Many of these appointments are for a relatively short-time and appointees often face the challenges and/or failure of their predecessors..Frequently they must unravel what came before their arrival prior to implementing their new programs.
The appointment process is riddled with politics as they serve as pawns in Congressional debates. So goes the confirmation of Karen DeSalvo who has already been beaten up in her role in healthcare.gov, which had a beginning.as a disaster.
ONC Chief DeSalvo Vacates Role, Reider Resigns CMO Post
ONC Chief DeSalvo Faces Resistance to Current HHS Nomination