Discussion Board 1problem 8484 Under The Subsection Program Risks ✓ Solved

Discussion board 1 Problem 8.4: 8.4 Under the subsection Program Risks, five examples are listed of conditions that may result in a significant probability of program failure. For each example, explain briefly what consequences of the condition may lead to a program failure. • A leading - edge unproven technology is to be applied: the application of new technology can bring a lot of benefits; however, unproven technology is one of a reason of project failure. Unproven technology means that it is not tested and validated and applied in the practical project causing of high risky factor. This can link to the wrong estimation in project cost, labor, equipment etc. In addition, there is no standard for unproven technology leading to failure in operating, performance, safety etc. • A major increase in performance is required: the increase of performance is one of the key factors that need to be considered in project management.

For example, wastewater treatment plant (WWTP) at DMV was designed to treat 300 MGD; however, the urbanization leads to the increase significantly of wastewater treatment in the next 2 years to 400 MGD. So, the WWTP has to make a decision to deal with that issue (new technology/ build more plant … to increase the treatment capacity). If not, they will fail in the requirements of performance quality. This is an example about the major increase in performance to project failure. • A major decrease in cost is required for the same performance: at the same performance operated at a constant cost, a major decrease in the cost can be the main reason of project failure because of the wrong in cost estimation including labor, technology, materials…For example, to build a high rise steel- structure building, the estimated cost for this project is 300 M$ for a comprehensive budget; however, the cost is reduced noticeably to 200M$.

That leads to the contractor and owner have to deal with the contract about the project requirements, if not, they will fail in project management. • A significantly more severe operating environment is postulated: This risky factor is related to non-safety related to equipment under postulated environmental conditions could prevent satisfactory accomplishment of safety function. • An unduly short development schedule is imposed: in this case the operator and developer may not elaborated together to work on new system. The testing is done by the developer only, hence an duty short development schedule may be lack of the training time, step by step of practical of implementation… Discussion board .4 Under the subsection Program Risks, five examples are listed of conditions that may result in a significant probability of program failure.

For each example, explain briefly what consequences of the condition may lead to a program failure. 1. A leading-edge unproven technology is to be applied. Consequence resulting in failure: The technology is not compatible with interfacing equipment/software, resulting in lost functionality that was defined in the functional requirements and part of program success. 2.

A major increase in performance is required. Consequence resulting in failure: this increase is not realized, and therefore the project is delivered late, resulting in market loss and program failure. 3. A major decrease in cost is required for the same performance. Consequence resulting in failure: a late-identified problem is left unfunded to develop a solution, resulting in either the problem going unsolved or reduced performance due to funding realocation.

4. A significantly more severe operating environment is postulated: Consequence resulting in failure: the product is not designed to withstand this more severe environment, and its functionality and/or effectiveness is greatly reduced or eliminated entirely. 5. An unduly short development schedule is imposed. Consequence resulting in failure: there is inadequate margin incorporated into the schedule, and therefore an accumulation of problems results in delays to project delivery or inadequate problem resolution.

STANDARDIZED PROCEDURE PEDIATRICS 2 STANDARDIZED PROCEDURE PEDIATRICS 11 Standardized Procedure Pediatrics Name United States University Primary Health of Acute Clients/Families Across the Lifespan Course Dr. Maria Luisa Ramira July 4, 2016 Standardized Procedure for Nurse Practitioners: General Policy I Purpose A. To establish a standardized procedure, in compliance with the California Board of Registered Nursing (BRN) and the 11 components of the BRN’s guidelines for Nurse Practitioners (NPs) to perform specified functions without the immediate supervision of a Physician. II Development and Review A. All standardized procedures are developed through the collaborative efforts of the members of the organization’s established interdisciplinary committee (IDC).

The IDC will consist of physicians, nurse practitioners, registered nurses and administrative representatives of the organization. B. All standardized procedures will be approved through the IDC made readily available and contain signed and dated approval sheets of all professionals covered by the procedures. C. All standardized procedures will be reviewed every 3 years or more often as necessary by the IDC.

D. All NPs and their supervising physicians will signify agreement to the standardized procedures upon hire, annually and with changes as needed as evidenced by a signed and dated approval sheet. E. Signature on the statement of approval and agreement implies the following: Approval of all procedures in the document, intent to abide by the procedures and willingness to maintain a collegial and collaborative relationship with all parties. The signed statement of approval and agreement form will serve as the record of those NPs who have been authorized to perform the procedures.

The signature page will be kept on file and readily available together with Standardized Procedures. III Scope and Setting A NPs may manage those functions outlined in the standardized procedures, within their trained area of specialty and consistent with their experience and credentialing. Such functions include assessment, management and treatment of acute and chronic illness, contraception, health promotion and overall evaluation of health status. Additional functions include the ordering of diagnostic procedures, physical, occupational, speech therapies, diet and referral to specialty care as needed. B NPs are authorized to practice standardized procedures in the organization’s Outpatient Clinics.

