For existing software we start with the gap analysis, because the report sizes everything after it.
The report lists the gaps between documentation, code and process, prioritised from P1 to P4. From there the remediation or the next development phase is ordered as a work package with fixed deliverables, or handed to a dedicated team that works inside your QMS.
New development without existing software starts with a scoping call and a written proposal for a work package or a team. In every model the manufacturer makes the release decision, and Silurus supplies the evidence it rests on.