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The opening chapter introduces the book's approach as well as the institutional development of the presidency and its organizational structure. Chapters 2 through 6 provide an extended discussion of the institutional presidency, first examining the working relationships of the White House with Congress and with the media, and then looking at policy-making in differing policy areas. In each of these five chapters, Kessel introduces the actors on the White House staff or in cabinet departments or agencies. He then considers their activities, looking at those common throughout the institutional presidency - and those specific to the task, such as negotiation in foreign policy, coping with business cycles in economics, and handling projects and patronage in dealing with Congress.

In the final two chapters, Kessel asks what presidents have been able to accomplish. In Chapter 7, he evaluates, for each contemporary president, examples of policy success, failure, and mixed results. He broadens the analysis in his concluding chapter to examine larger patterns of presidential accomplishment. His conclusion: all presidents have mixed records, but in the aggregate, presidents succeed more often than they fail by a factor of 3 to 2.