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.