According to the COBIT 2019 Study Manual from Isaca, the output of the "what needs to be done" phase is a high-level program plan. This plan identifies the required resources, activities, and timelines for the implementation of the governance system, as well as any proposed changes that need to be made to the existing system. It is important to have this plan in place before proceeding with the implementation of any changes, as it will help ensure the success of the governance system.

Explanation
The threat landscape is a design factor that describes the types and levels of threats that an enterprise faces from internal and external sources that could compromise its information and technology assets. The threat landscape helps to determine the level of security and resilience that an enterprise needs to protect its information and technology assets from unauthorized access use disclosure modification destruction or disruption. When tailoring a governance system for an enterprise what would be the most appropriate level of threat landscape for an enterprise in the health care sector is high. The health care sector is a sector that provides health care services such as diagnosis treatment prevention rehabilitation etc., to individuals or populations. The health care sector has a high level of threat landscape compared to other sectors such as manufacturing or retail which have lower levels of threat landscape. This is because the health care sector handles sensitive personal data such as medical records health insurance information patient identifiers etc., that are subject to strict privacy and security regulations such as HIPAA GDPR etc., as well as ethical and legal obligations. The health care sector also relies on critical information and technology systems such as electronic health records telemedicine devices medical devices etc., that are essential for delivering quality health care services to patients. The health care sector faces various types of threats such as cyberattacks data breaches identity theft ransomware malware phishing social engineering natural disasters human errors etc., that could compromise its information and technology assets resulting in financial losses reputational damage legal liabilities regulatory penalties patient harm etc. Therefore when tailoring a governance system for an enterprise in the health care sector it is important to consider a high level of threat landscape and design a governance system that can effectively manage the potential impacts of threats on its information and technology assets5 References: 5: COBIT 2019 Design Guide: page 41-43 : COBIT 2019 Design Guide: page
47-48

According to ISACA COBIT 2019, an enterprise may fail to realize implementation commitments during the execution of an EGIT (Enterprise Governance of IT) implementation program plan if it focuses on enabling IT value over business value. The EGIT implementation program should prioritize delivering business value and outcomes, rather than simply enabling IT. By focusing on delivering business value, the organization can ensure that the implementation of the EGIT program is aligned with the overall strategy and objectives of the organization and that the program is able to deliver tangible benefits to the organization. Focusing solely on enabling IT value may result in the implementation of IT solutions that do not support the overall goals and objectives of the organization, leading to a failure to realize the desired outcomes and benefits of the program.
An enterprise will often fail to realize implementation commitments during the execution of an EGIT implementation program plan if it focuses on enabling IT value over business value. The goal of an EGIT implementation program should be to effectively align IT with business objectives and enable the business to achieve its goals. An enterprise should always focus on business value rather than IT value, as this ensures that the IT implementation will provide the maximum value to the business. Reference: https://www.isaca.org/COBIT/Pages/COBIT-2019-Framework.aspx

According to the COBIT 2019 Official Manual, it is best to acquire or develop solutions for implementing process improvement projects when the EGIT implementation program plan is being developed. This allows the implementation plan to take into account any solutions or technologies that are required to support the process improvement projects. Acquiring or developing solutions should not be done when defining the EGIT implementation roadmap or when defining potential implementation problems and opportunities, as these do not involve the actual implementation of the program plan. Solutions should be acquired or developed when executing the EGIT implementation program plan, as this is when the actual implementation of the program plan takes place.