Peter Molyneux and James Leach came up with the idea of creating a Theme game based on a hospital, but Molyneux was not directly involved in development due to his work on Dungeon Keeper.
Peter Molyneux dan James Leach mendapat gagasan membuat permainan video untuk serial Theme dengan latar rumah sakit, tetapi Molyneux tidak terlibat langsung dalam pengembangannya karena sibuk dalam proyek Dungeon Keeper.