A grounded theory approach to identify information needs for optimizing emergency department wayfinding visual environment: a case study of a major general hospital in Guangzhou, China

In large-scale general hospitals across China, the emergency department (ED) is crowded with excessive visual elements, unclear signage, and convoluted spatial layouts, making wayfinding difficult and undermining both patient experience and service efficiency. How can we accurately identify and satisfy the wayfinding-visual-information needs of all hospital stakeholders – patients, families, staff, and managers – to eliminate the chronic ‘invisible, unfindable, unreachable’ problem? Taking Hospital A as the case, we first deconstructed wayfinding visual behavior into five perceptual stages. Stakeholders were then split into a ‘Perception’ group and an ‘Execution’ group for semi-structured interviews. Grounded-theory coding (open–axial–selective) was applied to build a conceptual optimization framework. Five critical issues emerged: poor visual experience, fragmented information needs, high spatial complexity, patients’ habitual visual behavior, and misplaced signage, which were translated into 16 specific information needs across three hierarchical levels, packaged as a ready-to-use toolkit for designers. The grounded-theory-based information-needs framework activates stakeholder participation and offers a translational, methodological contribution for future field studies. Through iterative application, it converts existing stakeholder-salience and wayfinding theories into actionable guidance for improving the ED visual environment in Chinese hospitals, thereby extending grounded theory into practice rather than proposing new theory.