Case study – Listening beneath the surface: Improving the Robin House hydrotherapy pool experience using the Care Experience Improvement Model (CEIM): September 2026
Children and families shaped improvements to the Robin House hydrotherapy pool by sharing what truly mattered to them.
Introduction
The hydrotherapy pool at Robin House, located in Balloch, is part of Children’s Hospices Across Scotland (CHAS). This pool is used by children and families for both care and play to benefit children’s health, mobility and all-round wellbeing. The benefits extend beyond the child receiving care and also positively affects the experiences of the whole family.
Staff knew the pool was highly valued, well-used and mattered deeply to families. The aim of using the Care Experience Improvement Model (CEIM) approach was to strengthen family voice and use lived and living experience to ensure family feedback was recognised as a priority for improvement and to address it with care and sensitivity
Situation
Although the pool was highly valued and well-used, the overall pool experience had not been reviewed through a family-led lens. Children’s conditions, needs and levels of complexity had changed significantly since the pool opened 20 years ago. Staff therefore wanted to understand whether the support provided and the physical environment, including the changing facilities and sensory comfort, continued to meet the needs of children and families.
Whilst some survey feedback had previously been gathered, this tended to focus on satisfaction rather than lived and living experience. There was an awareness that feelings of gratitude for care and worries about appearing unappreciative might be preventing families from sharing aspects of the experience that could be improved.
Staff believed a more conversational, sensitive approach was needed to understand the full pool experience, particularly around changing facilities and sensory comfort, to ensure future improvements were clearly grounded in what mattered most to families.
Approach
Using Experience Discovery Conversations from CEIM to engage with families offered a clear, structured way to explore experience holistically and to support meaningful, family led improvement. The approach focussed on listening before moving to solutions, creating psychological safety and valuing children expressing their views in different ways.
The approach aligned closely with the Lundy Model of Participation, which emphasises creating opportunities for children and young people to have a voice, be listened to, and influence decisions. Engagement was deliberately flexible and trauma-informed, recognising that family’s capacity to engage varies depending on circumstances. We did this by offering families different ways and times to take part, including information conversations, creative activities, online engagement and feedback in their own time, with trusted staff encouraging and supporting families to participate.
Engagement tools and methods
In engagement planning we recognised that the pool is used in three distinct ways, with families’ experiences and support needs varying across each context. To reflect this, engagement activities and conversations with families focused on three key areas:
- Outpatient Sessions (Sundays) – Physio led, booked sessions where children require higher levels of care and support e.g. tracheostomy.
- Family Splash Sessions (Sundays) – Physio led booked sessions where children require less intensive staffing input.
- Respite stays – pool use during hospice stay, either as a planned physio session or family play activity.
Alongside ’Experience Discovery Conversations’, which are structured discussions to help people share their experiences in their own words, a range of other inclusive methods were used to support conversations and ensure inclusion was central to the work.
A whiteboard was used in the parent’s lounge/kitchen to encourage families to share ideas. Children would draw on the whiteboard which helped to spark conversation and led to peer encouragement for others. Families also shared their thoughts on the whiteboard at a time that suited them.
Furthermore, a closed Facebook group for families was used to share when engagement was taking place and staff were available to talk with families on the engagement if they wanted. This enabled interaction between families on the page and captured those responses including emoji reaction to comments. This approach allowed for flexibility as families were able to talk to staff when it suited around their family life.
An email address was shared with families so they could share feedback and connect with staff in their own time, for example during late evenings when this was often the only time available. These methods ensured we were actively involving different forms of ‘voice’ and would meet the needs for families who are often under-represented in traditional feedback methods.
Who was involved
Children with life-shortening conditions, siblings, parents, family members and carers all took part. Physios, nursing and activities teams supported the CHAS Family Involvement Lead to carry out the engagement, encouraging and supporting families to take part in the discovery conversations and creative sessions.
Inclusion and diversity
Inclusion was central to the work. Methods were adapted to support children who were non-verbal, neurodivergent, visually or hearing impaired which ensured we were involving different voices and experiences. This was essential as it met the needs for individuals who are often under-represented in traditional feedback methods. We also used visuals and adjusted any reading materials to recommended reading ages.
Results (the outcome)
Our engagement lasted around four months from June 2025 to mid-September 2025. This included working flexibly outside normal work times to provide further opportunities to connect with families because of scheduled activities. It is estimated that around 60 families access the pool, and 22 families were actively engaged with by staff. The engagement process confirmed that the pool is one of the most valued experience families had at Robin House, supporting therapeutic movement, play and family togetherness.
The changing facilities emerged as the most significant area for further improvement, particularly in meeting the needs of older children, young people and those requiring intimate care. Families also identified opportunities to improve the sensory experience of the pool, including lighting, music and sound control and highlighted the importance of positioning aids and practical details that reduce stress.
As a result of this work, a themed pool report and summary was produced. A Pareto approach was used to identify the issues raised most frequently and those likely to have the greatest impact if addressed, helping to prioritise the findings and focus improvement efforts. The Health and Social Care Standards were then used to guide improvement planning. The findings were refined into specific priority areas, with decisions made about which actions to take forward as improvements and which aspects of practice to recognise as existing strengths, while also taking account of available resources and organisational constraints.
Initial improvements have focused on practical and achievable changes. This has included physios improving the process and awareness of pool sessions for staff and families. Larger improvement developments are being planned.
The intention is to return to families in future to understand the impact of changes once they are in place, whilst recognising not all original families may experience these improvements due to changing circumstances.
Key learning
The challenges encountered throughout the project provided valuable learning and highlighted opportunities for improvement. For example, engagement was impacted by timing of specific sessions, staff capacity, families feeling comfortable to share views and facility space being closed during engagement period. We learned to be flexible to family’s needs, and that building trust and psychological safety need to be actively supported.
Furthermore, we learned that informal and creative engagement generates richer insight than surveys alone and for the families we support using a more informal, conversational style is necessary.
Using CEIM supported our CHAS teams to listen deeply, focus on what mattered most and translate lived experience into action.
Next steps
Learning from this engagement activity is informing service improvement planning, particularly around changing facilities and enhancing sensory features in the pool environment.
Findings have been shared with physiotherapists, facilities, grant manager and leadership teams. We used a multifaceted approach to keeping families informed by using the Whiteboard and Facebook Group again using a ‘You said, We Did’ approach to maintain transparency and trust.