This research examined the structural properties of individual’s organizational change schemas. An organizational change schema is a particular sensemaking framework that contains knowledge about organizational change, including change attributes and relations among those attributes. Understanding the properties of these schemas is important because existing research suggests that the way individuals think about change influences their responses to it. Specifically, the present study investigated health care managers’ sensemaking regarding implementation of a quality initiative by examining: (1) the structure and content of organizational change schemas; (2) the extent to which schemas were shared by organizational members; and (3) the nature of the relationship between shared understanding and organizational inertia. A sample of 28 health care managers from a large hospital in the Northeastern U.S. completed the repertory grid, a method originating in cognitive psychology (Kelly, 1955). This method allowed organizational members to identify meaningful dimensions that distinguished between organizational change attributes while minimizing the imposition of the researcher’s frame of reference. The content and structure of members’ change schemas were also examined using a pre-designed instrument by Lau and Woodman (1995). Content analysis revealed that in their effort to make sense of organizational change, organizational members rely on a relatively small number of widely shared evaluative dimensions, and a larger number of essentially idiosyncratic dimensions. An analysis of change schemas by organizational level revealed important differences in the way top managers and middle managers make sense of change. The results of cluster analysis indicated that discrete shared organizational change schemas could be identified and meaningfully understood in terms of current and ideal orientations. Contrary to expectations, incongruence between members’ current and ideal change schemas did not give rise to negative emotions. However, incongruence between these schemas was positively related to resistance to change. Comparison of the two methods used in this study suggests that the preservation of the terms and dimensions people themselves use to describe organizational change represents an important consideration for future cognitive-based organizational change research. Implications for theory and practice as well as directions for future research are discussed.