Is the "top" a 4-year monarch, or that cast of hundreds who will fill the cabinet posts, the agencies within each Department, and the independent agencies which report to the White House? Just the Head, Deputy and Chief of Staff for each of these entities is a serious number. Span-of-control principles make it impossible for the Chief Executive to really know what's going on at the policy level within each of these operations, and a macro "let's make it better" doesn't do much if anything at all. It's the lower-tier decisions which really run things.