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How can I gain reputation?
It's the only thing keeping me from winning the level.
Besides the VIPs, who or what else can change my reputation?
This question / problem has been solved by GalagaGalaxianimage
Dealing with patients fast and efficient (and most importantly, not killing them) will raise your reputation.

Additionally there are several end of year awards that can boost your reputation, though some of them give cash instead.