"...

Why the heck don't the doctors do surgery at night? They sit on their expensive hands all god damn night and let the patients collapse and die.

Why the heck doesn't the orthapaedic surgery perform the operations it needs to? Some guy needs a hip replacement or some other surgery but allegedly the department can't do it. I think I've got all the things needed in the tooltip but I still can't send them to this "advanced" surgery.

If I am not mistaken, the doctors only do what the health insurance claims and pays. If all prerequisites are met, you still have to conclude the contract with the appropriate health insurance.

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It looks like it's a bug. Too many bugs related to patients, rooms and display: (
I paid for the game not to work as a beta tester!
How can I get the money back?

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Here:
https://support.gog.com/hc/de/requests/new?form=technical

The developers are already working on patches.

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Hi,

I had this issue as well. How many docs do you have at night? You need at least 3 (one with surgery skill, one with anaesthesia skill and a third one who assists). In addition you also need two nurses for the surgery. The problem is that your staff won't do surgery if they have to take care of other patients as well (in the wards). Therefore, you need to hire at least 3 nurses over night to be able to operate. It kind of makes sense but the game really does a bad job explaining what exactly is needed to optimise the workflow since you don't see why noone is doing anything.

For me it worked best when I had at least 4 nurses and 3 docs over night. I think the additional costs are worth getting the treatment done and make the bed available.

Hope that helps.

I think I had the minimum requirements in doctors for active surgery but maybe I was lacking nursing capacity. If I still have a save game from that point I might go and check.

One thing that seems to help is to designate at least the main surgeon, the anesthesiologist, and the surgical nurse as only performing those roles (with the check boxes at the bottom left of the character sheet). Then you only need any other doctor and any other nurse. You may then want to uncheck those boxes for others or the specialists could be sitting around doing nothing while some other doctor who can do anything does the surgery. If you don't limit roles then enough doctors or nurses may stay busy enough that not everyone is available at the same time.

Also, it sounds like the qualifications of the doctors and nurses affect the speed in some ways and I'm not sure exactly how that works but it might be responsible in some cases. Some surgery requires HDU hospitalization and I think the recent patches are better at explaining this. It might not be available if you don't have the HDU bed or it might be possible to click the surgery but nothing will happen unless you clicked HDU first (I think I've seen both). At least with the most recent version sometimes things are just not available from the ICU when they are available from patients in the department; I'm fairly sure this is just a bug. Sometimes the doctor can select the right thing but you can't so changing to doctor control can fix some issues. Sometimes doctors can transfer patients out of the ICU, although I don't know if they will ever do that before surgery. Sometimes there are synchronization issues if you have had the character sheet of the patient open while something changed (at least with department changes) and changing to a different character sheet and back will make more options available.

I haven't seen it with surgery so far but I did see what I'm fairly sure was a race condition involving scheduling an x-ray, unscheduling it, then transfering the patient out of the hospital and after that no more x-rays would be performed even though staff was idle (even after firing/hiring and shift changes). I think it might have been unscheduling it at just the right moment that caused the issue. I've seen cases of technicians getting more obviously stuck in labs and sonography units and in those cases firing them and waiting until after midnight sometimes helps, although IIRC sometimes it then gets into the "idle staff won't do anything" state. My memory isn't that great but I think I saw an office doctor get obviously stuck once as well but firing and waiting until after midnight seemed to fix the problem. I think I've had one or more issues along those lines in every game I've played that I didn't run out of money quickly.

I'm not certain but I think the "depressed" condition might cause staff to sometimes stay idle and not do anything for a shorter period of time when they could be doing something. If so, if one or more particular doctor or nurse needed for surgery is depressed it could be extra hard to get started.

You know, nursing is really hard. I myself am not a doctor, but I read a lot of essays and I will tell you this, sometimes they have to do operations at night. This is a very difficult profession and it requires a lot of concentration, which drops at night.