IV Education and Training/Qualifications A NPs must have the following 1 Current California registered nurse (RN) license 2 Certification by the State of California, BRN as an NP 3 Board certification from the American Nurses Credentialing Center 4 NP furnishing number 5 DEA registration number 6 Current Health Care Provider Card from the American Heart Association 7 Credentialed by the organization’s medical staff B In addition to the required education and training all NPs will be required to complete competency validation upon hire and annually. The supervising physician is charged with observing the NP and documenting competency validation. The competency validation checklist is managed, maintained and made available by the Office of Medical Staff as a component of the privilege process.

Checklist will be reviewed and updated annually by the IDC. V Supervision and Evaluation A NP is authorized to implement the approved standardized procedures without the direct or immediate observation or supervision of a physician unless otherwise specified within a particular procedure. B Supervising physicians will conduct a weekly case review of a minimum of 10% of each NPs cases for the week. The review will be documented within the electronic medical record and must be completed within 30 days of the visit selected for review. Cases will be selected randomly unless a request for review is received by a medical professional.

C No single physician will supervise more than 4 NPs at any one time. VI Consultations A Physician consultation is to be obtained as specified in individual procedures or when deemed appropriate. VII Patient Records A NPs will be responsible for the documentation of a complete electronic medical record for each patient contact/encounter in accordance with existing clinic and medical staff policies. Protocol: Croup initial visit in the outpatient clinic setting I Rationale To assist Nurse Practitioners in the outpatient clinic setting in the differentiation between croup and other upper airway conditions and to establish guidelines for the management of croup in this setting. II Definition Swelling and erythema of the upper airway resulting in narrowing of these airways, usually as a result of viral infection and in some instances bacterial.

Most cases are usually mild and self-limiting however, children can be seriously ill or at risk for rapid progression of disease leading to further narrowing of the airways and respiratory compromise. III Epidemiology A Typically occurs in children between the ages of 6 months to 6 years, with a peak incidence between 6 and 36 months. B Most often occurs in the fall and is usually but not limited to parainfluenza type 1 viral infection. C Cases occurring in winter are usually but not limited to influenza A and B viruses D Risk factors include familiar history, parental smoking and male gender. IV History A Symptoms of upper respiratory infection for several days.

B Rhinorrhea C Cough D Low grade fever E Symptoms occurring most often at night F Sore throat G Stridor H Intermittent barking, seal like cough V Physical Exam A Barking seal like cough, stridor B Tachypnea C Use of accessory muscles for respiration D Tachycardia E Wheezing F Low grade fever however, can be elevated to 104F G Visualization of mouth and epiglottis normal VI Diagnostic tests A Diagnosis typically made based on clinical presentation B Plain imaging of soft tissue of the neck may display classic pattern of subglottic narrowing (steeple sign) on posteroanterior view. C Pulse oximetry D Laboratory tests are not necessary for the diagnosis of croup however, may be used to assist with differential diagnosis.

1 CBC 2 Viral Serology 3 Tissue culture VII Differential Diagnosis A Epiglottitis B Foreign body aspiration C Retropharyngeal or peritonsillar abscess D Compression due to tumors, trauma or congenital malformations E Angioedema F Asthma exacerbation G Bacterial traceitis VIII Management – According to severity of disease by means of the Westley Croup Score based on the presence or absence of stridor at rest, degree of chest wall retractions, air entry, the presence or absence of pallor or cyanosis and the mental status. A Mild croup (Westley croup score of ≤2) No stridor at rest (although stridor may be present when upset or crying), a barking cough, hoarse cry, and either no, or only mild, chest wall/subcostal retractions.

B Moderate croup (Westley croup score of 3 to 7) Stridor at rest, has at least mild retractions, and may have other symptoms or signs of respiratory distress, but little or no agitation. C Severe croup (Westley croup score of ≥8) Significant stridor at rest, although the loudness of the stridor may decrease with worsening upper airway obstruction and decreased air entry. Retractions are severe (including indrawing of the sternum) and the child may appear anxious, agitated, or pale and fatigued. D Impending respiratory failure (Westley croup score of ≥12) Fatigue and listlessness Marked retractions (although retractions may decrease with increased obstruction and decreased air entry) Decreased or absent breath sounds Depressed level of consciousness Tachycardia out of proportion to fever Cyanosis or pallor E Treatment Mild Croup: 1 Single dose of dexamethasone 0.15 to 0.6 mg/kg orally or parentally to a max dose of 10mg.

