Individuals have multiple identities, and several of them may be simultaneously driving enacted behavior in a given context. Scholars have suggested that intrapersonal identity networks – the combination of identities, relationships between identities, and identity characteristics – influence enactment. However, very little is known about the process by which several components of one’s identity network result in a single stream of enactment. This is important because different factors (e.g., leader actions) may impact this process and, in turn, change the way people act in organizations and interpret the actions of others. I examined a healthcare system designed to surgically treat cancer patients. Taking an inductive interpretivist approach, and using grounded theory methodology, I developed a process model of intrapersonal identity network enactment that also takes into account interpretations of other system members’ enactment. My findings contribute to the social identity literature by suggesting that a common, highly central identity is not enough to align behavior in organizations. Instead individuals may enact a common “higher-order” identity in combination with the rest of their identity network in ways that actually work against each other, even as they genuinely work toward the same purpose. I also extend the literature on multiple identities by explicating a process by which four different identities, and four characteristics of each identity, foster enactment toward the surgical system. Finally, I show how one’s intrapersonal identity network influences how they interpret the enacted behavior of others. In doing so, I extend the identity threat and opportunity literature by showing how one person’s identity threat is another’s identity opportunity, even when they share a common higher-order identity. In short, my study shows how individuals can work against each other, even when they are genuinely working toward the same purpose.