This thesis is an explorative research study in which I interviewed 16 leaders at St. Jude Medical (SJM), which is an American company with a satellite site in Stockholm, Sweden with 700 employees. Twelve of these sixteen leaders are Swedish and constitute the main source of information for this thesis. The remaining four leaders were senior managers from the USA, included to contrast the outcome of the Swedish interviews. The interviews were semi-open and on average ~40 minutes long. The purpose of the study was to isolate what challenges the leaders at SJM face and then try to find and identify common patterns in how they attack these problems. I envision this work to be of use to any junior manager who is starting his/her career and especially so if it is at an international company where cultural differences are present. My main conclusions were that leaders at SJM need to - Build and maintain a network –and this is imperative to succeed. - Use the phone frequently and communicate all the time - Create your own vision, as nobody will give it to you - Help your co-workers define the limits of their responsibility and help them prioritize when heavily loaded - Find the appropriate level of work and learn that “good enough is perfect”. - Always strive to meet deadlines, exceed expectations and learn your internal customers’ trigger points. I also conclude that the company, SJM Sweden that is, may need to review their hiring policy and their cultural training. They also need to improve the knowledge management and knowledge transfer between managers and also expand the exchange programs and make it easier to travel for face to face meetings and encourage the same.