The purpose of this work is to find out how present manager contracts are set up in Landstinget Västmanland (the county council of Västmanland), explore managers’ perception of these contracts and why managers have chosen leadership. The work has also reviewed the question if managers need to have a relationship or expertise to the activities they lead and which qualifications are needed in such case. The survey was conducted in two divisions in which nine interviews were held with managers at all levels. In addition to this a questionnaire including the 87 managers in the divisions were held. Based on the result of the interviews and the questionnaire the study revealed five main areas : form of employment, content of manager contracts, relationships and expertise towards the operations, clinical work and profession. By applying theories the results were interpreted and the conclusion is that there is a complexity in leadership in a county organisation with strong professions and several levels of decision making. However, clear manager contracts may be a step towards successful leadership and organizational development.