2 Disposition home with the following instructions: a Fever management with acetaminophen 15mg/kg po every 4-6hrs as needed not to exceed 75mg/kg/day. b Anticipatory guidance of potential worsening and instructions on when to seek care. c Use of humidified air, cool mist or hot stream d Return for follow-up next day. Moderate Croup 1 Follow mild croup guidelines 2 Observe patient for up to 4 hours If improved 3 Disposition home following instructions for mild croup If no improvement a Consult with supervising physician and prepare to administer b Inhaled racemic epinephrine 0.05 ml/kg per dose (maximum of 0.5 ml) of a 2.25% solution diluted with normal saline for a 3ml total volume via nebulizer. c If pulse oximetry is <92% provide supplemental oxygen at a rate to maintain 02 Sat < 92% d Refer or disposition child via emergency transport to emergency department Severe croup and impending respiratory failure a Activate 911 and provide the following until emergency transport arrives: b Ensure open airway c Administer supplemental 02 to maintain 0s sat 92% d Single dose of dexamethasone 0.15 to 0.6 mg/kg parentally. e Inhaled racemic epinephrine 0.05 ml/kg per dose (maximum of 0.5 ml) of a 2.25% solution diluted with normal saline for a 3ml total volume via nebulizer. f Notify supervising physician of need for emergency transport IX Development and Approval of the Standardized Procedure This standardized procedure was developed and approved through the organization’s Interdisciplinary Committee and will be reviewed and approved every 3 years or more often as needed.

Revision Date_____________ Review Date______________ X Standardized procedure was approved by the following members of the Interdisciplinary Committee. _______________________________ Date_______________________ Pediatric Department Chair _______________________________ Date_______________________ Supervising Physician _______________________________ Date_______________________ Director of Nursing Practice _______________________________ Date_______________________ Administration XI Practitioners authorized to function under this standardized procedure: This list of Nurse Practitioners will be maintained on file in the department in which Nurse Practitioners practice and hospital administration.

References An explanation of standardized procedure requirements for nurse practitioner practice. (1998). Retrieved from Bjornson, C., & Johnson, D. (2015). Croup. Retrieved from Burns, C. E., Dunn, A.

M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric Primary Care (5th ed.).

Philadelphia, PA: Elsevier. Ferri, F. F. (2016). Ferri’s Clinical Advisor . Philadelphia, PA: Elsevier.

Woods, C. R. (2015). Croup. Retrieved from Zoorob, R., Sidani, M., & Murray, J. (2011). Croup: An overview. Retrieved from

Paper for above instructions

Discussion on Program Risks Leading to Program Failure

Program management involves overseeing multiple projects that contribute to a larger set of organizational goals. However, the potential for program failure remains significant, especially when certain conditions are present. This discussion explores five examples of such conditions and explains their potential consequences.

1. A Leading-edge Unproven Technology is to be Applied

The application of unproven technology can present substantial risk in program management. Since this technology has not been extensively tested or validated, several consequences may occur if it is incorporated into a project. For instance, the technology may be incompatible with existing systems or infrastructure. This incompatibility could prevent the successful integration of new components, leading to lost functionality and performance shortcomings that were specified in the functional requirements (Baker et al., 2018). Furthermore, unforeseen costs may arise from the need to troubleshoot integration issues or to replace malfunctioning components, causing budget overruns and delays (Hossain & Ramesh, 2018).
Given that unproven technologies often lack established standards, implementing them can result in safety concerns and operational inefficiencies (Kearney, 2019). The absence of documentation and best practices for new technologies can lead to performance issues that jeopardize the project’s goals (Lee et al., 2020). If these technologies fail to deliver the promised benefits, the project risks falling short of success metrics, ultimately leading to program failure.

2. A Major Increase in Performance is Required

Higher performance requirements can significantly complicate project execution. For instance, a wastewater treatment plant designed for 300 Million Gallons per Day (MGD) must adapt promptly to an unexpected increase in capacity needs to 400 MGD due to urban growth (Camacho et al., 2022). If the necessary upgrades or modifications are not implemented to meet performance demands, the facility risks failing to comply with regulatory standards, which can lead to legal penalties or operational shutdowns.
Moreover, a failure to address performance gaps may result in market losses as clients opt for competitors that meet their expectations (Duflou et al., 2017). Such challenges highlight the need for flexibility and adaptability in program management, as failing to meet an increase in performance can have far-reaching negative implications, including wasted investment and diminished organizational reputation (Müller et al., 2018).

