Dialogue at the 1995 conference offered jointly by the American Association of Colleges of Nursing and the American Organization of Nurse Executives and appropriately entitled, "Slippery Slopes and Uphill Battles: Response to a Rapidly Changing Health Care and Education Environment," reaffirmed the substantial reengineering and redesign that is occurring rapidly in the health care delivery system. Speaker after speaker emphasized the massive structural changes in the health care system, workforce transitioning, growth of health care mergers, and business/cost focus of the health care enterprise. In the era of chaos in the resource-driven health care delivery system, technology and partnerships were cited frequently by various presenters as key elements in successful restructuring ventures.
Because the future of nursing education is linked intricately and unquestionably to the process and outcomes of the structural reforms of health care redesign, technology and partnerships will also be increasingly important elements as nursing educational programs substantively reengineer instructional content and delivery linking nursing students and the health care community. In 1990, Simpson1 stressed the need to close the gap between school and the health care workplace and suggested some preliminary strategies to link the school with the automated environment of the hospital. The urgency to bridge that gap, not only to one clinical site but also to many health care information sites, has compounded exponentially as the rate of the reconceptualization of health care and the pervasiveness of electronic networks throughout the world has occurred.
Although there is an urgency in reengineering instructional content and delivery just as the reconceptualization of health care is occurring in the country, there also is the need for analysis and well-planned student-focused approaches rather than a fragmented approach toward restructuring of the curriculum. The reengineering process must include the traditional instructional design elements of assessment, extensive institution-wide and external collaboration, design and development of the project with a consideration of the most appropriate technology for the particular courses in the program, pilot testing, evaluation, and implementation. In addition, as Flarey and Blancett2 have pointed out, envisioning the future must also be an integral step in today's reengineering methodology. Otherwise, as Doucette3 emphasized we may misjudge the magnitude and speed of societal and economic imperatives and reap a "tinkering" outcome rather than "reengineering" the education and role of the health care practitioner for the future outcome.
A previous article reviewed experiences and recommendations from a case study example of establishing technological health care resource links with the distant learner4. Technology and partnerships were key components in a redesign that linked the distance education learner to the health care community5. Lessons learned from the design and implementation of technological links with the distance learner can provide process guidance in the more pervasive "on-campus" learning, as well as distance learning nursing educational program redesign and restructuring that will be required increasingly for the collaborative, worldwide information retrieval and communication paradigm of the 21st century. The following case study provides a sample of elements of an instructional redesign process successfully utilized for restructuring of a distance education that can be used to reengineer the on-campus course.
Case Study
Successful collaborative institutional and external agency approaches for planning, implementation, and evaluation that include community and network related external agency representation are serving as a prototype for the reengineering of an on-campus senior "capstone" professional issues course. Course faculty, program administrator, and learning resource center personnel have formed a "reengineer" instructional design, development and implementation team that is interacting with other institutional service and academic units to reformulate this professional bridge course. External partners in the redesign process include alumni and representatives from the health care community, as well as those available via asynchronous and/or synchronous electronic links6.
Just as the health care delivery reengineering system is moving toward patient-focused care, the educational content and delivery redesign process has included students as partners in the course content reengineering. Students are working collaboratively with the instructional team and alumni and representatives from the health care community in restructuring the course content. The use of asynchronous and/or synchronous electronic conferences are being incorporated in the redesign process as students progress toward the goal of becoming active and informed participants in the reconceptualization of the delivery of health care information.
Because the new paradigm of health information delivery is one of worldwide access to resources and increased opportunities for networking and collaboration, technology is a key component in the educational redesign of this on-campus course just as it was in the distance learning experience. Based on an analysis of course content, the redesign team is conceptualizing course delivery on a continuum from the traditional lecture/textbook mode to a synchronous and asynchronous data communication mode. In this sense, as Stahlke and Nyce7 envisioned, the potential instructional richness available in the properly content designed asynchronous distance education course and/or program may serve as a model for modular and asynchronous redesign elements for the oncampus educational course and/or program.
Although redesign transformation is occurring rapidly in health care and is linked intricately with reengineering in educational settings, implementation strategies must also be planned carefully for long term success and quality. The cited case study is one example of a university-wide and external redesign team utilizing successful elements from a reengineered distance learning educational program to redesign an oncampus course and enable the students to participate in an educational mode that the multidisciplinary team envisions will be the collaborative, worldwide information retrieval and communication health care practice standard of the 21st century. Technology and partnerships are key elements allowing faculty, students, alumni, and health care agency representatives to reengineer instructional content and delivery just as the reconceptualization of health care also is occurring in the country.
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