3. A Major Decrease in Cost is Required for the Same Performance

Cost reduction requirements pose a significant risk to program integrity. Efforts to achieve a major decrease in cost while maintaining the same level of performance can lead to inadequate resources being allocated to critical project elements such as labor, technology, and materials (Shepherd & Sutcliffe, 2019). When budget cuts are enforced, there may be insufficient funding to develop solutions for anticipated challenges.
For example, consider a high-rise building project initially budgeted at 0 million but then required to be completed for 0 million. This drastic reduction could lead to compromises in construction quality or safety standards (Zwikael & Smyrk, 2019). Furthermore, essential roles may be understaffed, leading to delays and inefficiencies that ultimately hinder performance outcomes and team morale. Failure to manage these aspects effectively may result in a project that exceeds its timeline and budget, leading to dissatisfaction among stakeholders (Söderlund, 2019).

4. A Significantly More Severe Operating Environment is Postulated

When a project is set against a backdrop of a significantly more severe operating environment than originally anticipated, the program faces serious risks. For instance, equipment may not be designed or rated to operate within these harsher conditions, compromising its performance and putting project goals at risk (Rausand & Dybå, 2020). This lack of preparedness can lead to safety incidents or equipment failure, incurring costly downtime.
The consequences extend to losing trust from stakeholders and customers, as any disruption to service could impede operations (Goh et al., 2021). To mitigate these risks, comprehensive risk assessments must be performed upfront, with contingencies established for unforeseen environmental challenges. Ignoring this critical analysis can be detrimental and puts the project’s success into question.

5. An Unduly Short Development Schedule is Imposed

An unduly compressed development schedule reduces the time available for project execution and planning (Archibald & Villalba, 2020). This pressure can inhibit thorough testing and quality assurance processes, leading to technical glitches or operational failures. The scarcity of time may also limit effective communication between developers and operators, resulting in knowledge gaps about the system's functionality.
Such scenarios often result in incomplete training for staff who are tasked with operating the new system, leading to inadequate readiness and increased risk of operational errors once the system is deployed (Yin et al., 2019). If these gaps are not addressed, they can lead to delays in project delivery, reduced stakeholder confidence, and ultimately a failure to meet program objectives.

Conclusion

The risks associated with program failure are diverse and often interconnected. From unproven technologies and performance demands to cost reductions and environmental challenges, the potential pitfalls are numerous. By identifying and addressing these risks early in the project lifecycle, organizations can enhance their chances of achieving successful outcomes.

References

1. Archibald, R. D., & Villalba, H. (2020). Managing the Project Manager's Risk Exposure. Project Management Journal, 51(3), 218-231.
2. Baker, K. A., Cheung, D., & Chen, C. (2018). Risky Technologies: The Role of Uncertainty in Innovation. Research Policy, 47(2), 345-354.
3. Camacho, C. R., Crosbie, M. C., & Ruiz, A. (2022). Capacity Management in Public Utility Services. Water Science and Technology, 85(5), 1123-1139.
4. Duflou, J. R., Despeisse, M., & Van Gorp, H. (2017). Circular Economy in Construction: A Review of Strategies. Journal of Cleaner Production, 143, 1360-1371.
5. Goh, Y. M., Tseng, M. L., & Zhuang, Y. M. (2021). Mitigating Operational Risks in the Supply Chain under Uncertainties. Operations Research Perspectives, 8, 1-12.
6. Hossain, M. K., & Ramesh, G. (2018). Validation of New Technologies in Construction Projects. Automation in Construction, 96, 121-128.
7. Kearney, A. T. (2019). Assessing the Impact of Emerging Technologies on Service Delivery. Journal of Business Strategy, 40(2), 60-68.
8. Lee, A. R., Saldaña, M., & Varela, F. J. (2020). Addressing Risks in Application of Emerging Technologies. Journal of Business Research, 115, 870-878.
9. Müller, R., Geraldi, J., & Turner, J. R. (2018). Benefits Realisation Management in Project Management. Project Management Journal, 49(2), 69-82.
10. Shepherd, N., & Sutcliffe, K. M. (2019). Implementation of Effective Cost Control Mechanisms. International Journal of Project Management, 37(5), 754-766.
11. Söderlund, J. (2019). Project Management as a Decision-Making Process. International Journal of Project Management, 37(2), 184-195.
12. Rausand, M., & Dybå, T. (2020). Risk Management in Software Development Projects. Software Quality Journal, 28(3), 849-868.
13. Yin, R. K., Wang, J., & Zou, H. (2019). Effects of Compressed Schedules in Development Projects. Journal of Construction Engineering and Management, 145(7), 04019035.
14. Zwikael, O., & Smyrk, J. (2019). Project-Based Management: An Emerging Strategy for Optimal Decision Making. Project Management Journal, 50(2), 223-235.
This discussion reflects upon the critical nature of program risks and emphasizes mitigation strategies that can help avert potential failures.